title: Factors associated with optimal long-term cosmetic results in patients treated with accelerated partial breast irradiation using balloon-based brachytherapy.
abstract: OBJECTIVE
  To evaluate factors associated with optimal cosmetic results at 72 months for early-stage breast cancer patients treated with Mammosite balloon-based accelerated partial breast irradiation (APBI).
  
  
  METHODS
  A total of 1,440 patients (1,449 cases) with early-stage breast cancer undergoing breast-conserving therapy were treated with balloon-based brachytherapy to deliver APBI (34 Gy in 3.4-Gy fractions). Cosmetic outcome was evaluated at each follow-up visit and dichotomized as excellent/good (E/G) or fair/poor (F/P). Follow-up was evaluated at 36 and 72 months to establish long-term cosmesis, stability of cosmesis, and factors associated with optimal results.
  
  
  RESULTS
  The percentage of evaluable patients with excellent/good (E/G) cosmetic results at 36 months and more than 72 months were 93.3% (n = 708/759) and 90.4% (n = 235/260). Factors associated with optimal cosmetic results at 72 months included: larger skin spacing (p = 0.04) and T1 tumors (p = 0.02). Using multiple regression analysis, the only factors predictive of worse cosmetic outcome at 72 months were smaller skin spacing (odds ratio [OR], 0.89; confidence interval [CI], 0.80-0.99) and tumors greater than 2 cm (OR, 4.96, CI, 1.53-16.07). In all, 227 patients had both a 36-month and a 72-month cosmetic evaluation. The number of patients with E/G cosmetic results decreased only slightly from 93.4% at 3 years to 90.8% (p = 0.13) at 6 years, respectively.
  
  
  CONCLUSIONS
  APBI delivered with balloon-based brachytherapy produced E/G cosmetic results in 90.4% of cases at 6 years. Larger tumors (T2) and smaller skin spacing were found to be the two most important independent predictors of cosmesis.
authors.affiliation: Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI 48072, USA. fvicini@beaumont.edu
authors.forename: Frank A
authors.initials: FA
authors.lastname: Vicini
authors.forename: Martin
authors.initials: M
authors.lastname: Keisch
authors.forename: Chirag
authors.initials: C
authors.lastname: Shah
authors.forename: Sharad
authors.initials: S
authors.lastname: Goyal
authors.forename: Atif J
authors.initials: AJ
authors.lastname: Khan
authors.forename: Peter D
authors.initials: PD
authors.lastname: Beitsch
authors.forename: Maureen
authors.initials: M
authors.lastname: Lyden
authors.forename: Bruce G
authors.initials: BG
authors.lastname: Haffty
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000295:instrumentation / Q000379:methods*; D001940:Breast / Q000473:pathology / Q000528:radiation effects* / Q000601:surgery; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy / Q000379:methods; D019583:Dose Fractionation, Radiation; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D015999:Multivariate Analysis; D012042:Registries; D012044:Regression Analysis; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden