Cosmetic Results In Patients Research Articles

The Impact of Chemotherapy on Toxicity and Cosmetic Outcome in Patients Receiving Hypofractionated Whole Breast Irradiation

The Impact of Chemotherapy on Toxicity and Cosmetic Outcome in Patients Receiving Hypofractionated Whole Breast Irradiation

Accelerated partial breast irradiation with perioperative multicatheter interstitial brachytherapy—A feasibility study

PurposeTo assess the feasibility of high-dose-rate perioperative multicatheter interstitial brachytherapy to deliver accelerated partial breast irradiation (APBI) in selected patients with early breast cancer. Methods and MaterialsPerioperative multicatheter interstitial brachytherapy for APBI has been used at our department since 2012 for patients with low-risk breast cancer. Interstitial catheters were inserted perioperatively via hollow needles immediately following tumorectomy with sentinel node biopsy. APBI started on Day 6 after surgery. The prescribed dose was 34 Gy (10 fractions of 3.4 Gy bid). Hormonal therapy was prescribed in all cases. ResultsBetween June 2012 and December 2017, 125 patients were scheduled for APBI. Of these, APBI was not performed in 12 patients (9.6%) due to adverse prognostic factors identified on the definitive biopsy. We observed wound dehiscence in 2/113 cases (1.8%), inflammatory complications requiring antibiotics in 7/113 cases (6.2%), transient Grade I radiodermatitis in 6/113 patients (4.4%), and seroma which resolved spontaneously in 3/113 patients (2.7%). With median followup of 39 months (range 3.3–75.3) no relapses were observed. No late complications in Radiation Therapy Oncology Group Grade 3 or higher were documented. Cosmetic outcome in patients with followup > 2 years was excellent or good in 92%. ConclusionOur preliminary results show that the perioperative multicatheter interstitial high-dose-rate brachytherapy for APBI in selected patients with early breast cancer is feasible. This treatment schedule reduces treatment duration, spares the patients of repeated anesthesia, and enables precise application of the afterloading tubes under direct visual control.

Comparison of Intraoperative and Postoperative Boost Radiotherapy in Terms of Local Recurrence and Cosmetic Outcomes in Patients with Early-Stage Breast Cancer

To compare intraoperative (IO) and postoperative (po.) boost radiotherapy (RT) in terms of local recurrence and cosmetic outcomes in patients with early-stage breast cancer during breast-conserving therapy (BCT). Patients who received BCT at our clinic in the past 60 months were analyzed based on their recorded data. Ninety-eight patients who received IO boost RT during breast-conserving surgery were classified as group A and 99 who received po. boost whole-breast RT afterward were classified as group B. Patients were graded using the LENT-SOMA (V06-7/2003) scale and compared using the chi-square test based on local recurrence and cosmetic outcomes at 1 year after the end of all RTs. Mean age of patients in groups A and B was 49 and 52 years; mean follow-up was 35 and 38 months; tumor diameter was 18 (4–30) mm and 19 (6–30) mm; and lymph node involvement was observed in 11 and 17 patients, respectively. The molecular subtypes were either luminal A or B in both groups. Histological analysis revealed 90 and 84 invasive ductal carcinomas, 8 and 5 invasive lobular tumors, respectively, and 10 mixed structure in group B. The boost area was planned so as to cover 15–20 mm of the surrounding tumor bed area in both methods. Local recurrence was not detected in group A; however, it was detected in two patients in group B at 20 and 32 months. According to the LENT-SOMA scale, 34 and 24 patients in groups A and B had grade 0, 41 each had grade 1, 21 and 29 had grade 2, and 2 and 5 had grade 3, respectively, but there was no significant difference between the two groups (p > 0.05). Based on the relatively superior results demonstrated by group A, IO boost RT can potentially improve both local control and cosmetic results.

