International comparison of cosmetic outcomes of breast conserving surgery and radiation therapy for women with ductal carcinoma in situ of the breast

•Cosmetic outcomes of BCS for DCIS were independent of treating centre geography.•Conventional and hypofractionated WBI achieved similar 3-year cosmesis.•Tumour bed boost (16 Gy in 8 fractions) doubled the risk of cosmetic deterioration.•The adverse impact of a tumour bed boost was independent of WB...

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Published in:Radiotherapy and oncology 2020-01, Vol.142, p.180-185
Main Authors: Olivotto, Ivo A., Link, Emma, Phillips, Claire, Whelan, Timothy J., Bryant, Guy, Kunkler, Ian H., Westenberg, A. Helen, Purohit, Kash, Ahern, Verity, Graham, Peter H., Akra, Mohamed, McArdle, Orla, Ludbrook, Joanna J., Harvey, Jennifer A., Maduro, John H., Kirkove, Carine, Gruber, Guenther, Martin, Joseph D., Campbell, Ian D., Delaney, Geoff P., Chua, Boon H.
Format: Article
Language:English
Subjects:
Boost
Breast cancer
Breast conservation
Cosmetic outcomes
Fractionation
Radiotherapy
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Summary:•Cosmetic outcomes of BCS for DCIS were independent of treating centre geography.•Conventional and hypofractionated WBI achieved similar 3-year cosmesis.•Tumour bed boost (16 Gy in 8 fractions) doubled the risk of cosmetic deterioration.•The adverse impact of a tumour bed boost was independent of WBI fractionation. To assess the cosmetic impact of breast conserving surgery (BCS), whole breast irradiation (WBI) fractionation and tumour bed boost (TBB) use in a phase III trial for women with ductal carcinoma in situ (DCIS) of the breast. Baseline and 3-year cosmesis were assessed using the European Organization for Research and Treatment of Cancer (EORTC) Cosmetic Rating System and digital images in a randomised trial of non-low risk DCIS treated with postoperative WBI +/− TBB. Baseline cosmesis was assessed for four geographic clusters of treating centres. Cosmetic failure was a global score of fair or poor. Cosmetic deterioration was a score change from excellent or good at baseline to fair or poor at three years. Odds ratios for cosmetic deterioration by WBI dose-fractionation and TBB use were calculated for both scoring systems. 1608 women were enrolled from 11 countries between 2007 and 2014. 85–90% had excellent or good baseline cosmesis independent of geography or assessment method. TBB (16 Gy in 8 fractions) was associated with a >2-fold risk of cosmetic deterioration (p 
ISSN:0167-8140
1879-0887
DOI:10.1016/j.radonc.2019.07.024