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01-01-2016 | Original Article

Late radiation side effects, cosmetic outcomes and pain in breast cancer patients after breast-conserving surgery and three-dimensional conformal radiotherapy

Risk-modifying factors

Authors: Ursula Hille-Betz, M.D., Bernhard Vaske, Michael Bremer, M.D., Ph.D., Philipp Soergel, M.D.,Ph.D., Sudip Kundu, M.D., Rüdiger Klapdor, M.D., Peter Hillemanns, M.D., Ph.D., Christoph Henkenberens, M.D.

Published in: Strahlentherapie und Onkologie | Issue 1/2016

Abstract

Background and purpose

The purpose of this work was to identify parameters influencing the risk of late radiation side effects, fair or poor cosmetic outcomes (COs) and pain in breast cancer patients after breast-conserving therapy (BCT) and three-dimensional conformal radiotherapy (3D-CRT).

Patients and methods

Between 2006 and 2013, 159 patients were treated at the Hannover Medical School. Physician-rated toxicity according to the LENT-SOMA criteria, CO and pain were assessed by multivariate analysis.

Results

LENT-SOMA grade 1–4 toxicity was observed as follows: fibrosis 10.7 %, telangiectasia 1.2 %, arm oedema 8.8 % and breast oedema 5.0 %. In addition, 15.1 % of patients reported moderate or severe breast pain, and 21.4 % complained about moderate or severe pain in the arm or shoulder. In multivariate analysis, axillary clearing (AC) was significantly associated with lymphoedema of the arm [odds ratio (OR) 4.37, p = 0.011, 95 % confidence interval (CI) 1.4–13.58]. Breast oedema was also highly associated with AC (OR 10.59, p = 0.004, 95 % CI 2.1–53.36), a ptosis grade 2/3 or pseudoptosis and a bra size ≥ cup C (OR 5.34, p = 0.029, 95 % CI 1.2–24.12). A ptosis grade 2/3 or pseudoptosis and a bra size ≥ cup C were the parameters significantly associated with an unfavourable CO (OR 3.19, p = 0.019, 95 % CI 1.2–8.4). Concerning chronic breast pain, we found a trend related to the prescribed radiation dose including boost (OR 1.077, p = 0.060, 95 % CI 0.997–1.164). Chronic shoulder or arm pain was statistically significantly associated with lymphoedema of the arm (OR 3.9, p = 0.027, 95 % CI 1.17–13.5).

Conclusion

Chronic arm and breast oedema were significantly influenced by the extent of surgery (AC). Ptotic and large breasts were significantly associated with unfavourable COs and chronic breast oedema. Late toxicities exclusive breast pain were not associated with radiotherapy parameters.

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Title: Late radiation side effects, cosmetic outcomes and pain in breast cancer patients after breast-conserving surgery and three-dimensional conformal radiotherapy
Risk-modifying factors
Authors: Ursula Hille-Betz, M.D.
Bernhard Vaske
Michael Bremer, M.D., Ph.D.
Philipp Soergel, M.D.,Ph.D.
Sudip Kundu, M.D.
Rüdiger Klapdor, M.D.
Peter Hillemanns, M.D., Ph.D.
Christoph Henkenberens, M.D.
Publication date: 01-01-2016
Publisher: Springer Berlin Heidelberg
Published in: Strahlentherapie und Onkologie / Issue 1/2016
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-015-0899-y

At a glance: The STEP trials

Springer Medicine

Late radiation side effects, cosmetic outcomes and pain in breast cancer patients after breast-conserving surgery and three-dimensional conformal radiotherapy

Risk-modifying factors

Abstract

Background and purpose

Patients and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background and purpose

Patients and methods

Results

Conclusion

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