Reddy Jay P, Lei Xiudong, Huang Sheng-Cheng, Nicklaus Krista M, Fingeret Michelle C, Shaitelman Simona F, Hunt Kelly K, Buchholz Thomas A, Merchant Fatima, Markey Mia K, Smith Benjamin D
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Int J Radiat Oncol Biol Phys. 2017 Apr 1;97(5):894-902. doi: 10.1016/j.ijrobp.2016.12.021. Epub 2016 Dec 21.
To measure, by quantitative analysis of digital photographs, breast cosmetic outcome within the setting of a randomized trial of conventionally fractionated (CF) and hypofractionated (HF) whole-breast irradiation (WBI), to identify how quantitative cosmesis metrics were associated with patient- and physician-reported cosmesis and whether they differed by treatment arm.
From 2011 to 2014, 287 women aged ≥40 with ductal carcinoma in situ or early invasive breast cancer were randomized to HF-WBI (42.56 Gy/16 fractions [fx] + 10-12.5 Gy/4-5 fx boost) or CF-WBI (50 Gy/25 fx + 10-14 Gy/5-7 fx). At 1 year after treatment we collected digital photographs, patient-reported cosmesis using the Breast Cancer Treatment and Outcomes Scale, and physician-reported cosmesis using the Radiation Therapy Oncology Group scale. Six quantitative measures of breast symmetry, labeled M1-M6, were calculated from anteroposterior digital photographs. For each measure, values closer to 1 imply greater symmetry, and values closer to 0 imply greater asymmetry. Associations between M1-M6 and patient- and physician-reported cosmesis and treatment arm were evaluated using the Kruskal-Wallis test.
Among 245 evaluable patients, patient-reported cosmesis was strongly associated with M1 (vertical symmetry measure) (P<.01). Physician-reported cosmesis was similarly correlated with M1 (P<.01) and also with M2 (vertical symmetry, P=.01) and M4 (horizontal symmetry, P=.03). At 1 year after treatment, HF-WBI resulted in better values of M2 (P=.02) and M3 (P<.01) than CF-WBI; treatment arm was not significantly associated with M1, M4, M5, or M6 (P≥.12).
Quantitative assessment of breast photographs reveals similar to improved cosmetic outcome with HF-WBI compared with CF-WBI 1 year after treatment. Assessing cosmetic outcome using these measures could be useful for future comparative effectiveness studies and outcome reporting.
通过对数码照片进行定量分析，在一项关于常规分割（CF）和大分割（HF）全乳照射（WBI）的随机试验中测量乳房美容效果，以确定定量美容指标与患者和医生报告的美容效果之间的关联，以及它们在不同治疗组之间是否存在差异。
2011年至2014年，287名年龄≥40岁的导管原位癌或早期浸润性乳腺癌女性被随机分为HF-WBI组（42.56 Gy/16次分割[fx]+10 - 12.5 Gy/4 - 5次分割加量）或CF-WBI组（50 Gy/25次分割+10 - 14 Gy/5 - 7次分割）。治疗后1年，我们收集了数码照片、患者使用乳腺癌治疗与结果量表报告的美容效果，以及医生使用放射治疗肿瘤学组量表报告的美容效果。从前后位数码照片中计算出六项乳房对称性的定量指标，标记为M1 - M6。对于每项指标，数值越接近1表示对称性越高，数值越接近0表示不对称性越高。使用Kruskal-Wallis检验评估M1 - M6与患者和医生报告的美容效果及治疗组之间的关联。
在245名可评估患者中，患者报告的美容效果与M1（垂直对称指标）密切相关（P<.01）。医生报告的美容效果与M1同样相关（P<.01），也与M2（垂直对称，P =.01）和M4（水平对称，P =.03）相关。治疗后1年，HF-WBI组的M2（P =.02）和M3（P<.01）值优于CF-WBI组；治疗组与M1、M4、M5或M6无显著关联（P≥.12）。
乳房照片的定量评估显示，与CF-WBI相比，治疗后1年HF-WBI的美容效果相似或有所改善。使用这些指标评估美容效果可能对未来的比较疗效研究和结果报告有用。
