Does concurrent radiochemotherapy affect cosmetic results in the adjuvant setting after breast-conserving surgery? Results of the ARCOSEIN multicenter, Phase III study: patients' and doctors' views.
OBJECTIVE
To evaluate the cosmetic results of sequential vs. concurrent adjuvant chemotherapy with radiotherapy after breast-conserving surgery for breast cancer, and to compare ratings by patients and physicians.


METHODS
From 1996 to 2000, 716 patients with Stage I-II breast cancers were included in a multicenter, Phase III trial (the ARCOSEIN study) comparing, after breast-conserving surgery with axillary dissection, sequential treatment with chemotherapy first followed by radiotherapy vs. chemotherapy administered concurrently with radiotherapy. Cosmetic results with regard to both the overall aspect of the breast and specific changes (color, scar) were evaluated in a total of 214 patients (107 in each arm) by means of questionnaires to both the patient and a physician whose rating was blinded to treatment allocation.


RESULTS
Patients' overall satisfaction with cosmesis was not statistically different between the two arms, with approximately 92% with at least satisfactory results (p = 0.72), although differences between the treated and untreated breasts were greater after the concurrent regimen (29% vs. 14% with more than moderate differences; p = 0.0015). Physician assessment of overall cosmesis was less favorable, with lower rates of at least satisfactory results in the concurrent arm (60% vs. 85%; p = 0.001). Consequently, the concordance for overall satisfaction with cosmesis between patients and doctors was only fair (kappa = 0.62).


CONCLUSIONS
After breast-conserving surgery, the concurrent use of chemotherapy with radiotherapy is significantly associated with greater differences between the breasts. These differences do not translate into patients' lessened satisfaction with cosmesis.
Toledano
Alain H
AH
Department of Radiation Oncology, Hôpital Tenon, AP-HP, Paris, France. alain.toledano@gmail.com
Bollet
Marc A
MA
Fourquet
Alain
A
Azria
David
D
Gligorov
Joseph
J
Garaud
Pascal
P
Serin
Daniel
D
Bosset
Jean-François
JF
Miny-Buffet
Joelle
J
Favre
Anne
A
LeFoch
Olivier
O
Calais
Gilles
G
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001365:Axilla; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000523:psychology / Q000532:radiotherapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D002792:Cholestyramine Resin; D004954:Esthetics / Q000523:psychology*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D015412:Mastectomy, Segmental; D008875:Middle Aged; D017060:Patient Satisfaction; D018787:Radiation Oncology
D002792:Cholestyramine Resin