Vrieling C, Collette L, Fourquet A, Hoogenraad W J, Horiot J H, Jager J J, Pierart M, Poortmans P M, Struikmans H, Maat B, Van Limbergen E, Bartelink H
Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, The, Amsterdam, Netherlands.
Radiother Oncol. 2000 Jun;55(3):219-32. doi: 10.1016/s0167-8140(00)00210-3.
To analyze the influence of different patient, tumor, and treatment parameters on the cosmetic outcome after breast-conserving therapy at 3-year follow-up. A subjective and an objective cosmetic scoring method was used and the results of both methods were compared.
In EORTC trial 22881/10882, 5569 early-stage breast cancer patients were treated with tumorectomy and axillary dissection, followed by tangential fields irradiation of the breast to a dose of 50 Gy in 5 weeks, at 2 Gy per fraction. A total of 5318 patients, having a microscopically complete tumorectomy, were randomized between no further treatment and a boost of 16 Gy to the primary tumor bed. The cosmetic result at 3-year follow-up was assessed by a panel for 731 patients, and by digitizer measurements, measuring the displacement of the nipple, for 1141 patients. Univariate and multivariate analyses were used to evaluate the correlation between various patient, tumor, and treatment factors and cosmesis.
The factors associated with a worsened cosmesis according to the panel evaluation were: an inferior tumor location, a large excision volume, the presence of postoperative breast complications, and the radiotherapy boost. According to the digitizer measurements, a central/superior tumor location, a large excision volume, an increased pathological tumor size, an increased radiation dose inhomogeneity, and an increased bra cup size resulted in an increased asymmetry in nipple position. It appeared that the evaluation of the nipple position (whether by panel or by digitizer) is only moderately representative of the overall cosmetic outcome.
To achieve a good cosmesis, it is necessary to excise the tumor with a limited margin, to avoid postoperative complications, to assess the need for a boost in the individual patient, and to give the radiation dose as homogeneously as possible. As far as the method of evaluation is concerned, the panel evaluation is the most appropriate method for giving an overall impression of the cosmetic result after breast-conserving therapy (BCT). The use of the digitizer is recommended for comparing the cosmetic outcome of two different approaches to BCT or for analyzing cosmetic changes over time.
分析不同患者、肿瘤及治疗参数对保乳治疗3年随访时美容效果的影响。采用主观和客观两种美容评分方法，并对两种方法的结果进行比较。
在欧洲癌症研究与治疗组织（EORTC）22881/10882试验中，5569例早期乳腺癌患者接受了肿瘤切除术和腋窝清扫术，随后对乳房进行切线野照射，5周内给予50 Gy剂量，每次分割剂量为2 Gy。共有5318例显微镜下肿瘤完全切除的患者被随机分为不再接受进一步治疗组和对原发肿瘤床追加16 Gy照射组。由一个小组对731例患者进行3年随访时的美容效果评估，并对1141例患者采用数字化测量乳头移位情况进行评估。采用单因素和多因素分析评估各种患者、肿瘤及治疗因素与美容效果之间的相关性。
根据小组评估，与美容效果变差相关的因素有：肿瘤位置较低、切除体积较大、术后乳房出现并发症以及放疗追加剂量。根据数字化测量结果，肿瘤位于中央/上方、切除体积较大、病理肿瘤大小增加、放射剂量不均匀性增加以及胸罩罩杯尺寸增大导致乳头位置不对称增加。似乎乳头位置的评估（无论是通过小组还是通过数字化测量）仅能适度代表整体美容效果。
为获得良好的美容效果，有必要以有限的切缘切除肿瘤，避免术后并发症，评估个体患者是否需要追加剂量，并尽可能均匀地给予放射剂量。就评估方法而言，小组评估是对保乳治疗（BCT）后美容效果给出总体印象的最合适方法。建议使用数字化测量来比较两种不同保乳治疗方法的美容效果或分析随时间的美容变化。
