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Erschienen in: Strahlentherapie und Onkologie 7/2019

17.05.2019 | Original Article

Long-term cosmetic outcome after preoperative radio-/chemotherapy in locally advanced breast cancer patients

verfasst von: Christiane Matuschek, Carolin Nestle-Kraemling, Jan Haussmann, Edwin Bölke, Sylvia Wollandt, Vanessa Speer, Freddy Joel Djiepmo Njanang, Bálint Tamaskovics, Peter Arne Gerber, Klaus Orth, Eugen Ruckhaeberle, Tanja Fehm, Stefanie Corradini, Guido Lammering, Svjetlana Mohrmann, Werner Audretsch, Stephan Roth, Kai Kammers, Wilfried Budach

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 7/2019

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Abstract

Background

Preoperative radiotherapy and chemoradiotherapy (PRT/PCRT) represent an increasingly used clinical strategy in different tumor sites. We have previously reported on a PRT/PRCT protocol in patients with locally advanced non-inflammatory breast cancer (LABC) with promising clinical results. However, concerns regarding a possible unfavorable influence on cosmesis still exist. Thus, the aim of the current study was to examine long-term cosmetic outcome in our series of LABC patients treated with PRT/PCRT followed by breast-conserving surgery (BCS) or mastectomy (ME).

Patients and methods

Of the 315 patients treated with PRT/PCRT in the years 1991 to 1999, 203 were still alive at long-term follow-up of mean 17.7 years (range 14–21). Thirty-seven patients were lost to follow-up and 58 patients refused to be contacted, which resulted in 107 patients (64 patients after BCS and 43 after mastectomy) being available and willing to undergo further cosmetic assessment. One patient had a complete response after PRT/PCRT and refused surgery. PRT/PCRT consisted of external beam radiation therapy (EBRT) with 50 Gy (5 × 2 Gy/week) to the breast and the supra-/infraclavicular lymph nodes combined with a consecutive electron boost or (in case of BCS) a 10-Gy interstitial brachytherapy boost with Ir-192 prior to EBRT. Overall, chemotherapy was administered either prior to RT or concomitantly in the majority of patients. BCS and mastectomy were performed with and without reconstruction. The cosmetic outcome was assessed by patient questionnaire, panel evaluation, and breast retraction assessment (BRA) score.

Results

Eighty percent of all BCS patients rated their overall cosmetic result as “excellent” or “good” as compared to 55.8% after mastectomy. Patient and panel ratings on cosmetic outcomes were similar between the two groups. No grade III or IV fibrosis were detected in any of the groups. The median BRA score after breast conserving surgery was 2.9.

