Physician Rated Cosmesis and Patient Reported Outcomes after Concomitant Boost (CB) vs. Sequential Boost (SB) for Adjuvant Treatment of Breast Cancer: A Prospective Randomized Study

Abstract

<h3>Purpose/Objective(s)</h3> The aim of the current study was to compare toxicity, cosmesis and patient reported outcomes after sequential radiation therapy boost vs. concomitant boost in the adjuvant setting of breast cancer treatment. <h3>Materials/Methods</h3> One hundred and forty-five breast cancer patients who underwent breast conserving surgery and were candidates for tumor bed boost following whole breast irradiation (WBI) were randomized to receive either concomitant boost (CB) (n=71) or sequential boost (SB) (n=74). All patients received WBI to a total dose of 40.05 Gy/15 F/3 weeks. Patients in the SB arm received 10 Gy/5 F / 1 week to the boost volume following WBI. Patients in the CB arm received 7.95 Gy/15 F/3 weeks to the boost volume concomitant with the WBI. All treatments were carried out using 3D conformal radiation therapy. Physicians rated cosmesis prior to starting radiation and at 6 and 12 months after end of treatment. All patients filled a validated quality of Life questionnaire 12 months after end of treatment. <h3>Results</h3> Median follow-up 30 months (range, 18-48). G III or higher acute skin toxicity was observed in 12 (16.4%) patients in the SB arm and in 4 (6.3%) patients in the CB arm (p 0.042). GII or higher late skin toxicity developed in 4 (5.4%) patients in the SB arm and in 1 (1.4%) patient in the CB arm (p 0.18). GII subcutaneous fibrosis was observed in 3 (4%) patients in the SB arm and in none of the patients in the CB arm. Prior to radiation treatment, 50 (67.5%) patients had Excellent/good cosmesis in the SB arm vs. 47 (66.2%) patients in the CB arm (p 0.59). At 6 months after radiation, 44 (59.4%) patients had Excellent/good cosmesis in the SB arm vs. 40 (56.3%) patients in the CB arm (p 0.83). At 12 months after radiation, 50 (67.5%) patients in the SB arm had Excellent/good cosmesis vs 42 (59.2%) patients in the CB arm (p 0.57). twelve months after radiation, 50 (78.1%) patients in the SB arm reported very satisfied/satisfied with their cosmetic outcomes compared to 44 (72.1%) patients in the CB arm (p 0.43). <h3>Conclusion</h3> Concomitant boost radiation therapy is non-inferior to sequential boost in terms of late toxicity, cosmesis and patient satisfaction with slightly more favorable outcome in the acute toxicity and shorter overall treatment time.