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

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. After conservative treatment, 115 patients received a single dose of 7Gy 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 56.6years. Invasive ductal carcinoma (78%) and lumpectomy (60%) were predominantly reported. 48% received chemotherapy (CT). 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. HDR-BT boost shows good cosmetic effects with acceptable toxicity. Patients overestimate the esthetic outcome. LENT/SOMA is useful to assess chronic toxicity.