Predictors for poor cosmetic outcome in patients with early stage breast cancer treated with breast conserving therapy: Results of the Young boost trial

PurposeIn the Young Boost trial (YBT), breast cancer patients ≤50 years of age, treated with breast conserving therapy (BCT) were randomized between a 26 Gy boost dose and a 16 Gy boost dose, with local recurrence as primary and cosmetic outcome (CO) as secondary endpoint. Data of the YBT was used to investigate which factors are related with worse cosmetic outcome after BCT. MethodsFrom 2004 to 2011, 2421 cT1-2N0-2a breast cancer patients were randomized. CO was scored subjectively by the patient and physician, and objectively using BCCT.core: at baseline, one and four years after treatment. Associations between potential risk factors for worse cosmetic outcome, based on the objective BCCT.core, were investigated using a proportional odds model. ResultsAt four years, CO was significantly better in the standard boost group for all three scoring methods (satisfied CO ±65% vs 55%). A photon boost, high boost dose, poor cosmesis before radiation therapy, large boost volume and adjuvant chemotherapy significantly deteriorated CO. ConclusionImportant risk factors for worse CO were the use of a photon boost instead of an electron boost, a high boost dose, cosmesis at baseline, adjuvant chemotherapy and boost volume. These results can be used to define strategies aimed at improving CO.

Basic Oncoplastic Surgery for Breast Conservation: Tips and Techniques.

The demand for oncoplastic breast surgery has increased significantly in recent years. However, these procedures are often not taught in standard training for breast surgeons, and a simple guide for surgeons to start performing basic oncoplastic breast surgery techniques is not available. The basic concepts of oncoplastic breast surgery and the tools needed prior to starting these types of procedures are discussed, and the procedure, in a stepwise pattern, for the building blocks of oncoplastic techniques is outlined. The importance of oncoplastics from a quality of life and oncologic standpoint are described. Key concepts are defined and the decision on when it is necessary to consult reconstructive plastic surgeryis delineated. The basic necessities for oncoplastic breast surgery, including patient photographs, important intraoperative tools, anatomic knowledge, and patient selection, are discussed. The building block procedures include aesthetic scar placement, parenchymal closure, deepithelialization, and donut therapeutic mastopexy, which are described in detail. Oncoplastic breast surgery techniques and clinical reasoning build on one another, allowing a surgeon to move from level I to level II oncoplastic procedures. Even the most basic level I breast conservation oncoplastic skills can improve a patient's cosmetic outcome and are easily learned by a general surgeon.

Surgical repair via submammary thoracotomy, right axillary thoracotomy and median sternotomy for ventricular septal defects

BackgroundRight submammary thoracotomy and right vertical infra-axillary thoracotomy are performed for ventricular septal defect (VSD) to reduce the invasiveness of the conventional surgical repair through median sternotomy approach. No comparative studies have been conducted among these three procedures.MethodsFrom January 2016 to December 2016, 182 patients with isolated VSD who underwent surgical repair via one of these 3 approaches were reviewed to compare these three procedures.ResultsThe procedure success rates were similar in these three groups. There was no statistically significant difference in operative time, aortic cross-clamping time, the duration of CPB, blood transfusion amount and medical cost. However, postoperative mechanical ventilation time, the duration of intensive care and postoperative length of hospital stay were longer in median sternotomy group than the other two groups. (P < 0.05) The median sternotomy group required the longest incision. No significant difference was noted in major adverse events. There were different advantages and disadvantages in the three kinds of operative procedures.ConclusionsRegarding conventional surgical repair VSD, right submammary thoracotomy and right vertical infra-axillary thoracotomy both delivered better cosmetic results for patients with isolated VSD, while all the three procedures could obtain satisfactory clinical effect.

(OA27) Outcome in Patients Treated With Partial Breast Reconstruction or Bilateral Reduction Mammoplasty at the Time of Breast Conserving Surgery (BCS) Followed by Whole Breast Radiation Therapy (WBRT)

