Decline of Cosmetic Outcomes Following Accelerated Partial Breast Irradiation Using Intensity-Modulated Radiotherapy: Results of a Single Institution Prospective Clinical Trial
Abstract
Purpose To report the final cosmetic results from a single-arm prospective clinical trial evaluating accelerated partial breast irradiation (APBI) using intensity-modulated radiotherapy (IMRT) with active-breathing control (ABC). Methods/Materials Women greater than 40 years old with stages 0–1 breast cancer who received breast-conserving surgery were enrolled in an institutional review board-approved prospective study evaluating APBI using IMRT administered with deep-inspiration breath-hold. Patients received 38.5 Gy in 3.85 Gy fractions given twice daily over 5 consecutive days. The PTV was defined as the lumpectomy cavity with a 1.5 cm margin. Cosmesis was scored on a 4 category scale by the treating physician. Toxicity was scored according to the National Cancer Institute Common Terminology Criteria For Adverse Events (CTCAE v. 3.0). We report the cosmetic and toxicity results with a median follow-up of 5 years. Results A total of 34 patients were enrolled. Two patients were excluded because of fair baseline cosmesis. The trial was terminated early because fair/poor cosmesis developed in 7 of 32 women with a median follow-up of 2.5 years. At a median follow-up of 5 years, further decline in the cosmetic outcome was observed in 5 women. Cosmesis at time of last assessment was 43.3% excellent, 30% good, 20% fair, and 6.7% poor. Fibrosis according to the CTCAE at last assessment is as follows: 3.3% grade 2 toxicity and 0% grade 3 toxicity. There was no correlation of CTCAE…
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