TY - JOUR
T1 - Cosmetic Outcomes of a Phase 1 Dose Escalation Study of 5-Fraction Stereotactic Partial Breast Irradiation for Early Stage Breast Cancer
AU - Rahimi, Asal
AU - Morgan, Howard E.
AU - Kim, Dong W.
AU - Zhang, Yuanyuan
AU - Leitch, Marilyn
AU - Wooldridge, Rachel D
AU - Goudreau, Sally
AU - Haley, Barbara B
AU - Rao, Roshni
AU - Rivers, Aeisha
AU - Spangler, Ann E
AU - Jones, Ryan T.
AU - Stevenson, Stella
AU - Staley, Jason
AU - Albuquerque, Kevin
AU - Ahn, Chul
AU - Neufeld, Sarah
AU - Alluri, Prasanna G.
AU - Ding, Chuxiong
AU - Garwood, Dan
AU - Seiler, Stephen
AU - Zhao, Bo
AU - Gu, Xuejun
AU - Timmerman, Robert
N1 - Publisher Copyright:
© 2021
PY - 2021/7/1
Y1 - 2021/7/1
N2 - Purpose: Our purpose was to evaluate cosmetic changes after 5-fraction adjuvant stereotactic partial breast irradiation (S-PBI). Methods and Materials: Seventy-five women with in situ or invasive breast cancer stage 0, I, or II, with tumor size ≤3 cm, were enrolled after lumpectomy in a phase 1 dose escalation trial of S-PBI into cohorts receiving 30, 32.5, 35, 37.5, or 40 Gy in 5 fractions. Before S-PBI, 3 to 4 gold fiducial markers were placed in the lumpectomy cavity for tracking with the Synchrony respiratory tracking system. S-PBI was delivered with a CyberKnife robotic radiosurgery system. Patients and physicians evaluated global cosmesis using the Harvard Breast Cosmesis Scale. Eight independent panelists evaluated digital photography for global cosmesis and 10 subdomains at baseline and follow-up. McNemar tests were used to evaluate change in cosmesis, graded as excellent/good or fair/poor, from baseline to year 3. Wilcoxon signed rank tests were used to evaluate change in subdomains. Cohen's kappa (κ) statistic was used to estimate interobserver agreement (IOA) between raters, and Fleiss’ κ was used to estimate IOA between panelists. Results: Median cosmetic follow-up was 5, 5, 5, 4, and 3 years for the 30, 32.5, 35, 37.5, and 40 Gy cohorts. Most patients reported excellent/good cosmesis at both baseline (86.3%) and year 3 (89.8%). No dose cohort had significantly worsened cosmesis by year 3 on McNemar analysis. No cosmetic subdomain had significant worsening by year 3. IOA was fair for patient-physician (κ = 0.300, P <.001), patient-panel (κ = 0.295, P <.001), physician-panel (κ = 0.256, P <.001), and individual panelists (Fleiss κ = 0.327, P <.001). Conclusions: Dose escalation of S-PBI from 30 to 40 Gy in 5 fractions for early stage breast cancer was not associated with a detectable change in cosmesis by year 3. S-PBI is a promising modality for treatment of early stage breast cancer.
AB - Purpose: Our purpose was to evaluate cosmetic changes after 5-fraction adjuvant stereotactic partial breast irradiation (S-PBI). Methods and Materials: Seventy-five women with in situ or invasive breast cancer stage 0, I, or II, with tumor size ≤3 cm, were enrolled after lumpectomy in a phase 1 dose escalation trial of S-PBI into cohorts receiving 30, 32.5, 35, 37.5, or 40 Gy in 5 fractions. Before S-PBI, 3 to 4 gold fiducial markers were placed in the lumpectomy cavity for tracking with the Synchrony respiratory tracking system. S-PBI was delivered with a CyberKnife robotic radiosurgery system. Patients and physicians evaluated global cosmesis using the Harvard Breast Cosmesis Scale. Eight independent panelists evaluated digital photography for global cosmesis and 10 subdomains at baseline and follow-up. McNemar tests were used to evaluate change in cosmesis, graded as excellent/good or fair/poor, from baseline to year 3. Wilcoxon signed rank tests were used to evaluate change in subdomains. Cohen's kappa (κ) statistic was used to estimate interobserver agreement (IOA) between raters, and Fleiss’ κ was used to estimate IOA between panelists. Results: Median cosmetic follow-up was 5, 5, 5, 4, and 3 years for the 30, 32.5, 35, 37.5, and 40 Gy cohorts. Most patients reported excellent/good cosmesis at both baseline (86.3%) and year 3 (89.8%). No dose cohort had significantly worsened cosmesis by year 3 on McNemar analysis. No cosmetic subdomain had significant worsening by year 3. IOA was fair for patient-physician (κ = 0.300, P <.001), patient-panel (κ = 0.295, P <.001), physician-panel (κ = 0.256, P <.001), and individual panelists (Fleiss κ = 0.327, P <.001). Conclusions: Dose escalation of S-PBI from 30 to 40 Gy in 5 fractions for early stage breast cancer was not associated with a detectable change in cosmesis by year 3. S-PBI is a promising modality for treatment of early stage breast cancer.
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U2 - 10.1016/j.ijrobp.2021.01.015
DO - 10.1016/j.ijrobp.2021.01.015
M3 - Article
C2 - 33476737
AN - SCOPUS:85101700544
SN - 0360-3016
VL - 110
SP - 772
EP - 782
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 3
ER -