Lumpectomy/ partial mastectomy may result in asymmetry of the treated breast relative to the unaffected breast. Volume loss is the most common cause of the negative cosmetic outcome in patients undergoing BCS. To help improve cosmetic results the practice of breast oncoplasty at the time of lumpectomy ± sentinel node surgery is gaining popularity. In this paper, we report our experience on patients who underwent autologous flap partial breast reconstruction or bilateral reduction mammoplasty at the time of BCS. Postoperatively, all patients received WBRT. The objective of the study was to evaluate cosmetic outcomes and local control. In addition, we sought to study the incidence for the recommendations of BIRADS 3 or 4, and fat necrosis on follow up mammograms and sonograms. In this retrospective study, we identified 24 breast cancer patients who at the time of BCS either underwent partial breast reconstruction using autologous flap or had bilateral reduction mammoplasty. Postoperatively, all patients received WBRT to a dose ranging from 50.4Gy to 60Gy. Adjuvant systemic therapy was prescribed at the discretion of the treating oncologist. In follow up, all patients were seen at regular intervals by the multidisciplinary team, and mammograms and directed sonograms were obtained at scheduled intervals. A total of 27 breasts in 24 patients (3 bilateral) are included in this review. The median follow up is 48 months (range: 4 months to 79 months). The median age is 52 years (range: 29 to 71 years). The pathologic stage distribution was: 7 stage 0, 13 stage I, 5 stage II, and 2 had stage ypT0N0M0 having presented with clinical stage IIB and undergone BCS following neoadjuvant therapy. All but 1 patient had negative resections margins. The median number of excisions to achieve clear margins was 2 (range 1 to 3). Fifteen patients underwent bilateral reduction mammoplasty, while 9 had either thoracodorsal artery perforator flap (TDAP), lateral intercostal artery perforator flap (LICAP), or other autologous free flaps. Twenty patients also received systemic chemotherapy and/or hormonal therapy. Cosmetic results in the majority were excellent/very good. In follow up we observed that 4 patients underwent additional revisions for cosmetic indications; and 3 of the 4 patients were among those who had partial breast reconstruction using free-flaps. Follow up mammography noted recommendation of BIRADS 3 and 4 in 3/27 (11.1%) and 2/27 (7.4%) breasts, respectively. Additionally, 5/27 (18.5%) had radiographic evidence of fat necrosis. No patient has developed a local recurrence. In the multidisciplinary care of breast cancer the integration of plastic surgery procedures is increasingly gaining acceptance. We observed that partial breast reconstruction as an adjunct to BCS prior to WBRT results in excellent cosmetic result and local control. Radiographically, the incidence of fat necrosis was the most common finding and the recommendation for BIRADS 4 was low. In select cases, partial breast reconstruction at the time of BCS prior to WBRT may be a reasonable approach to offset the volume loss of an extensive lumpectomy.

Assessment of functional outcome after parotidectomy reconstruction

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Total or superficial parotidectomy, when a reconstructive technique is not used, usually leads to Frey’s syndrome, preauricular and retromandibular depression. These together with the scar from a classic or modified Blair incision limit the final aesthetic outcome. The superiorly based sternocleidomastoid muscle (SCM) flap or superficial musculo-aponeurotic system (SMAS) flap can be used for reconstruction of the defect to achieve better facial contour restoration. The aim and objective of the study was to evaluate the functional and cosmetic outcome of patients after reconstruction in parotid surgeries.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This study was done in the department of Otorhinolaryngology &amp;amp; Head-Neck Surgery. Total number of patients with parotid tumours were 24 in each group namely- Group A: Patients undergoing parotid surgery without reconstruction. Group B: Patients undergoing parotid surgery with reconstruction using superiorly based sternocleidomastoid muscle flap. All patients were followed and analyzed on 6 weeks, 6 months and 1 year postoperatively on the basis of patient’s satisfaction, cosmesis, subjective Frey’s syndrome, retromandibular and pre-auricular depression using visual analogue scale. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In Group A, subjective Frey’s syndrome was present in 8.3% patients from 6 month to 1 year. In contrast, in Group B, it remain absent in all patients at all periods. In Group A, preauricular depression was present in 79.2% patients in immediate postop and 95.8% patients from 6 week to 1 year. In contrast, in Group B, it was present in only 4.2% patients at all periods. In Group A, retromandibular depression was present in 70.8% patients while in Group B, it was absent in all patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The superiorly based SCM flap for reconstruction of defect following superficial or total parotidectomy improves the final outcome in terms of the facial deformity (pre-auricular, retro-auricular depression) and lowers the incidence of Frey’s syndrome.&lt;/p&gt;

