Peterson David, Truong Pauline T, Parpia Sameer, Olivotto Ivo A, Berrang Tanya, Kim Do-Hoon, Kong Iwa, Germain Isabelle, Nichol Alan, Akra Mohamed, Roy Isabelle, Reed Melanie, Fyles Anthony, Trotter Theresa, Perera Francisco, Balkwill Susan, Lavertu Sophie, Elliott Elizabeth, Julian Jim A, Levine Mark N, Whelan Timothy J
Vancouver Island Centre, British Columbia Cancer Agency, Victoria, British Columbia, Canada.
Ontario Clinical Oncology Group, McMaster University, Hamilton, Ontario, Canada.
Int J Radiat Oncol Biol Phys. 2015 Apr 1;91(5):968-76. doi: 10.1016/j.ijrobp.2014.12.040.
To evaluate factors associated with adverse cosmesis outcome in breast cancer patients randomized to accelerated partial breast irradiation (APBI) using 3-dimensional conformal radiation therapy or whole-breast irradiation in the RAPID (Randomized Trial of Accelerated Partial Breast Irradiation) trial.
Subjects were trial participants with nurse-assessed global cosmetic scores at baseline and at 3 years. Adverse cosmesis was defined as a score of fair or poor. Cosmetic deterioration was defined as any adverse change in score from baseline to 3 years. The analysis is based on data from the previously reported interim analysis. Logistic regression models were used to assess the association of risk factors for these outcomes among all patients and those treated with APBI only.
Clinicopathologic characteristics were similar between subjects randomized to APBI (n=569) or whole-breast irradiation (n=539). For all subjects, factors associated with adverse cosmesis at 3 years were older age, central/inner tumor location, breast infection, smoking, seroma volume, breast volume, and use of APBI; factors associated with cosmetic deterioration were smoking, seroma volume, and use of APBI (P<.05). For APBI subjects, tumor location, smoking, age, and seroma volume were associated with adverse cosmesis (P<.05), and smoking was associated with cosmetic deterioration (P=.02). An independent association between the V95/whole-breast volume ratio and adverse cosmesis (P=.28) or cosmetic deterioration (P=.07) was not detected. On further exploration a V95/whole-breast volume ratio <0.15 was associated with a lower risk of cosmetic deterioration (p=.04), but this accounted for only 11% of patients.
In the RAPID trial, a number of patient tumor and treatment-related factors, including the use of APBI, were associated with adverse cosmesis and cosmetic deterioration. For patients treated with APBI alone, the high-dose treatment volume was not independently associated with an adverse cosmetic outcome, and a useful clinical threshold could not be identified.
在RAPID（加速部分乳腺照射随机试验）试验中，评估随机接受三维适形放射治疗的加速部分乳腺照射（APBI）或全乳照射的乳腺癌患者中，与不良美容结局相关的因素。
研究对象为在基线和3年时由护士评估整体美容评分的试验参与者。不良美容定义为评分一般或较差。美容恶化定义为从基线到3年评分的任何不良变化。该分析基于先前报告的中期分析数据。采用逻辑回归模型评估所有患者以及仅接受APBI治疗的患者中这些结局的危险因素之间的关联。
随机接受APBI治疗的受试者（n = 569）和全乳照射的受试者（n = 539）之间的临床病理特征相似。对于所有受试者，与3年时不良美容相关的因素有年龄较大、肿瘤位于中央/内侧、乳腺感染、吸烟、血清肿体积、乳房体积以及使用APBI；与美容恶化相关的因素有吸烟、血清肿体积以及使用APBI（P<0.05）。对于接受APBI治疗的受试者，肿瘤位置、吸烟、年龄和血清肿体积与不良美容相关（P<0.05），吸烟与美容恶化相关（P = 0.02）。未检测到V95/全乳体积比与不良美容（P = 0.28）或美容恶化（P = 0.07）之间存在独立关联。进一步探究发现，V95/全乳体积比<0.15与美容恶化风险较低相关（p = 0.04），但这仅占患者的11%。
在RAPID试验中，包括使用APBI在内的许多患者肿瘤和治疗相关因素与不良美容和美容恶化相关。对于仅接受APBI治疗的患者，高剂量治疗体积与不良美容结局无独立关联，且无法确定有用的临床阈值。
