ESTRO meets Asia 2024 - Abstract Book

S72

Interdisciplinary – Breast

ESTRO meets Asia

61

Digital Poster

Assessment of breast retraction and cosmetic outcome in early stage breast cancer

Ankita Pandey, Uday Pratap Shahi, Himanshu Mishra, Ritusha Mishra, Shreya Singh

Radiotherapy and Radiation Medicine, Institute of Medical Sciences, BHU, Varanasi, India

Purpose/Objective:

Breast conservation therapy (BCT) is a well-established treatment of choice for patients with early stage breast cancer. The main goal of BCT is to provide equivalent local control as mastectomy along with good cosmetic outcome. The aim of our study was to develop a new tool for quick and easy assessment of cosmesis in out patient setting

Material/Methods:

Fifty patients of EBC were prospectively recruited after breast conserving surgery and treated by external beam RT to whole breast followed by tumor bed boost by interstial brachytherapy or external beam photon therapy. For the cosmesis evaluation, photograph including both breasts were obtained in all patients preRT and postRT. The measurement technique included degree of horizontal and vertical nipple deviation from the baseline (preRT). For horizontal nipple deviation assessment, nipple deviation from midline horizontally was recorded in centimeters. For vertical nipple deviation assessment, the difference between the two breast nipple levels in the vertical direction was recorded in centimeters. The difference between two breast nipple levels both horizontally and vertically was recorded pre-RT, one-year post-RT, and on last follow-up. Photographs of each patient were shown to the clinician separately (2 radiation oncologists, 1 radiologist, 1 surgical oncologist) and were asked to grade the cosmetic outcome. the grading was then correlated with the recorded horizontal and vertical deviation post-treatment in comparison to the baseline.

Results:

The median follow up duration was 36 months. Tumors of the upper outer quadrant and central location, larger lumpectomy cavity volume, and grade 3 skin induration were associated with vertical retraction of nipple more than 2cm. Comparable to RTOG objective and patient subjective criteria, our method of grading showed that vertical shift of ≥2cm was associated with poor cosmetic outcome. Horizontal nipple shift in all patients was less than 1cm and did not affect the cosmesis.

Conclusion:

Surgical and radiation-related parameters should be carefully assessed to determine the overall cosmetic outcome. Vertical breast retraction of ≥2cm was associated with inferior cosmetic outcome. Our method to quantify Harvard RTOG objective grading is simple and reliable. It can be performed by clinicians on outpatient basis without the use of a complicated algorithm to evaluate cosmetic outcomes in BCS patients.

Keywords: Breast cancer, Cosmesis, Grading criteria

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