Comparison of subjective, objective and patient-reported cosmetic outcomes between accelerated partial breast irradiation and whole breast radiotherapy: a prospective propensity score-matched pair analysis

Wadasadawala, Tabassum; Sinha, Shwetabh; Parmar, Vani; Verma, Suman; Gaikar, Mithila; Kannan, Sadhana; Mondal, Monidipa; Pathak, Rima; Jain, Urvashi; Sarin, Rajiv

doi:10.1007/s12282-019-01009-7

Cited by 9 publications

(5 citation statements)

References 30 publications

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“…Nonetheless, clinical outcomes were satisfactory, with 7-year disease-free survival of 97.5% and overall survival of 89%. High level of patient satisfaction with APBI, as observed previously [14], and similar QOL scores in the present study should encourage further uptake of APBI for suitably selected patients with early breast cancer in India. Additionally, it was impossible to embark randomized evidence in Indian setting, especially using brachytherapy because of the lack of availability of the expertise for breast brachytherapy across the country.…”

Section: Discussionsupporting

confidence: 88%

“…Using the propensity-score matching, a total of 64 APBI patients were matched with 99 WBRT patients out of the entire study cohort of 320 cases. Details of propensity-score matching have been reported along with analysis of cosmetic outcomes previously [14]. Mean QOL scores for the matched cohorts of WBRT and APBI are shown in Table 2, and scores for the unmatched cohorts are presented in Appendix 1.…”

Section: Resultsmentioning

confidence: 99%

“…Patients treated with APBI were propensity-score matched to a similar cohort of WBRT using nearest neighborhood algorithm with calliper width of 0.2 for covariates known to effect body image significantly, as described previously [14]. These covariates included menopausal status, size of the surgical cavity (< 100 cc vs. > 100 cc), size of the tumor in greatest dimension (pathological tumor size < 2 cm vs. ≥ 2 cm), number of lymph nodes dissected, treatment with any chemotherapy (neoadjuvant or adjuvant), and treatment with hormonal therapy.…”

Section: Discussionmentioning

confidence: 99%

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Patient-reported quality of life with interstitial partial breast brachytherapy and external beam whole breast radiotherapy: a comparison using propensity-score matching

Wadasadawala

Maitre

Sinha

et al. 2021

jcb

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Purpose: The aim of this study was to compare patient-reported quality of life (QOL) scores after accelerated partial breast irradiation (APBI) using interstitial brachytherapy vs. external beam whole breast radiotherapy (WBRT) for breast cancer.Material and methods: Women with breast cancer treated with WBRT or APBI after breast conservation surgery were enrolled in this prospective study. Single cross-sectional QOL assessment was performed using EORTC QLQ-C30 and BR-23 questionnaires. Patients treated with APBI were propensity-score matched to similar cohort of patients treated with WBRT. QOL scores were analyzed for the entire unmatched cohort and compared between the two matched cohorts using Student's two-tailed t-test. P-value of < 0.05 was considered statistically significant, and a 10-point difference between mean scores was considered clinically meaningful.Results: A total of 64 APBI patients were matched with 99 WBRT patients out of the entire study cohort of 320 cases. QOL scores for functional scales of QLQ-C30 were similar between the two groups for both matched and unmatched cohorts, while symptom scores of QLQ-C30 did not show any clinically significant difference. Functional scales of BR-23 did not show any clinical or statistically significant difference. Among symptom scales of BR-23, scores were similar for APBI and WBRT groups except for a worse score of "upset by hair loss" sub-scale in the brachytherapy group of the matched cohort (51.9 vs. 22.7, p = 0.006).Conclusions: Patients undergoing APBI reported similar QOL compared to WBRT when matched for various factors.

