Effect of the Order of Adjuvant Treatment on the Cosmetic Results of Patients with Breast Cancer Treated with Breast-Conserving Surgery and Intraoperative Boost Radiotherapy

OBJECTIVE The aim of this study was to investigate the cosmetic outcome of adjuvant treatment after breast conserving surgery (BCS) and intraoperative boost radiotherapy (IOBRT) performed at the clinic over a 4-year period. METHODS A total of 65 patients who underwent at least 1 year of treatment for a diagnosis of early stage breast cancer were included in the study. Whole breast irradiation cases were included in Group A (n=34), and patients who underwent chemotherapy followed by WBI comprised Group B (n=31). Various details, including cosmetic outcome and score according to Johansen's scoring system were evaluated at postoperative month 1, after first treatment, and at the conclusion of 1 year of treatment. RESULTS The mean age of the patients was 53.5 years (range: 38-74 years), and the mean follow-up period was 23 months (range: 12-39 months). The mean tumor diameter was 16.95 mm (range: 4-30 mm). The tumor was located in the upper outer quadrant In 36 patients. It was determined that 14 patients had a comorbid disease, 7 were premenopausal, 7 were cigarette smokers, 7 had a tumor of >2 cm and 11 had inner quadrant localization. In 15 cases, the score was 9 or greater, indicating a poor cosmetic result. There were 7 patients with a poor cosmetic result in Group A, with a mean score of 10, and 8 patients from group B, with a mean score of 10.3. An independent t-test did not reveal a statistically significant difference between the groups (p>0.1). CONCLUSION The effects of radiotherapy and chemotherapy in addition to BCS and IOBRT hi early breast cancer cases were similar with respect to cosmetic results. Smoking, comorbid disease, the size of the tumor and quadrant of localization may contribute to poor cosmetic outcome.