The COSMAM TRIAL a prospective cohort study of quality of life and cosmetic outcome in patients undergoing breast conserving surgery

BackgroundCosmetic result in breast cancer surgery is gaining increased interest. Currently, some 30–40% of the patients treated with breast conserving surgery (BCS) are dissatisfied with their final cosmetic result. In order to prevent disturbing breast deformity oncoplastic surgical techniques have been introduced. The extent of different levels of oncoplastic surgery incorporated in breast conserving surgery and its value with regard to cosmetic outcome, patient satisfaction and quality of life remains to be defined. The aim of this prospective cohort study is to investigate quality of life and satisfaction with cosmetic result in patients with breast cancer, undergoing standard lumpectomy versus level I or II oncoplastic breast conserving surgery.MethodsFemale breast cancer patients scheduled for BCS, from 18 years of age, referred to our outpatient clinic from July 2015 are asked to participate in this study. General, oncologic and treatment information will be collected. Patient satisfaction will be scored preceding surgery, and at 1 month and 1 year follow up. Photographs of the breast will be used to score cosmetic result both by the patient, an independent expert panel and BCCT.Core software. Quality of life will be measured by using the BREAST-Q BCT, EORTC-QLQ and EQ-5D-5 L questionnaires.DiscussionThe purpose of this prospective study is to determine the clinical value of different levels of oncoplastic techniques in breast conserving surgery, with regard to quality of life and cosmetic result. Analysis will be carried out by objective measurements of the final cosmetic result in comparison with standard breast conserving surgery. The results of this study will be used to development of a clinical decision model to guide the use oncoplastic surgery in future BCS.Trial registrationCentral Commission of Human Research (CCMO), The Netherlands: NL54888.015.15.Medical Ethical Commission (METC), Maxima Medical Centre, Veldhoven, The Netherlands: 15.107.Dutch Trial Register: NTR5665, retrospectively registered, 02-25-2016.

CORRECTIVE LIPOFILLING IN PATIENTS WITH BREAST CANCER AFTER COMBINED TREATMENT

Breast cancer (BC) takes the first place in the structure of morbidity and mortality among the female population. One of the main methods of treating the disease is surgical one, it can lead to both complete removal of the breast and partial tissue damage. In most cases, the further socially active behavior of the patient depends on the quality of the performed operation. In this article, two clinical cases of corrective lipofilling at the final stage of reconstructive and plastic surgeries in patients with breast cancer after complex treatment are presented. Specifi c examples showed a positive effect after a single lipofilling session of the formed breast using both syringe and water jet techniques. This procedure is carried out to improve the cosmetic results in patients after comprehensive treatment for breast cancer. It is proved that mesenchymal stromal cells, or messenger cells present in all fatty tissues, promote its regeneration by forming new blood vessels or directly affect damaged or susceptible structures — restore and rejuvenate the areas of lipofilling. Therefore, adipose tissue is a natural source of regeneration of the human body. On these clinical examples, after a successful one lipophilic session, improvement of the quality of the skin in the reconstructed breast area was noted and, as a result, a good cosmetic result after reconstructive plastic surgery, both in the patient with the use of a silicone endoprosthesis and without it.

Effect of the Order of Adjuvant Treatment on the Cosmetic Results of Patients with Breast Cancer Treated with Breast- Conserving Surgery and Intraoperative Boost Radiotherapy

Effect of the Order of Adjuvant Treatment on the Cosmetic Results of Patients with Breast Cancer Treated with Breast- Conserving Surgery and Intraoperative Boost Radiotherapy

W-Plasty Improves Cosmetic Outcomes in Patients with Facial Lacerations

W-plasty is a plastic surgery technique for closure of wounds that are not aligned with skin tension lines. It involves removing skin to create a

Nuss procedure for a case of asymmetric pectus excavatum associated with Ehlers-Danlos syndrome

Abstract Ehlers-Danlos syndrome (EDS) is an inherited connective tissue disorder that is often associated with pectus excavatum (PE). The Nuss procedure, which is a minimally invasive approach for the treatment of PE achieves good functional and cosmetic outcomes. We experienced a case of EDS-associated asymmetric PE that was corrected by the Nuss procedure using chondrotomy of the costal cartilages. After this procedure, an excellent chest appearance was achieved. Our experience suggests that the repair of PE can be accomplished safely in EDS patients and that this procedure can achieve good cosmetic results in patients with asymmetric PE.

