Cosmetic outcome of breast conservative treatment for early stage breast cancer

Evaluation of breast cosmetic changes with a computer-software; the breast cancer conservative treatment cosmetic results (BCCT. core) in hypofractionated whole breast irradiation after breast-conserving surgery-supplementary analysis of multicenter single-arm confirmatory trial: JCOG0906

BACKGROUND

A good cosmetic outcome has been defined as an important endpoint in breast-conserving therapy (BCT). Various evaluation methods have been studied, but the optimal method has yet to be identified. The present supplementary analysis of JCOG0906 focused on comparing evaluation methods for breast cosmetic outcomes following hypofractionated whole breast irradiation (HFWBI) to examine whether a computer-software (the Breast Cancer Conservative Treatment cosmetic results [BCCT. core])-based program evaluation (CE) can be used for Asian women in clinical trials of BCT.

METHODS

Of 306 women, 292 underwent institutional evaluation (IE) for breast cosmetic outcomes before (pre) and 3 years after (post) HFWBI using a 4-point scale (excellent/good/fair/poor), and they were evaluated by CE and a central panel evaluation (PE) on the same scale using 292 pairs of pre/post-HFWBI photographs. PE was performed twice by consensus of the same two experts with a 3-year interval. CE was assessed individually by two radiation oncologists, an expert and a non-expert. Intra-observer variability and inter-observer variability were calculated using the kappa (k) and weighted kappa (wk) statistics.

RESULTS

The agreement between the first and second PE using pre/post-HFWBI photographs was moderate (k = 0.60, wk = 0.64. k = 0.53, wk = 0.60). The agreement between the expert and non-expert on CE was substantial (k = 0.72, wk = 0.76. k = 0.72, wk = 0.77). The inter-observer variability of CE was smaller than the intra-observer variability of PE.

CONCLUSION

CE with BCCT. core was considered a reproducible and an appropriate evaluation method for Asian women in clinical trials of BCT, when breast cosmetic changes were compared between pre/post therapy.

Factors related to patient-reported cosmetic outcome after breast-conserving therapy for breast cancer

BACKGROUND

Multiple factors can affect cosmetic outcome after breast-conserving therapy. We investigated which combination of factors could optimally predict patient reported cosmetic outcome.

METHODS AND MATERIALS

Dutch patients treated with BCT between 2008 and 2013 were retrospectively analysed. Demographics, tumour characteristics, and treatment-related factors were obtained from available digital medical records. Patients were asked to indicate their degree of cosmetic satisfaction using the Harvard scale. Both univariable and multivariable logistic regression analyses were performed to create a prediction model.

RESULTS

The present study based on 220 patients shows that univariable analysis radiotherapy boost (OR 4.01 [1.85-8.70], p ≤ 0.001) and adjuvant chemotherapy (OR 2.67 [1.45-4.92], p = 0.002) were significantly associated with unsatisfactory cosmetic outcome. In multivariable analyses, only a radiotherapy boost remained significantly associated (OR 4.08 [1.76-9.49], p = 0.001) with poor cosmetic outcome, while adjuvant chemotherapy was no longer associated with it (OR 1.61 [0.81-3.24), p = 0.18). These two factors, together with tumour histology and lymph node staging, showed the highest predictive values, although the predictive property of the overall model was limited (AUC = 0.69).

CONCLUSION

In the present study, a variety of factors is explored. However, a radiotherapy boost was the only factor that was independently associated with a poor cosmetic outcome after BCT. This finding can be used for counselling in daily clinical practice. Creation of a prediction model will require further investigation.

Patients' view of the differences in topical creams for radiation dermatitis prevention. A pilot study of cosmetic properties

Aim

To investigate the feasibility of including patients' reports on the cosmetic properties of topical formulations for acute radiation dermatitis (ARD).

Background

No topical agent tested for acute radiation dermatitis (ARD) has proven to be better than any other, all achieving similar objective outcomes. No clear guidelines have therefore been established in clinics. Because the vehicle for such creams has shown to be an important factor in patient adherence to treatments in other dermatological diseases, patients' opinions are evaluated.