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Section: Discussionsupporting

confidence: 88%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Patient-reported quality of life with interstitial partial breast brachytherapy and external beam whole breast radiotherapy: a comparison using propensity-score matching

Wadasadawala

Maitre

Sinha

et al. 2021

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“…A low incidence of long-term toxicity was also noted as previously published. Moreover, our recent match pair analysis of the APBI group with the whole-breast radiation group documented superior cosmetic outcome in the APBI cohort irrespective of the method of cosmetic assessment (35). The advantage of relatively wider margins is reflected in the form of very low rates of re-excision (!5%) as it is technically difficult to manage positive margins with brachytherapy catheters in situ after intraoperative implants, which is the most common and preferred approach at our institute.…”

Section: Discussionmentioning

confidence: 99%

What is the dosimetric impact of isotropic vs anisotropic safety margins for delineation of the clinical target volume in breast brachytherapy?

et al. 2021

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The purpose of the study was to report dosimetric differences for breast brachytherapy plans optimized for clinical target volume (CTV) generated using conventional isotropic expansion of tumor bed volume (TBV) and Groupe Europ een de Curieth erapieeEuropean Society for Radiotherapy and Oncology (GEC-ESTRO) recommendations to expand the TBV anisotropically to achieve a total safety margin of 2 cm (resection margin size þ added safety margin). METHODS: Institutional records of 100 patients who underwent accelerated partial breast irradiation using multicatheter interstitial brachytherapy from May 2015 to March 2020 were reviewed retrospectively. Two sets of CT-based plans were made, one with 1-cm isotropic margins around the tumor bed (CTV_ISO) and the other with anisotropic margins (CTV_GEC). Plans were evaluated and compared using the American Brachytherapy Society and GEC-ESTRO guidelines. RESULTS: The median TBV was 36.97 cc. The median margin widths were as follows: anterior 1.2, posterior 1.0, superior 1.0, inferior 0.9, medial 1.2, and lateral 1.2 cm. The mean tumor bed coverage index was 0.94; 0.93 [p.066], the CTV coverage index 0.86; 0.84 [p 0.001], the dose homogeneity index (DHI) 0.77; 0.75 [p ! 0.001] and the conformity index 0.66; 0.64 [p ! 0.001] in CTV_ISO and CTV_GEC plans, respectively. In smaller volume implants (TBV! 35 cc), the DHI was 0.76; 0.75 [p 0.008] and the conformity index was 0.66; 0.62 [p ! 0.001], whereas in larger volumes O35 cc, the CTV coverage index was 0.86; 0.84 [p 0.003] and the DHI 0.78; 0.76 [p 0.001] in CTV_ISO and CTV_GEC plans, respectively.CONCLUSIONS: In this cohort of patients who underwent accelerated partial breast irradiation, plans with anisotropic margins had lower conformity, the impact of which was predominantly seen in smaller implants. Rest of the dosimetric constraints were achieved in both the plans as per the American Brachytherapy Society and GEC-ESTRO guidelines.

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“…While 23 studies were identified which reported results of PBI, mature clinical outcome data were available from one institute (Wadasadawala & colleagues) 77 78 where a multi-catheter PBI technique was followed. Clinical, cosmetic and patient-reported outcomes were favourable, with better outcomes reported for cosmesis and patient-reported outcomes with APBI as compared to whole-breast irradiation 77 78 79 . Perioperative implant placement was generally favoured.…”

Section: New Treatment Volume Conceptsmentioning

confidence: 99%

Adjuvant radiation therapy in breast cancer

Chakraborty

Chatterjee

2021

Indian Journal of Medical Research

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Breast cancer is the most common cancer among women in India, and adjuvant radiotherapy is an integral part of curative treatment in most patients. The recent decades have witnessed several advances in radiation therapy delivery. Several advances in radiation oncology have been identified which include technological advances, change in fractionation used, use of cardiac-sparing radiotherapy as well as efforts to personalize radiotherapy using accelerated partial breast irradiation or avoidance of radiotherapy in certain subpopulations. Indian data are available in most areas which have been summarized. However, increasing emphasis on research in these areas is needed so that effectiveness and safety in our setting can be established. Advances in breast cancer radiotherapy have resulted in improved outcomes. Data published from India suggest that these improved outcomes can be replicated in patients when appropriate treatment protocols are followed.

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Comparison of subjective, objective and patient-reported cosmetic outcomes between accelerated partial breast irradiation and whole breast radiotherapy: a prospective propensity score-matched pair analysis

Cited by 9 publications

References 30 publications

Patient-reported quality of life with interstitial partial breast brachytherapy and external beam whole breast radiotherapy: a comparison using propensity-score matching

Patient-reported quality of life with interstitial partial breast brachytherapy and external beam whole breast radiotherapy: a comparison using propensity-score matching

What is the dosimetric impact of isotropic vs anisotropic safety margins for delineation of the clinical target volume in breast brachytherapy?

Adjuvant radiation therapy in breast cancer

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