Conclusion

PRT/PCRT is associated with low grades of fibrosis and a good to excellent long-term cosmetic outcome.
Literatur
1.
Zurück zum Zitat Budach W, Kammers K, Boelke E, Matuschek C (2013) Adjuvant radiotherapy of regional lymph nodes in breast cancer—A meta-analysis of randomized trials. Radiat Oncol 8:267CrossRefPubMedPubMedCentral Budach W, Kammers K, Boelke E, Matuschek C (2013) Adjuvant radiotherapy of regional lymph nodes in breast cancer—A meta-analysis of randomized trials. Radiat Oncol 8:267CrossRefPubMedPubMedCentral
2.
Zurück zum Zitat Krug D, Baumann R, Budach W et al (2018) Individualization of post-mastectomy radiotherapy and regional nodal irradiation based on treatment response after neoadjuvant chemotherapy for breast cancer: A systematic review. Strahlenther Onkol 194:607–618CrossRefPubMed Krug D, Baumann R, Budach W et al (2018) Individualization of post-mastectomy radiotherapy and regional nodal irradiation based on treatment response after neoadjuvant chemotherapy for breast cancer: A systematic review. Strahlenther Onkol 194:607–618CrossRefPubMed
3.
Zurück zum Zitat Krug D, Baumann R, Budach W et al (2018) Neoadjuvant chemotherapy for breast cancer-background for the indication of locoregional treatment. Strahlenther Onkol 194:797–805CrossRefPubMed Krug D, Baumann R, Budach W et al (2018) Neoadjuvant chemotherapy for breast cancer-background for the indication of locoregional treatment. Strahlenther Onkol 194:797–805CrossRefPubMed
4.
Zurück zum Zitat Piroth MD, Baumann R, Budach W et al (2019) Heart toxicity from breast cancer radiotherapy: Current findings, assessment, and prevention. Strahlenther Onkol 195:1–12CrossRefPubMed Piroth MD, Baumann R, Budach W et al (2019) Heart toxicity from breast cancer radiotherapy: Current findings, assessment, and prevention. Strahlenther Onkol 195:1–12CrossRefPubMed
5.
Zurück zum Zitat Kaidar-Person O, Kuten A, Belkacemi Y (2014) Primary systemic therapy and whole breast irradiation for locally advanced breast cancer: A systematic review. Crit Rev Oncol Hematol 92:143–152CrossRefPubMed Kaidar-Person O, Kuten A, Belkacemi Y (2014) Primary systemic therapy and whole breast irradiation for locally advanced breast cancer: A systematic review. Crit Rev Oncol Hematol 92:143–152CrossRefPubMed
6.
Zurück zum Zitat Pazos M, Corradini S, Dian D et al (2017) Neoadjuvant radiotherapy followed by mastectomy and immediate breast reconstruction: An alternative treatment option for locally advanced breast cancer. Strahlenther Onkol 193:324–331CrossRefPubMed Pazos M, Corradini S, Dian D et al (2017) Neoadjuvant radiotherapy followed by mastectomy and immediate breast reconstruction: An alternative treatment option for locally advanced breast cancer. Strahlenther Onkol 193:324–331CrossRefPubMed
7.
Zurück zum Zitat Gerlach B, Audretsch W, Gogolin F et al (2003) Remission rates in breast cancer treated with preoperative chemotherapy and radiotherapy. Strahlenther Onkol 179:306–311CrossRefPubMed Gerlach B, Audretsch W, Gogolin F et al (2003) Remission rates in breast cancer treated with preoperative chemotherapy and radiotherapy. Strahlenther Onkol 179:306–311CrossRefPubMed
8.
Zurück zum Zitat Matuschek C, Bolke E, Roth SL et al (2012) Long-term outcome after neoadjuvant radiochemotherapy in locally advanced noninflammatory breast cancer and predictive factors for a pathologic complete remission: Results of a multivariate analysis. Strahlenther Onkol 188:777–781CrossRefPubMed Matuschek C, Bolke E, Roth SL et al (2012) Long-term outcome after neoadjuvant radiochemotherapy in locally advanced noninflammatory breast cancer and predictive factors for a pathologic complete remission: Results of a multivariate analysis. Strahlenther Onkol 188:777–781CrossRefPubMed
9.
Zurück zum Zitat Cocquyt VF, Blondeel PN, Depypere HT et al (2003) Better cosmetic results and comparable quality of life after skin-sparing mastectomy and immediate autologous breast reconstruction compared to breast conservative treatment. Br J Plast Surg 56:462–470CrossRefPubMed Cocquyt VF, Blondeel PN, Depypere HT et al (2003) Better cosmetic results and comparable quality of life after skin-sparing mastectomy and immediate autologous breast reconstruction compared to breast conservative treatment. Br J Plast Surg 56:462–470CrossRefPubMed