Material and methods

Seventy breast cancer patients referred for postoperative radiotherapy after conservative surgery were enrolled. Patients were assigned to use one of the 7 topical agents that are most-commonly used in the prevention of ARD. Patients' reports were assessed using continuous visual analogue scales (VAS), objective signs and symptoms produced by ARD, and were rated using the RTOG and RISRAS scales.

Results

The creams tested differed in their cosmetic properties significantly (p = 0.044). The performance of the agent, their absorption and any residue left over were also significantly different (p = 0.022, 0.014 and 0.02, respectively).

Conclusions

Topical agents for preventive ARD are reported by patients to show different cosmetic properties. Cosmetic properties are important when choosing topical agents for ARD prevention. Recommending those with better cosmetic profiles would improve patient adherence to treatments.

Patient-reported outcome measurement compared with professional judgment of cosmetic results after breast-conserving therapy

Background

In the present study, we set out to compare patient-reported outcomes with professional judgment about cosmesis after breast-conserving therapy (bct) and to evaluate which items (position of the nipple, color, scar, size, shape, and firmness) correlate best with subjective outcome.

Methods

Dutch patients treated with bct between 2008 and 2009 were analyzed. Exclusion criteria were prior amputation or bct of the contralateral breast, metastatic disease, local recurrence, or any prior cosmetic breast surgery. Structured questionnaires and standardized six-view photographs were obtained with a minimum of 3 years' follow-up. Cosmetic outcome was judged by the patients and, based on photographs, by 5 different medical professionals using 3 different scoring systems: the Harvard scale, the Sneeuw questionnaire, and a numeric rating scale. Agreement was scored using the intraclass correlation coefficient (icc). The association between items of the Sneeuw questionnaire and a fair-poor Harvard score was estimated using logistic regression analysis.

Results

The study included 108 female patients (age: 40-91 years). Based on the Harvard scale, agreement on cosmetic outcome between the professionals was good (icc: 0.78). In contrast, agreement between professionals as a group compared with the patients was found to be fair to moderate (icc range: 0.38-0.50). The items "size" and "shape" were identified as the strongest determinants of cosmetic outcome.

Conclusions

Cosmetic outcome was scored differently by patients and professionals. Agreement was greater between the professionals than between the patients and the professionals as a group. In general, size and shape were the most prominent items on which cosmetic outcome was judged by patients and professionals alike.

Cosmetic Consequences of Breast-Conserving Treatment for Breast Cancer: Something Worth Talking About

BACKGROUND

Breast-conserving treatment (BCT) for breast cancer can lead to deformation of the treated breast, resulting in patient dissatisfaction with the final cosmetic outcome. Currently, literature on the specific information needs of patients concerning the cosmetic effects of BCT is lacking. The aim of the present study was to investigate the information needs of breast cancer patients regarding the long-term cosmetic outcome after BCT.

SUBJECTS, MATERIALS, AND METHODS

The data from 115 women who had undergone BCT in a general teaching hospital breast cancer unit in The Netherlands were studied. Structured questionnaires and semi-structured interviews were conducted between October 2012 and April 2013. A mixed model of quantitative and qualitative research was used to explore patient-reported information needs. A phenomenological approach was used to analyze the qualitative data.

RESULTS

This study shows that women undergoing BCT want to discuss long-term cosmetic effects. Most patients appreciate such information immediately after the diagnosis. Patients indicated that it is also important to pay attention to the cosmetic effects during the follow-up visits, because deformation of the breast can also occur at a later stage. Furthermore, half the patients indicated that they would not likely raise the subject of cosmetic effects of the treatment themselves.

CONCLUSION

Breast cancer patients have a need for long-term attention for cosmetic outcome of BCT, which should be tailored during the treatment and follow-up process.

