title: Late radiation side effects, cosmetic outcomes and pain in breast cancer patients after breast-conserving surgery and three-dimensional conformal radiotherapy : Risk-modifying factors.
abstract: OBJECTIVE
  The purpose of this work was to identify parameters influencing the risk of late radiation side effects, fair or poor cosmetic outcomes (COs) and pain in breast cancer patients after breast-conserving therapy (BCT) and three-dimensional conformal radiotherapy (3D-CRT).
  
  
  METHODS
  Between 2006 and 2013, 159 patients were treated at the Hannover Medical School. Physician-rated toxicity according to the LENT-SOMA criteria, CO and pain were assessed by multivariate analysis.
  
  
  RESULTS
  LENT-SOMA grade 1-4 toxicity was observed as follows: fibrosis 10.7 %, telangiectasia 1.2 %, arm oedema 8.8 % and breast oedema 5.0 %. In addition, 15.1 % of patients reported moderate or severe breast pain, and 21.4 % complained about moderate or severe pain in the arm or shoulder. In multivariate analysis, axillary clearing (AC) was significantly associated with lymphoedema of the arm [odds ratio (OR) 4.37, p = 0.011, 95 % confidence interval (CI) 1.4-13.58]. Breast oedema was also highly associated with AC (OR 10.59, p = 0.004, 95 % CI 2.1-53.36), a ptosis grade 2/3 or pseudoptosis and a bra size ≥ cup C (OR 5.34, p = 0.029, 95 % CI 1.2-24.12). A ptosis grade 2/3 or pseudoptosis and a bra size ≥ cup C were the parameters significantly associated with an unfavourable CO (OR 3.19, p = 0.019, 95 % CI 1.2-8.4). Concerning chronic breast pain, we found a trend related to the prescribed radiation dose including boost (OR 1.077, p = 0.060, 95 % CI 0.997-1.164). Chronic shoulder or arm pain was statistically significantly associated with lymphoedema of the arm (OR 3.9, p = 0.027, 95 % CI 1.17-13.5).
  
  
  CONCLUSIONS
  Chronic arm and breast oedema were significantly influenced by the extent of surgery (AC). Ptotic and large breasts were significantly associated with unfavourable COs and chronic breast oedema. Late toxicities exclusive breast pain were not associated with radiotherapy parameters.
authors.affiliation: Department of Obstetrics and Gynaecology, Hannover Medical School, Hannover, Germany.
authors.forename: Ursula
authors.initials: U
authors.lastname: Hille-Betz
authors.affiliation: Institute of Medical Biometry and Informatics, Hannover Medical School, Hannover, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Vaske
authors.affiliation: Department of Radiation Oncology and Special Oncology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Bremer
authors.affiliation: Department of Obstetrics and Gynaecology, Hannover Medical School, Hannover, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Soergel
authors.affiliation: Department of Obstetrics and Gynaecology, Hannover Medical School, Hannover, Germany.
authors.forename: Sudip
authors.initials: S
authors.lastname: Kundu
authors.affiliation: Department of Obstetrics and Gynaecology, Hannover Medical School, Hannover, Germany.
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Klapdor
authors.affiliation: Department of Obstetrics and Gynaecology, Hannover Medical School, Hannover, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Hillemanns
authors.affiliation: Department of Radiation Oncology and Special Oncology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany. henkenberens.christoph@mh-hannover.de.
authors.forename: Christoph
authors.initials: C
authors.lastname: Henkenberens
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001940:Breast / Q000528:radiation effects*; D001943:Breast Neoplasms / Q000175:diagnosis / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D004954:Esthetics; D005260:Female; D006801:Humans; D016462:Mammaplasty; D015412:Mastectomy, Segmental; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology*; D017060:Patient Satisfaction; D011832:Radiation Injuries / Q000209:etiology*; D020266:Radiotherapy, Conformal
keywords: Breast-conserving therapy; Cosmesis; Late side effects; Quality of life; Radiotherapy