10.
Zurück zum Zitat Coles CE, Brunt AM, Wheatley D, Mukesh MB, Yarnold JR (2013) Breast radiotherapy: Less is more? Clin Oncol (R Coll Radiol) 25:127–134CrossRef Coles CE, Brunt AM, Wheatley D, Mukesh MB, Yarnold JR (2013) Breast radiotherapy: Less is more? Clin Oncol (R Coll Radiol) 25:127–134CrossRef
11.
Zurück zum Zitat Dujmovic A, Marcinko D, Bulic K, Kisic H, Dudukovic M, Mijatovic D (2017) Quality of life and depression among female patients undergoing surgical treatment for breast cancer: A prospective study. Psychiatr Danub 29:345–350CrossRefPubMed Dujmovic A, Marcinko D, Bulic K, Kisic H, Dudukovic M, Mijatovic D (2017) Quality of life and depression among female patients undergoing surgical treatment for breast cancer: A prospective study. Psychiatr Danub 29:345–350CrossRefPubMed
12.
Zurück zum Zitat Nestle-Kramling C, Bolke E, Budach W, Andree C (2016) Breast reconstruction after neoadjuvant radio chemotherapy: Review and personal technique IDEAL concept REV-EJMR-D-15-00268. Eur J Med Res 21:24CrossRefPubMedPubMedCentral Nestle-Kramling C, Bolke E, Budach W, Andree C (2016) Breast reconstruction after neoadjuvant radio chemotherapy: Review and personal technique IDEAL concept REV-EJMR-D-15-00268. Eur J Med Res 21:24CrossRefPubMedPubMedCentral
13.
Zurück zum Zitat Roth SL, Audretsch W, Bojar H, Lang I, Willers R, Budach W (2010) Retrospective study of neoadjuvant versus adjuvant radiochemotherapy in locally advanced noninflammatory breast cancer: Survival advantage in cT2 category by neoadjuvant radiochemotherapy. Strahlenther Onkol 186:299–306CrossRefPubMed Roth SL, Audretsch W, Bojar H, Lang I, Willers R, Budach W (2010) Retrospective study of neoadjuvant versus adjuvant radiochemotherapy in locally advanced noninflammatory breast cancer: Survival advantage in cT2 category by neoadjuvant radiochemotherapy. Strahlenther Onkol 186:299–306CrossRefPubMed
14.
Zurück zum Zitat Harris JR, Levene MB, Svensson G, Hellman S (1979) Analysis of cosmetic results following primary radiation therapy for stages I and II carcinoma of the breast. Int J Radiat Oncol Biol Phys 5:257–261CrossRefPubMed Harris JR, Levene MB, Svensson G, Hellman S (1979) Analysis of cosmetic results following primary radiation therapy for stages I and II carcinoma of the breast. Int J Radiat Oncol Biol Phys 5:257–261CrossRefPubMed
15.
Zurück zum Zitat Pezner RD, Patterson MP, Hill LR et al (1985) Breast retraction assessment: An objective evaluation of cosmetic results of patients treated conservatively for breast cancer. Int J Radiat Oncol Biol Phys 11:575–578CrossRefPubMed Pezner RD, Patterson MP, Hill LR et al (1985) Breast retraction assessment: An objective evaluation of cosmetic results of patients treated conservatively for breast cancer. Int J Radiat Oncol Biol Phys 11:575–578CrossRefPubMed
16.
Zurück zum Zitat Pezner RD, Patterson MP, Hill LR, Vora NL, Desai KR, Lipsett JA (1985) Breast retraction assessment. Multiple variable analysis of factors responsible for cosmetic retraction in patients treated conservatively for stage I or II breast carcinoma. Acta Radiol Oncol 24:327–330CrossRefPubMed Pezner RD, Patterson MP, Hill LR, Vora NL, Desai KR, Lipsett JA (1985) Breast retraction assessment. Multiple variable analysis of factors responsible for cosmetic retraction in patients treated conservatively for stage I or II breast carcinoma. Acta Radiol Oncol 24:327–330CrossRefPubMed
17.
Zurück zum Zitat Van Limbergen E, van der Schueren E, Van Tongelen K (1989) Cosmetic evaluation of breast conserving treatment for mammary cancer. 1. Proposal of a quantitative scoring system. Radiother Oncol 16:159–167CrossRefPubMed Van Limbergen E, van der Schueren E, Van Tongelen K (1989) Cosmetic evaluation of breast conserving treatment for mammary cancer. 1. Proposal of a quantitative scoring system. Radiother Oncol 16:159–167CrossRefPubMed
18.
