Cosmesis, late sequelae and local control after breast-conserving therapy: Influence of type of tumour bed boost and adjuvant chemotherapy

Aims: To study the influence of various factors affecting cosmetic outcome and late sequelae in a large cohort of women treated with breast-conserving therapy. Materials and methods: Between 1980 and 2000, 1022 pathological stage I/II breast cancer patients underwent breast-conserving therapy. On the basis of the type of tumour bed boost they received after whole breast radiotherapy, these women were assigned to three groups: (A) low dose rate (LDR) brachytherapy of 15-20 Gy (n = 383); (B) high dose rate (HDR) brachytherapy of 10 Gy (optimised) in a single fraction (n = 153); (C) electron beam 15 Gy/six fractions (n = 460). Systemic adjuvant therapy was given to 757 women, of whom 570 received adjuvant chemotherapy. Results: Cosmesis at the last follow-up was good or excellent in 77% of women. Post-radiation worsening of cosmesis was observed in 11.5% of women and was similar in the three boost groups. Moderate to severe late breast sequelae were observed in 22% of women in group B, which was significantly higher than the 12% in group A (P = 0.002) and 9% in group C (P = 0.0001). The actuarial 5-year local control rate was 91% and was 90, 92 and 93% in groups A, B and C, respectively. Tumour size (P = 0.049) and adjuvant chemotherapy (P = 0.04) were the significant factors affecting cosmetic outcome on univariate analysis. On multivariate analysis, adjuvant chemotherapy was the only factor leading to worsening in the cosmetic outcome, with P = 0.03 (hazard ratio 1.65 [95% confidence interval 1.05-2.59]). Conclusion: The type of tumour bed boost did not have a significant effect on the worsening of cosmetic outcome. However, there were significantly more late breast sequelae in women treated with single fraction HDR implants. Chemotherapy had an adverse effect on the cosmetic outcome, but the late breast sequelae and local control rates were comparable.