(S005) Long-Term Toxicity and Cosmetic Outcomes in Patients Treated With APBI Via Multi-Catheter Interstitial HDR Brachytherapy (ISI)

(S005) Long-Term Toxicity and Cosmetic Outcomes in Patients Treated With APBI Via Multi-Catheter Interstitial HDR Brachytherapy (ISI)

Cosmetic changes following surgery and accelerated partial breast irradiation using HDR interstitial brachytherapy : Evaluation by amultidisciplinary/multigender committee.

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). Between 2006 and 2014, 114patients 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 amultigender multidisciplinary team using the Harvard Breast Cosmesis Scale. Dose-volume histogram (DVH) parameters and the observed cosmetic results were investigated for potential correlations. The median follow-up period was 3.5years (range0.6-8.5years). 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 abetter final score, and 4.4% had aworse 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. 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. Alower DNR value is significantly associated with a better cosmetic outcome.

224. Lipomodelling – An initial experience in improving cosmetic outcomes in patients undergoing breast surgery

224. Lipomodelling – An initial experience in improving cosmetic outcomes in patients undergoing breast surgery

Abstract P2-12-09: Long-term follow-up of nipple-sparing mastectomy for early-stage breast cancer without radiotherapy: A single-center study at a Japanese institution

Abstract Introduction: Achievement of a good cosmetic outcome is one of the most important goals of surgical treatment of breast cancer. However, most patients must undergo a mastectomy if the outcome of breast-conserving surgery is discordant. All potential techniques that maintain oncological safety should be considered to maximize the cosmetic outcome for patients who require a mastectomy. We began performing nipple-sparing mastectomy (NSM) in 1978. Recent reports have suggested that NSM is oncologically as safe as mastectomy and affords a better cosmetic outcome. Conversely, the surgical complications and recurrence associated with NSM remain controversial. Objective: In the present study, we review the safety of the NSM surgical technique, discuss nipple–areola recurrence and skin flap recurrence after NSM, and compare recurrence and prognosis between NSM and mastectomy based on our long-term follow-up data. Patients and Methods: We retrospectively analyzed 723 patients with early-stage breast cancer who underwent NSM from 1985 to 2007. The patients' median age, tumor size, and tumor–areola distance were 50 y, 2.1 cm, and 1.5 cm, respectively. We used a thick skin flap method to avoid surgical complications including nipple and skin flap necrosis. We analyzed nipple–areola recurrence and skin flap recurrence after NSM. We also analyzed 100 patients who underwent mastectomy for early-stage breast cancer during the same period as those who underwent NSM. We compared the local recurrence rate (LRR), disease-free survival (DFS) rate, and overall survival (OS) rate among all 723 patients who underwent NSM and 100 patients who underwent mastectomy. No patients in either group received radiotherapy. Results: Among all patients who underwent NSM, stage 0, 1, 2A, and 2B disease was present in 21, 320, 253, and 129 patients, respectively. Notably, no nipple necrosis occurred during the average 114-month follow-up period. Local recurrence developed in 49 patients (6.7%), including recurrence at the nipple–areola complex in 24 (3.3%) and recurrence at the skin flap in 25 (3.4%). The average disease-free interval in patients with nipple–areola recurrence was 50 months, and that in patients with skin flap recurrence was 68 months. The clinical features of nipple–areola recurrence were a low rate of ER positivity (27%), high rate of Her2/neu positivity (60%), Paget type recurrence rate of 52%, and small tumor–areola distance (0.5 cm). The clinical features of skin flap recurrence were a relatively high rate of ER positivity (55%), solitary type recurrence rate of 88%, and diffuse type recurrence rate of 12%. The prognosis of diffuse type skin flap recurrence was significantly worse than that of solitary type recurrence (p = 0.01). There were no significant differences between the NSM and mastectomy groups in the LLR (6.7% vs. 4.0%, respectively), 10-y DFS rate (88% vs. 90%, respectively), or 10-y OS rate (92% vs. 91%, respectively). Conclusion: Our long-term follow-up data show that NSM should be considered as an alternative option for mastectomy when the outcome of breast-conserving surgery is discordant in patients with early-stage breast cancer. Citation Format: Sakurai T, Suzuma T, Yoshimura G, Jinta E, Umemura T, Sakurai T. Long-term follow-up of nipple-sparing mastectomy for early-stage breast cancer without radiotherapy: A single-center study at a Japanese institution. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-12-09.

