Physician and Software Assessed Cosmetic Outcomes Following Whole Breast or Partial Breast Radiation Therapy for...

This study aims to compare the cosmetic outcomes in early-stage breast cancer patients treated with whole breast irradiation (WBI) or partial-breast irradiation (PBI), using both subjective and objective tools, to assess clinical factors contributing to cosmesis scores, and to compare radiation toxicity outcomes.

Breast cosmesis was scored by using the physician-rated Harvard cosmesis scale at the time of consultation and at each follow-up visit and objectively using the BCCT.core software on standardized photographs.

Ninety-nine patients received WBI, and thirty-six received PBI. 91% of patients treated with WBI and 86.1% with PBI scored excellent/good by physician ratings at follow-up vs. 68.4% and 72.2 % by BCCT.core software. Agreement between both tools was low (κ = 0.057 for WBI patients and κ = 0.012 for PBI patients). There was less than a 15% decline in physician-rated cosmetic scores for either WBI or PBI patients, but a 27.3% decline for WBI patients by BCCT.core software scoring. There was no association of prone vs. supine position, tumor bed boost, fractionation scheme, or addition of regional nodal irradiation with long-term cosmesis scores determined by either assessment tool, except for oncoplastic surgery which was associated with a higher score.

Breast cosmesis scores after either WBI or PBI are favorable; however, the agreement between physician rating and the BCCT.core software is poor. The BCCT.core software was more likely to indicate a decline in cosmetic results over time. Surgical outcomes may be the most impactful clinical factor in predicting long-term breast cosmesis.