Zurück zum Zitat Mornex F, Pavy JJ, Denekamp J, Bolla M (1997) Scoring system of late effects of radiations on normal tissues: The SOMA-LENT scale. Cancer Radiother 1:622–668CrossRefPubMed Mornex F, Pavy JJ, Denekamp J, Bolla M (1997) Scoring system of late effects of radiations on normal tissues: The SOMA-LENT scale. Cancer Radiother 1:622–668CrossRefPubMed
19.
Zurück zum Zitat Rubin P, Constine LS 3rd, Fajardo LF, Phillips TL, Wasserman TH (1995) Overview of late effects normal tissues (LENT) scoring system. Radiother Oncol 35(1):9–10CrossRefPubMed Rubin P, Constine LS 3rd, Fajardo LF, Phillips TL, Wasserman TH (1995) Overview of late effects normal tissues (LENT) scoring system. Radiother Oncol 35(1):9–10CrossRefPubMed
20.
Zurück zum Zitat Rubin P, Constine LS, Fajardo LF, Phillips TL, Wasserman TH (1995) Overview. Late effects of normal tissues (LENT) scoring system. Int J Radiat Oncol Biol Phys 31:1041–1042CrossRefPubMed Rubin P, Constine LS, Fajardo LF, Phillips TL, Wasserman TH (1995) Overview. Late effects of normal tissues (LENT) scoring system. Int J Radiat Oncol Biol Phys 31:1041–1042CrossRefPubMed
21.
Zurück zum Zitat Chang EI, Ly DP, Wey PD (2007) Comparison of aesthetic breast reconstruction after skin-sparing or conventional mastectomy in patients receiving preoperative radiation therapy. Ann Plast Surg 59:78–81CrossRefPubMed Chang EI, Ly DP, Wey PD (2007) Comparison of aesthetic breast reconstruction after skin-sparing or conventional mastectomy in patients receiving preoperative radiation therapy. Ann Plast Surg 59:78–81CrossRefPubMed
22.
Zurück zum Zitat Hultman CS, Daiza S (2003) Skin-sparing mastectomy flap complications after breast reconstruction: Review of incidence, management, and outcome. Ann Plast Surg 50:249–255 (discussion 255)CrossRefPubMed Hultman CS, Daiza S (2003) Skin-sparing mastectomy flap complications after breast reconstruction: Review of incidence, management, and outcome. Ann Plast Surg 50:249–255 (discussion 255)CrossRefPubMed
23.
Zurück zum Zitat Selber JC, Kurichi JE, Vega SJ, Sonnad SS, Serletti JM (2006) Risk factors and complications in free TRAM flap breast reconstruction. Ann Plast Surg 56:492–497CrossRefPubMed Selber JC, Kurichi JE, Vega SJ, Sonnad SS, Serletti JM (2006) Risk factors and complications in free TRAM flap breast reconstruction. Ann Plast Surg 56:492–497CrossRefPubMed
24.
Zurück zum Zitat Krueger EA, Wilkins EG, Strawderman M et al (2001) Complications and patient satisfaction following expander/implant breast reconstruction with and without radiotherapy. Int J Radiat Oncol Biol Phys 49:713–721CrossRefPubMed Krueger EA, Wilkins EG, Strawderman M et al (2001) Complications and patient satisfaction following expander/implant breast reconstruction with and without radiotherapy. Int J Radiat Oncol Biol Phys 49:713–721CrossRefPubMed
25.
Zurück zum Zitat Ascherman JA, Hanasono MM, Newman MI, Hughes DB (2006) Implant reconstruction in breast cancer patients treated with radiation therapy. Plast Reconstr Surg 117:359–365CrossRefPubMed Ascherman JA, Hanasono MM, Newman MI, Hughes DB (2006) Implant reconstruction in breast cancer patients treated with radiation therapy. Plast Reconstr Surg 117:359–365CrossRefPubMed
26.
Zurück zum Zitat Berbers J, van Baardwijk A, Houben R et al (2014) ‘Reconstruction: Before or after postmastectomy radiotherapy?’ A systematic review of the literature. Eur J Cancer 50:2752–2762CrossRefPubMed Berbers J, van Baardwijk A, Houben R et al (2014) ‘Reconstruction: Before or after postmastectomy radiotherapy?’ A systematic review of the literature. Eur J Cancer 50:2752–2762CrossRefPubMed
27.
Zurück zum Zitat Nava MB, Pennati AE, Lozza L, Spano A, Zambetti M, Catanuto G (2011) Outcome of different timings of radiotherapy in implant-based breast reconstructions. Plast Reconstr Surg 128:353–359CrossRefPubMed Nava MB, Pennati AE, Lozza L, Spano A, Zambetti M, Catanuto G (2011) Outcome of different timings of radiotherapy in implant-based breast reconstructions. Plast Reconstr Surg 128:353–359CrossRefPubMed
28.
Zurück zum Zitat Baltodano PA, Flores JM, Kone L et al (2014) Abstract 120: Neoadjuvant radiotherapy is not associated with increased post-mastectomy/reconstruction morbidity events: A critical analysis of 85,851 patients from the ACS-NSQIP database. Plast Reconstr Surg 133:135–136CrossRefPubMed Baltodano PA, Flores JM, Kone L et al (2014) Abstract 120: Neoadjuvant radiotherapy is not associated with increased post-mastectomy/reconstruction morbidity events: A critical analysis of 85,851 patients from the ACS-NSQIP database. Plast Reconstr Surg 133:135–136CrossRefPubMed
29.
Zurück zum Zitat Mukai H, Watanabe T, Mitsumori M et al (2013) Final results of a safety and efficacy trial of preoperative sequential chemoradiation therapy for the nonsurgical treatment of early breast cancer: Japan Clinical Oncology Group Study JCOG0306. Oncology 85:336–341CrossRefPubMed Mukai H, Watanabe T, Mitsumori M et al (2013) Final results of a safety and efficacy trial of preoperative sequential chemoradiation therapy for the nonsurgical treatment of early breast cancer: Japan Clinical Oncology Group Study JCOG0306. Oncology 85:336–341CrossRefPubMed
30.
Zurück zum Zitat Touboul E, Lefranc JP, Blondon J et al (1997) Primary chemotherapy and preoperative irradiation for patients with stage II larger than 3 cm or locally advanced non-inflammatory breast cancer. Radiother Oncol 42:219–229CrossRefPubMed Touboul E, Lefranc JP, Blondon J et al (1997) Primary chemotherapy and preoperative irradiation for patients with stage II larger than 3 cm or locally advanced non-inflammatory breast cancer. Radiother Oncol 42:219–229CrossRefPubMed
31.
Zurück zum Zitat Semiglazov VF, Topuzov EE, Bavli JL et al (1994) Primary (neoadjuvant) chemotherapy and radiotherapy compared with primary radiotherapy alone in stage IIb–IIIa breast cancer. Ann Oncol 5:591–595CrossRefPubMed Semiglazov VF, Topuzov EE, Bavli JL et al (1994) Primary (neoadjuvant) chemotherapy and radiotherapy compared with primary radiotherapy alone in stage IIb–IIIa breast cancer. Ann Oncol 5:591–595CrossRefPubMed
32.
Zurück zum Zitat Shanta V, Swaminathan R, Rama R, Radhika R (2008) Retrospective analysis of locally advanced noninflammatory breast cancer from Chennai, South India, 1990–1999. Int J Radiat Oncol Biol Phys 70:51–58CrossRefPubMed Shanta V, Swaminathan R, Rama R, Radhika R (2008) Retrospective analysis of locally advanced noninflammatory breast cancer from Chennai, South India, 1990–1999. Int J Radiat Oncol Biol Phys 70:51–58CrossRefPubMed
33.
Zurück zum Zitat Mukesh MB, Barnett GC, Wilkinson JS et al (2013) Randomized controlled trial of intensity-modulated radiotherapy for early breast cancer: 5‑year results confirm superior overall cosmesis. J Clin Oncol 31:4488–4495CrossRefPubMed Mukesh MB, Barnett GC, Wilkinson JS et al (2013) Randomized controlled trial of intensity-modulated radiotherapy for early breast cancer: 5‑year results confirm superior overall cosmesis. J Clin Oncol 31:4488–4495CrossRefPubMed
34.
Zurück zum Zitat Keller LM, Sopka DM, Li T et al (2012) Five-year results of whole breast intensity modulated radiation therapy for the treatment of early stage breast cancer: The Fox Chase Cancer Center experience. Int J Radiat Oncol Biol Phys 84:881–887CrossRefPubMed Keller LM, Sopka DM, Li T et al (2012) Five-year results of whole breast intensity modulated radiation therapy for the treatment of early stage breast cancer: The Fox Chase Cancer Center experience. Int J Radiat Oncol Biol Phys 84:881–887CrossRefPubMed
Metadaten
Titel
Long-term cosmetic outcome after preoperative radio-/chemotherapy in locally advanced breast cancer patients
verfasst von
Christiane Matuschek
Carolin Nestle-Kraemling
Jan Haussmann
Edwin Bölke
Sylvia Wollandt
Vanessa Speer
Freddy Joel Djiepmo Njanang
Bálint Tamaskovics
Peter Arne Gerber
Klaus Orth
Eugen Ruckhaeberle
Tanja Fehm
Stefanie Corradini
Guido Lammering
Svjetlana Mohrmann
Werner Audretsch
Stephan Roth
Kai Kammers
Wilfried Budach
Publikationsdatum
17.05.2019
Verlag
Springer Berlin Heidelberg
Erschienen in
Strahlentherapie und Onkologie / Ausgabe 7/2019
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-019-01473-2

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