IMPLICATIONS FOR PRACTICE

Currently, no literature exists concerning patients' needs for information regarding the cosmetic effects of breast-conserving therapy (BCT). Bringing up the cosmetic effects of BCT by health care professionals does not appear to be a standard part of treatment and follow-up. It is expected that the quality of care and life will be improved by providing information and guidance regarding the cosmetic outcome of BCT within the existing structure of the breast cancer pathway. Discussion and visualization of the cosmetic effects prior to treatment will lead to more realistic expectations, and as a result, secondary interventions, such as partial prostheses and plastic surgery, may be easier to discuss and accept.

Development and psychometric validation of a shorter version of the Breast Cancer Treatment Outcome Scale (BCTOS-12)

OBJECTIVES

Aesthetic and functional outcomes after oncoplastic breast-conserving surgery (BCS) are directly related to the patients' quality of life (QoL). The Breast Cancer Treatment Outcome Scale (BCTOS) is a validated but burdensome questionnaire for the assessment of these outcomes. The aim of the study was to strengthen and focus the BCTOS instrument by reducing the number of items and subscales without loss of information and validity.

METHODS

This study used a dataset of 871 patients with stage 0 - III breast cancer, from a prospective cohort study, who underwent BCS. We investigated correlations and other criteria of homogeneity of the BCTOS items to identify redundancies. An exploratory factor analysis was used to remodel the item-factor structure. Correlation and linear regression analysis with validated QoL subscales assessed the convergent and discriminant validity of the modified BCTOS structure.

RESULTS

The factor analysis revealed two distinct subscales for aesthetic and functional outcomes. It was possible to reduce the 22 items of the original BCTOS to 12 items, thus the "BCTOS-12". The two new scales had very good internal consistency: Cronbach's α = 0.86 for the new Aesthetic Status subscale and α = 0.81 for the new Functional Status subscale. Bootstrapping confirmed the item-factor structure for all 10,000 samples, remarkably.

CONCLUSION

The modified BCTOS questionnaire with only 12 items (BCTOS-12) is shorter, easier to interpret, and shows good validity.

High-dose-rate brachytherapy in the treatment of skin Kaposi sarcoma

Purpose

The aim of the study is to review our experience in treatment of Kaposi sarcoma (KS) lesions with high-dose-rate (HDR) brachytherapy.

Material and methods

We present five new KS lesions (three patients) that were treated in our hospital from May 2016 to February 2017 with HDR brachytherapy using Valencia applicators. The treatment was delivered in 5 Gy fractions over five sessions, on alternate days. Total dose of 25 Gy (EQD₂ 31.25 Gy) was delivered. All patients were male, Caucasian, without a history of HIV, organ transplantation, or current immunosuppressive therapy. The median age was 76 years.

Results

All lesions (100%) were located in lower limbs (60% in the ankle, 20% in the leg, and 20% in the foot), and their development was progressive. No lesion was greater than 2 cm (range, 0.5-1.5 cm). With a median follow-up of 15 months, all patients had a complete response to the treatment, with no evidence of local recurrence or tumor progression. Most of the patients (80%) had no acute toxicity; only one patient developed erythema grade 2.

Conclusions

HDR brachytherapy could be a good option of treatment for these types of lesions, especially in elderly patients, or when cosmetic results are not good after surgery. Brachytherapy with the Valencia applicator, using hypofractionated regimen provides excellent results in terms of cosmetic and local control, and furthermore, facilitates treatment compliance, which is very relevant in elderly patients. HDR brachytherapy offers a simple, safe, quick, and attractive non-surgical treatment option.

Prevention and treatment of acute and chronic radiodermatitis

More than half the number of patients with cancer, who are treated with radiotherapy, will have radiodermatitis at some point during their treatment. Radiodermatitis either occurs early on in the treatment period or appears months or up to several years later. Acute radiodermatitis is a burn injury that varies in severity according to both treatment and inherent patient factors. Most acute radiodermatitis reactions resolve after several weeks but some reactions persist and can cause complications. Late-onset radiodermatitis is characterized by telangiectasia that forms on atrophic and fragile skin. These radiodermatitis reactions can have a significant negative impact on concomitant and subsequent therapeutic protocols and most particularly on the patient’s quality of life. Today, treatment of radiodermatitis reactions is in its infancy. Although there is insufficient evidence available to form recommendations that would prevent or reduce radiodermatitis, some advances have been made using low level light therapy (LLLT) or vascular lasers to control the symptoms. Some recent preclinical and clinical research suggests that LLLT has biostimulating properties which allow the tissues to regenerate and heal faster, reduce inflammation, and prevent fibrosis. Also, in late-onset radiodermatitis pulsed dye laser treatment has been shown to be beneficial in clearing radiation-induced telangiectasia. In the absence of evidence-based recommendations, the objective of this paper is to review how to prevent or manage the symptoms of radiodermatitis reactions.

Aesthetic result after breast-conserving therapy is associated with quality of life several years after treatment. Swedish women evaluated with BCCT.core and BREAST-Q™

Purpose

A gold standard for evaluation of aesthetic outcome after breast-conserving therapy (BCT) is still lacking. The BCCT.core software has been developed to assess aesthetic result in a standardised way. We aimed to study how the result of BCCT.core after BCT is associated with quality of life, measured with the BREAST-Q™, a validated questionnaire.

Methods

Women eligible for BCT were consecutively recruited between February 1st 2008 and January 31st 2012 (n = 653). Photographs of 310 women, taken one year after BCT, were evaluated using the BCCT.core software. The postoperative BCT module of the BREAST-Q™ questionnaire was administered by mail and 348 questionnaires were returned (median 5.5 years after BCT). In all, 216 women had both BCCT.core results and completed BREAST-Q™ questionnaires available.

Results

The results from the BCCT.core evaluation were: excellent n = 49 (15.8%); good n = 178 (57.4%); fair n = 73 (23.5%); poor n = 10 (3.2%). The median BREAST-Q™ score for satisfaction with breasts was 66 [interquartile range (IQR) 57–80] and for psychosocial well-being 82 (IQR 61–100). Poor/fair results on BCCT.core were associated with Q-scores below median for both satisfaction with breasts [odds ratio (OR) 3.4 (confidence interval (CI) 1.7–6.8)] as well as for psychosocial well-being [OR 2.2 (CI 1.1–4.2)].

Conclusions

A statistically significant association between BCCT.core results one year after BCT and quality of life ratings using BREAST-Q™ several years later is shown in this study. This implies that the BCCT.core may be valuable in BCT follow-up and used as a standardised instrument in the evaluation of aesthetic results.

The Cambridge Breast Intensity-modulated Radiotherapy Trial: Comparison of Clinician- versus Patient-reported Outcomes

AIMS

Breast radiotherapy-associated toxicity is often reported using clinical and photographic assessments. The addition of patient-reported outcome measures (PROMs) is becoming more common. This study investigated the concordance between clinician- and patient-reported outcomes.

MATERIALS AND METHODS

The Cambridge Breast Intensity-modulated Radiotherapy (IMRT) trial prospectively collected data on clinician assessment and PROMs at 2 and 5 years after breast radiotherapy. Clinician assessment included physical examination and photographic assessment. PROMs included European Organization for Research and Treatment of Cancer (EORTC) BR23 questionnaire and four breast radiotherapy-specific questions. The correlation between patient and clinician scores were analysed on an independent patient basis using percentage agreement, Cohen's kappa coefficient (k) and Bowker's test of symmetry. The analysis was repeated after stratifying patients based on age, baseline Hospital Anxiety and Depression Score (HADS) and baseline body image score.

RESULTS

At 2 and 5 years, a weak level of concordance was seen between the clinician-based assessment and PROMS for all the five toxicity end points (k = 0.05-0.21), with individual patient-based agreement of 32.9-78.3% and a highly discordant Bowker's test of symmetry (P < 0.001). The most frequently reported moderate-severe toxicity by patients was change in breast appearance (14% at both 2 and 5 years), whereas it was breast induration (36% and 25% at 2 and 5 years, respectively) by the clinicians. The lack of concordance was not affected by patient's age, baseline HADS and baseline body image score.

CONCLUSIONS

This study found that moderate-severe toxicity reported by patients is low and the overall concordance between clinicians and patients is low. This could be due to methodological limitations or alternatively reflects the subjective nature of PROMs. Incorporation of a patient's perception on treatment-related toxicity will have important implications for treatment decisions and follow-up care.

Hypofractionated high-dose-rate plesiotherapy in nonmelanoma skin cancer treatment

PURPOSE

Nonmelanoma skin cancer (NMSC) is the commonest cancer in humans. NMSC treatment currently includes surgery, radiation therapy, and topical approaches. The objective was to analyze and compare the outcomes, toxicity, and cosmesis of NMSC treated by two hypofractionated high-dose-rate (HDR) plesiotherapy techniques.

METHODS AND MATERIALS

A retrospective institutional clinical study of 134 basal cell or squamous cell skin carcinomas treated at Radiation Oncology Department. Lesions were treated from November 2006 to December 2011 with a moderate hypofractionated HDR plesiotherapy using a fixed applicator or a customized mold.

RESULTS

After a median follow-up of 33 months, overall disease-free survival at 3 and 5 years was 95.12% and 93.36%, respectively. For Leipzig applicator, disease-free survival at 3 years was 94.9% and 94.9% at 5 years, for customized mold was 93.1% at 3 years and 88% at 5 years. Complete regression was achieved in 98% of lesions. Two lesions persisted after treatment; both had been treated by a Leipzig applicator. Six lesions suffered local recurrence (five Leipzig applicators and three molds, p = 0.404). Grade <2 acute toxicity noted in 57.3% of patients. Only 2.2% of lesions had Grade 4 acute toxicity. Borderline significant increase of toxicity was associated with customized molds (p = 0.067). Larger tumors were associated with higher acute skin toxicity. The cosmesis outcomes were excellent or good in 82% of patients, fair in 13%, and not available in 5%.

CONCLUSIONS

Hypofractionated HDR plesiotherapy is an effective and well-tolerated treatment for NMSC with different toxicity levels depending on the plesiotherapy technique used.

Do breast cups improve breast cancer dosimetry? A comparative study for patients with large or pendulous breasts

PURPOSE

Treating patients with large or pendulous breasts is challenging. Although brassiere cups are currently in use, no study has yet been carried out to assess their dosimetric impact. The aim of the present study was to evaluate the possible dosimetric advantages of the use of breast cups on patients with large or pendulous breasts.

MATERIALS AND METHODS

Two CT studies were carried out on 12 breast cancer patients with large or pendulous breasts, with one study involving the use of breast cups. Radiation plans were developed in accordance with each of the CT studies. The following were compared: planning target volume (PTV), volume irradiated by the 95% isodose, conformity index, homogeneity index, mean lung dose, and mean heart dose was also compared for left breast treatment. The plan involving the use of cups was found to be the best option, leading to all patients being treated with cups. The resulting acute toxicity and cosmesis were also recorded. Both scenarios involved the use of film dosimetry to evaluate the skin doses.

RESULTS

The use of breast cups resulted in a significant reduction of the PTV volume (from 1640 cm3 to 1283 cm3), of the irradiated volume (from 2154 cm3 to 1477 cm3) and of the conformity index (from 1383 to 1213). Despite slight improvements in the homogeneity index (from 0.12 to 0.10), statistical significance was not attained. The use of breast cups also led to significant dose reductions in V20 for lung (from 13.7% to 1.7%) and V5 for heart (from 9.8% to 2.7%). No differences in acute toxicity or cosmesis were observed compared to patients treated without cups.

CONCLUSIONS

Our results show that the use of brassiere cups during breast radiation therapy leads to improvements in the main dosimetric factors analyzed. Furthermore, modifications to standard irradiation protocols are not required. In summary, we consider the technique of using breast cups with radiation therapy highly appropriate when treating breast cancer patients with large or pendulous breasts.

["V" axillary incision for the management of tumors of upper outer quadrant and axillary tail of the breast: retrospective study and technical description]

INTRODUCTION

Tumors of the upper outer quadrant of the breast represent the most common location of breast malignant tumors. Although the choice of surgical approach should be dictated primarily by an imperative of oncological safety, esthetic and practical considerations of the surgeon as well as the esthetic demands of patients have become increasingly important with the development of breast conservative surgery.

MATERIALS AND METHODS

In this retrospective study, we reviewed 30 patients (mean age: 62.3 years) who were operated for a tumor of the upper outer quadrant (50 %) or the axillary tail (50 %) of the breast and who received a "V" axillary incision between 2008 and 2012. The incision draws a "V" that comprises a horizontal incision in an axilla fold associated with a vertical arcuate incision in a Langer line of the breast. The number and type of postoperative complications were collected. Patients were asked about the quality of their scar, position of the areola and breast shape was notified during consultations control.

RESULTS

The mean follow-up of patients was 32.7 months. No postoperative complications were observed. A percentage of 86.6 % of patients rated their scar result as excellent. We found no areolar malposition and no morphological deformation of the breast. The surgeons who performed this technique were very pleased with the wide exposure and the uniqueness of this incision fully respecting the architecture of the breast.

CONCLUSION

"V" axillary incision is a useful and easily reproducible technical option for the management of tumors of the upper outer quadrant and the axillary tail of the breast.

Conservative surgery, external radiotherapy, and HDR brachytherapy in a single fraction of 7 Gy in early breast cancer: long-term toxicity and esthetic assessment

INTRODUCTION

The essential issue in conservative treatment is the quality in breast preservation. When risk factors for local relapse exist, a tumour bed boost is required, but the boost choice remains controversial. Prospectively, we studied long-term toxicity, cosmetic outcome and prognostic factors.

MATERIALS AND METHODS

After conservative treatment, 115 patients received a single dose of 7 Gy HDR-brachytherapy (HDR-BT) boost between June 1996 and December 2005. Late toxicity was assessed using the LENT-SOMA scale. For esthetic assessment, a subjective scale was used for patients and a modified Fehlauer scale for physicians. Mean age was 56.6 years. Invasive ductal carcinoma (78 %) and lumpectomy (60 %) were predominantly reported. 48 % received chemotherapy (CT).

RESULTS

Regarding toxicity, 39 % of patients reported breast pain, 75 % fibrosis, 56 % telangiectasias, 19 % lymphoedema, and 51 % retraction/atrophy. Concerning management, 22 % of patients with pain and 45 % with lymphoedema were treated. The esthetic result was found satisfactory by 96 % of the patients and 85 % of the physicians. Fibrosis was influenced by CT and a larger irradiated volume and telangiectasias by a greater implant volume.

CONCLUSIONS

HDR-BT boost shows good cosmetic effects with acceptable toxicity. Patients overestimate the esthetic outcome. LENT/SOMA is useful to assess chronic toxicity.

Long-term cosmetic changes after breast-conserving treatment of patients with stage I-II breast cancer and included in the EORTC 'boost versus no boost' trial

BACKGROUND

In breast cancer treated with breast-conserving radiotherapy, the influence of the boost dose on cosmetic outcome after long-term follow-up is unknown.

PATIENTS AND METHODS

We included 348 patients participating in the EORTC 'boost versus no boost' mega trial with a minimum follow-up of 6 years. Digitalised pictures were analysed using specific software, enabling quantification of seven relative asymmetry features associated with different aspects of fibrosis.

RESULTS

After 3 years, we noted a statistically significantly poorer outcome for the boost patients for six features compared with those of the no boost patients. Up to 9 years of follow-up, results continued to worsen in the same magnitude for the both patient groups. We noted the following determinants for poorer outcome: (i) boost treatment, (ii) larger excision volumes, (iii) younger age, (iv) tumours located in the central lower quadrants of the breast and (v) a boost dose administered with photons.

CONCLUSIONS

A boost dose worsens the change in breast appearance in the first 3 years. Moreover, the development of fibrosis associated with whole-breast irradiation, as estimated with the relative asymmetry features, is an ongoing process until (at least) 9 years after irradiation.

Cosmetic outcomes and complications reported by patients having undergone breast-conserving treatment

PURPOSE

Over the past 30 years, much work in treatment of breast cancer has contributed to improvement of cosmetic and functional outcomes. The goal of breast-conservation treatment (BCT) is avoidance of mastectomy through use of lumpectomy and adjuvant radiation. Modern data demonstrate "excellent" or "good" cosmesis in >90% of patients treated with BCT.

METHODS AND MATERIALS

Patient-reported data were gathered via a convenience sample frame from breast cancer survivors using a publically available, free, Internet-based tool for creation of survivorship care plans. During use of the tool, breast cancer survivors are queried as to the cosmetic appearance of the treated breast, as well as perceived late effects. All data have been maintained anonymously with internal review board approval.

RESULTS

Three hundred fifty-four breast cancer survivors having undergone BCT and voluntarily using this tool were queried with regard to breast cosmesis and perceived late effects. Median diagnosis age was 48 years, and median current age 52 years. "Excellent" cosmesis was reported by 27% (n = 88), "Good" by 44% (n = 144), "Fair" by 24% (n = 81), and "Poor" by 5% (n = 18). Of the queries posted to survivors after BCT, late effects most commonly reported were cognitive changes (62%); sexual concerns (52%); changes in texture and color of irradiated skin (48%); chronic pain, numbness, or tingling (35%); and loss of flexibility in the irradiated area (30%). Survivors also described osteopenia/osteoporosis (35%), cardiopulmonary problems (12%), and lymphedema (19%).

CONCLUSIONS

This anonymous tool uses a convenience sample frame to gather patient reported assessments of cosmesis and complications after breast cancer. Among the BCT population, cosmetic assessment by survivors appears less likely to be "excellent" or "good" than would be expected, with 30% of BCT survivors reporting "fair" or "poor" cosmesis. Patient reported incidence of chronic pain, as well as cognitive and sexual changes, also appears higher than expected.

Aesthetics in breast conserving therapy: do objectively measured results match patients' evaluations?

BACKGROUND

To analyze the relationship of objective and subjective evaluation tools of breast aesthetics, we compare the results of the BCCT.core (breast cancer conservative treatment.cosmetic results) software, a semiautomated objective symmetry evaluation tool, with those of the Aesthetic Status of the BCTOS (Breast Cancer Treatment Outcome Scale) patient questionnaire.

MATERIALS AND METHODS

We included 128 patients with one-sided, primary breast cancer, treated conservatively in a prospective, exploratory study in order to assess the inter-rater reliability of the BCCT.core and the agreement between the BCCT.core and the BCTOS preoperatively, shortly and 1 year after surgery. Therefore, we use agreement rates, multiple (mk), and weighted (wk) kappa coefficients as statistical methods. Furthermore, we analyzed patient-, tumor-, and therapy-related variables as possible covariates to explain agreement.

RESULTS

The inter-rater reliability for the semiautomated BCCT.core is very good with agreement rates up to 84% (mk = 0.80). The agreement rates of the BCCT.core and the BCTOS Aesthetic Status range between 35 and 44% subject to the different times of assessment (wk = 0.34 at best). Moreover, the patients judge their aesthetic outcome more positively than the software. None of the considered patient-, tumor-, and therapy-related covariates turned out to explain agreement.

CONCLUSION

The BCCT.core is a reliable instrument that shows fair agreement with patient's perspective.