title: Conservative surgery, external radiotherapy, and HDR brachytherapy in a single fraction of 7 Gy in early breast cancer: long-term toxicity and esthetic assessment.
abstract: BACKGROUND
  The essential issue in conservative treatment is the quality in breast preservation. When risk factors for local relapse exist, a tumour bed boost is required, but the boost choice remains controversial. Prospectively, we studied long-term toxicity, cosmetic outcome and prognostic factors.
  
  
  METHODS
  After conservative treatment, 115 patients received a single dose of 7 Gy HDR-brachytherapy (HDR-BT) boost between June 1996 and December 2005. Late toxicity was assessed using the LENT-SOMA scale. For esthetic assessment, a subjective scale was used for patients and a modified Fehlauer scale for physicians. Mean age was 56.6 years. Invasive ductal carcinoma (78 %) and lumpectomy (60 %) were predominantly reported. 48 % received chemotherapy (CT).
  
  
  RESULTS
  Regarding toxicity, 39 % of patients reported breast pain, 75 % fibrosis, 56 % telangiectasias, 19 % lymphoedema, and 51 % retraction/atrophy. Concerning management, 22 % of patients with pain and 45 % with lymphoedema were treated. The esthetic result was found satisfactory by 96 % of the patients and 85 % of the physicians. Fibrosis was influenced by CT and a larger irradiated volume and telangiectasias by a greater implant volume.
  
  
  CONCLUSIONS
  HDR-BT boost shows good cosmetic effects with acceptable toxicity. Patients overestimate the esthetic outcome. LENT/SOMA is useful to assess chronic toxicity.
authors.affiliation: Radiation Oncology Department, Hospital Central de la Defensa Gómez-Ulla, C/Glorieta del Ejército s/n, Madrid, Spain.
authors.forename: Aurora
authors.initials: A
authors.lastname: Rodríguez Pérez
authors.forename: Maria Concepción
authors.initials: MC
authors.lastname: López Carrizosa
authors.forename: Pilar Maria
authors.initials: PM
authors.lastname: Samper Ots
authors.forename: José Fermín
authors.initials: JF
authors.lastname: Pérez-Regadera Gómez
authors.forename: José
authors.initials: J
authors.lastname: Zapatero Ortuño
authors.forename: Juan de Dios
authors.initials: Jde D
authors.lastname: Sáez Garrido
authors.forename: Manuel Joaquín
authors.initials: MJ
authors.lastname: Martín de Miguel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects; D001940:Breast / Q000473:pathology / Q000528:radiation effects* / Q000601:surgery*; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome