Chapman Bhavana V, Lei Xiudong, Patil Prithvi, Tripathi Shikha, Nicklaus Krista M, Grossberg Aaron J, Shaitelman Simona F, Thompson Alastair M, Hunt Kelly K, Buchholz Thomas A, Merchant Fatima, Markey Mia K, Smith Benjamin D, Reddy Jay P
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Adv Radiat Oncol. 2020 May 21;5(5):824-833. doi: 10.1016/j.adro.2020.04.035. eCollection 2020 Sep-Oct.
Our purpose was to use 3-dimensional (3D) surface photography to quantitatively measure breast cosmesis within the framework of a randomized clinical trial of conventionally fractionated (CF) and hypofractionated (HF) whole breast irradiation (WBI); to identify how 3D measurements are associated with patient- and physician-reported cosmesis; and to determine whether objective measures of breast symmetry varied by WBI treatment arm or transforming growth factor β 1 () status.
From 2011 to 2014, 287 women age ≥40 with ductal carcinoma in situ or early-stage invasive breast cancer were enrolled in a multicenter trial and randomized to HF-WBI or CF-WBI with a boost. Three-dimensional surface photography was performed at 3 years posttreatment. Patient-reported cosmetic outcomes were recorded with the Breast Cancer Treatment Outcome Scale. Physician-reported cosmetic outcomes were assessed by the Radiation Therapy Oncology Group scale. Volume ratios and 6 quantitative measures of breast symmetry, termed F1-6C, were calculated using the breast contour and fiducial points assessed on 3D surface images. Associations between all metrics, patient- and physician-reported cosmesis, treatment arm, and genotype were performed using the Kruskal-Wallis test and multivariable logistic regression models.
Among 77 (39 CF-WBI and 38 HF-WBI) evaluable patients, both patient- and physician-reported cosmetic outcomes were significantly associated with the F1C vertical symmetry measure (both < .05). Higher dichotomized F1C and volumetric symmetry measures were associated with improved patient- and physician-reported cosmesis on multivariable logistic regression (both ≤ .05). There were no statistically significant differences in vertical symmetry or volume measures between treatment arms. Increased F6C horizontal symmetry was observed in the CF-WBI arm ( = .05). Patients with the C-509T variant allele had lower F2C vertical symmetry measures ( = .02).
Quantitative 3D image-derived measures revealed comparable cosmetic outcomes with HF-WBI compared with CF-WBI. Our findings suggest that 3D surface imaging may be a more sensitive method for measuring subtle cosmetic changes than global patient- or physician-reported assessments.
我们的目的是在一项关于常规分割（CF）和大分割（HF）全乳照射（WBI）的随机临床试验框架内，使用三维（3D）表面摄影术定量测量乳房美容效果；确定3D测量结果与患者和医生报告的美容效果之间的关联；并确定乳房对称性的客观测量指标是否因WBI治疗组或转化生长因子β1（）状态而异。
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患者参加了一项多中心试验，并随机分为接受HF-WBI或CF-WBI加量照射。在治疗后3年进行三维表面摄影。使用乳腺癌治疗结果量表记录患者报告的美容结果。医生报告的美容结果通过放射治疗肿瘤学组量表进行评估。使用在3D表面图像上评估的乳房轮廓和基准点计算体积比和6项乳房对称性定量测量指标，称为F1-6C。使用Kruskal-Wallis检验和多变量逻辑回归模型对所有指标、患者和医生报告的美容效果、治疗组和基因型之间的关联进行分析。
在77名（39名CF-WBI和38名HF-WBI）可评估患者中，患者和医生报告的美容结果均与F1C垂直对称测量指标显著相关（均P<.05）。在多变量逻辑回归中，较高的二分法F1C和体积对称测量指标与患者和医生报告的更好的美容效果相关（均P≤.05）。治疗组之间在垂直对称或体积测量方面没有统计学上的显著差异。在CF-WBI组中观察到F6C水平对称性增加（P=.05）。携带C-509T变异等位基因的患者F2C垂直对称测量指标较低（P=.02）。
与CF-WBI相比，基于3D图像的定量测量结果显示HF-WBI的美容效果相当。我们的研究结果表明，与患者或医生的整体报告评估相比，3D表面成像可能是一种更敏感的测量细微美容变化的方法。