Clinical and Cosmetic Outcomes in Patients Treated With High Dose Rate Electronic Brachytherapy for Nonmelanoma Skin Cancer

To analyze clinical and cosmetic outcomes of patients treated for nonmelanoma skin cancer (NMSC) with high dose rate (HDR) electronic brachytherapy (EBT) using surface applicators. We identified 142 patients who had 169 NMSC lesions, 164 of which were basal cell carcinoma, treated with HDR EBT at our institution between July 2012 and March 2014. Lesions were treated to 40 Gy in eight fractions. Local control, acute toxicity, late toxicity, and cosmetic outcomes were analyzed retrospectively. Acute and late toxicities were graded using the Common Terminology Criteria for Adverse Events v4.0 (CTCAE v4.0). Cosmetic outcomes were graded using a standard scale based on the RTOG/EORTC Late Radiation Morbidity Scoring Schema. Mean follow-up time was 11.8 months. The overall recurrence rate was 1.2% (n=2). Grade 0-1 acute radiation dermatitis was observed in 53.2% of treated lesions (n=90), grade 2 in 35.5% (n=60), and grade 3 in 12.4% (n=21). No acute toxicity greater than grade 3 was observed and all acute toxic events resolved after treatment. Grade 0-1 late toxicity was observed in 94.7% of cases (n=160), and grade 2 in 5.3% (n=9). No late toxicity greater than grade 2 was observed. Across the 167 controlled lesions, cosmetic results were excellent in 95.2% of treated lesions (n=159), good in 3.6% (n=6), fair in 0.6% (n=1), and poor in 0.6% (n=1). HDR EBT confers excellent local control, minimal toxicity, and excellent cosmesis in our institutional experience. It should be considered ideal for NMSC of the head and neck, particularly for basal cell carcinoma involving central facial locations where surgical cosmesis may be inferior.

P20. Lipomodelling – An initial experience in improving cosmetic outcomes in patients undergoing breast surgery

P20. Lipomodelling – An initial experience in improving cosmetic outcomes in patients undergoing breast surgery

Hypofractionated Breast Radiation: Shorter Scheme, Lower Toxicity

BackgroundWe analyzed the toxicity and cosmetic outcomes for patients who had undergone 3-dimensional conformal radiotherapy with a hypofractionated schedule and identified the risk factors associated with such a schedule. Materials and MethodsA total of 143 patients were treated for breast cancer (stage 0-III) with a hypofractionated radiation schedule after breast-conserving surgery from 2006 to 2011. Most patients received 42.4 Gy in 16 daily fractions, 2.65 Gy per fraction to the whole breast plus an additional simultaneous integrated or sequential boost to the tumor bed. ResultsThe median follow-up period was 36 months. Mild acute skin toxicity was observed in 62%; 7% of the patients developed moderate skin toxicity, but no grade 4 toxicity was observed. The prevalence of fibrosis within the boost area was 5%, but no grade ≥ 2 was observed. The prevalence of fibrosis of any grade was greater in the nonboost (23%) than in the boost area. Of all the patients, 91% had good or excellent cosmetic outcomes. From the multivariate analysis, the incidence of epithelitis correlated with the patient's treated volume (P = .044). The incidence of acute toxicity correlated with the boost type to the tumor bed and the total treatment dose (P = .012 and P = .002, respectively). Also, a poor to fair cosmetic outcome was significantly associated statistically with the surgery type (P = .05), boost type (P = .004), and total dose (P = .001). ConclusionDelivering whole-breast irradiation with a hypofractionated schedule of 42.4 Gy plus a simultaneous integrated boost to the tumor bed appears to be a safe and effective technique, with good cosmetic results and lower toxicity.