title: Cosmetic changes following surgery and accelerated partial breast irradiation using HDR interstitial brachytherapy : Evaluation by a multidisciplinary/multigender committee.
abstract: BACKGROUND
  Patients with early-stage breast cancer can benefit from adjuvant accelerated partial breast irradiation (APBI) following breast-conserving surgery (BCS). This work reports on cosmetic results following APBI using multicatheter high-dose-rate interstitial brachytherapy (HDR-IBT).
  
  
  METHODS
  Between 2006 and 2014, 114 patients received adjuvant APBI using multicatheter HDR-IBT. For each patient, two photographs were analyzed: the first was taken after surgery (baseline image) and the second at the last follow-up visit. Cosmesis was assessed by a multigender multidisciplinary team using the Harvard Breast Cosmesis Scale. Dose-volume histogram (DVH) parameters and the observed cosmetic results were investigated for potential correlations.
  
  
  RESULTS
  The median follow-up period was 3.5 years (range 0.6-8.5 years). The final cosmetic scores were 30% excellent, 52% good, 14.5% fair, and 3.5% poor. Comparing the baseline and follow-up photographs, 59.6% of patients had the same score, 36% had a better final score, and 4.4% had a worse final score. Only lower target dose nonuniformity ratio (DNR) values (0.3 vs. 0.26; p = 0.009) were significantly associated with improved cosmetic outcome vs. same/worse cosmesis.
  
  
  CONCLUSIONS
  APBI using multicatheter HDR-IBT adjuvant to BCS results in favorable final cosmesis. Deterioration in breast cosmesis occurs in less than 5% of patients. The final breast cosmetic outcome in patients treated with BCS and APBI using multicatheter HDR-IBT is influenced primarily by the cosmetic result of the surgery. A lower DNR value is significantly associated with a better cosmetic outcome.
authors.affiliation: Interdisciplinary Brachytherapy Unit, University of Luebeck/UKSH-CL, Ratzeburger Allee 160, 23538, Luebeck, Germany. tamer.soror@uksh.de.|National Cancer Institute (NCI), Radiation Oncology Department, Cairo University, Cairo, Egypt. tamer.soror@uksh.de.
authors.forename: Tamer
authors.identifier: http://orcid.org/0000-0002-5986-8707
authors.initials: T
authors.lastname: Soror
authors.affiliation: Interdisciplinary Brachytherapy Unit, University of Luebeck/UKSH-CL, Ratzeburger Allee 160, 23538, Luebeck, Germany.
authors.forename: György
authors.initials: G
authors.lastname: Kovács
authors.affiliation: Interdisciplinary Brachytherapy Unit, University of Luebeck/UKSH-CL, Ratzeburger Allee 160, 23538, Luebeck, Germany.
authors.forename: Nina
authors.initials: N
authors.lastname: Seibold
authors.affiliation: Interdisciplinary Brachytherapy Unit, University of Luebeck/UKSH-CL, Ratzeburger Allee 160, 23538, Luebeck, Germany.
authors.forename: Corinna
authors.initials: C
authors.lastname: Melchert
authors.affiliation: Clinic for Gynecology and Obstetrics, University of Luebeck/UKSH-CL, Luebeck, Germany.
authors.forename: Kristin
authors.initials: K
authors.lastname: Baumann
authors.affiliation: Clinic for Plastic Surgery, University of Luebeck/UKSH-CL, Luebeck, Germany.
authors.forename: Eike
authors.initials: E
authors.lastname: Wenzel
authors.affiliation: Institute for Oncology and Radiology (IORS), Medical School University of Belgrade, Belgrade, Serbia.
authors.forename: Suzana
authors.initials: S
authors.lastname: Stojanovic-Rundic
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D001943:Breast Neoplasms / Q000473:pathology* / Q000628:therapy*; D003131:Combined Modality Therapy / Q000379:methods; D003357:Cosmetic Techniques; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008297:Male; D015412:Mastectomy, Segmental / Q000379:methods*; D008875:Middle Aged; D015588:Observer Variation; D059351:Organ Sparing Treatments / Q000379:methods*; D016896:Treatment Outcome
keywords: Breast cancer; Breast-conserving surgery; Photographs; Survival; Toxicity