Quantitative Assessment of Breast Cosmetic Outcome After Whole-Breast Irradiation.
To measure, by quantitative analysis of digital photographs, breast cosmetic outcome within the setting of a randomized trial of conventionally fractionated (CF) and hypofractionated (HF) whole-breast irradiation (WBI), to identify how quantitative cosmesis metrics were associated with patient- and physician-reported cosmesis and whether they differed by treatment arm.



From 2011 to 2014, 287 women aged ≥40 with ductal carcinoma in situ or early invasive breast cancer were randomized to HF-WBI (42.56 Gy/16 fractions [fx] + 10-12.5 Gy/4-5 fx boost) or CF-WBI (50 Gy/25 fx + 10-14 Gy/5-7 fx). At 1 year after treatment we collected digital photographs, patient-reported cosmesis using the Breast Cancer Treatment and Outcomes Scale, and physician-reported cosmesis using the Radiation Therapy Oncology Group scale. Six quantitative measures of breast symmetry, labeled M1-M6, were calculated from anteroposterior digital photographs. For each measure, values closer to 1 imply greater symmetry, and values closer to 0 imply greater asymmetry. Associations between M1-M6 and patient- and physician-reported cosmesis and treatment arm were evaluated using the Kruskal-Wallis test.



Among 245 evaluable patients, patient-reported cosmesis was strongly associated with M1 (vertical symmetry measure) (P<.01). Physician-reported cosmesis was similarly correlated with M1 (P<.01) and also with M2 (vertical symmetry, P=.01) and M4 (horizontal symmetry, P=.03). At 1 year after treatment, HF-WBI resulted in better values of M2 (P=.02) and M3 (P<.01) than CF-WBI; treatment arm was not significantly associated with M1, M4, M5, or M6 (P≥.12).



Quantitative assessment of breast photographs reveals similar to improved cosmetic outcome with HF-WBI compared with CF-WBI 1 year after treatment. Assessing cosmetic outcome using these measures could be useful for future comparative effectiveness studies and outcome reporting.
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Jay P
JP
Reddy
Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Xiudong
X
Lei
Department of Biomedical Engineering, University of Texas, Austin, Texas.
Sheng-Cheng
SC
Huang
Department of Biomedical Engineering, University of Texas, Austin, Texas.
Krista M
KM
Nicklaus
Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Michelle C
MC
Fingeret
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Simona F
SF
Shaitelman
Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Kelly K
KK
Hunt
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Thomas A
TA
Buchholz
Department of Engineering Technology, University of Houston, Houston, Texas.
Fatima
F
Merchant
Department of Biomedical Engineering, University of Texas, Austin, Texas; Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Mia K
MK
Markey
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: bsmith3@mdanderson.org.
Benjamin D
BD
Smith
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000523:psychology / Q000532:radiotherapy*; D003357:Cosmetic Techniques / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D015995:Prevalence; D011788:Quality of Life / Q000523:psychology*; D000069473:Radiation Dose Hypofractionation; D020266:Radiotherapy, Conformal / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome