THERAPEUTIC FACTORS INFLUENCING THE COSMETIC OUTCOME AND LATE COMPLICATIONS IN THE CONSERVATIVE MANAGEMENT OF EARLY BREAST-CANCER

Purpose: To investigate the impact of clinical and physical parameters on the cosmetic result and complications, in cancer breast treated wi th conservative surgery and definitive irradiation. Methods and Materi als: Between October 1980 and December 1990, 289 patients were treated with lumpectomy and/or axillary dissection, radical irradiation with or without adjuvant therapy. The radiation therapy technique consisted of external beam therapy followed by an Ir-192 implant or electron be am boost. Univariate and multivariate analysis were used to evaluate t he correlation between multiple factors affecting the cosmetic outcome and the complications. Results: Of 289 patients, cosmesis was evaluab le in 285 and recorded as excellent to good in 226 (79%), fair in 35 ( 12%), and poor in 24 (9%). On multivariate analysis of these results, a high dose per fraction (p = .0018), and use of electrons as boost to the tumor bed (p = .001) were found to be significant. When patients boosted with electrons were excluded, a high boost dose (p = .0433) wa s also found significant. Fifteen (5%) patients developed severe late radiation sequelae and 14 (5%) moderate or severe arm edema. On multiv ariate analysis only dose per fraction of 2.5 Gy (p < .0001) and highe r boost doses (p = .017) were significant. Conclusion: In 289 patients of early breast cancer treated with conservative surgery and radical irradiation, multivariate analysis suggests that higher dose per fract ion with teletherapy and higher brachytherapy boost dose adversely aff ect cosmesis and contribute to the late complications.