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(Radiology. 1999;213:61-66.)
© RSNA, 1999

Radiation Oncology

Cosmetic Outcome in Patients Receiving an Interstitial Implant as Part of Breast-Conservation Therapy1

Bradley A. Kramer, MD, Douglas W. Arthur, MD, Kenneth Ulin, PhD, Rupert K. A. Schmidt-Ullrich, MD, Robert D. Zwicker, PhD and David E. Wazer, MD

1 From the Department of Radiation Oncology, New England Medical Center, Tufts University School of Medicine, Boston, Mass (B.A.K., K.U., D.E.W.), and the Department of Radiation Oncology, Massey Cancer Center, Medical College of Virginia of Virginia Commonwealth University, Richmond (D.W.A., R.K.A.S.U., R.D.Z.). From the 1998 RSNA scientific assembly. Received August 26, 1998; revision requested October 22; revision received January 14, 1999; accepted February 23. Address reprint requests to B.A.K., Department of Radiation Oncology, Midwestern Regional Medical Center, 2520 Elisha Ave, Zion, IL 60099.

PURPOSE: To study factors related to breast cosmetic outcome in patients treated with an interstitial implant as part of breast-conservation therapy.

MATERIALS AND METHODS: One hundred fifty-six patients with stage I or II breast carcinoma who received 50 Gy of external-beam irradiation followed by a 20-Gy interstitial boost were examined. The dose homogeneity index (DHI) was calculated for each evaluable implant and was examined in light of other patient-, treatment-, and tumor-related variables previously demonstrated to affect cosmesis.

RESULTS: Of the variables examined, both the DHI (P = .021) and the total excision volume (P = .019) were significantly related to cosmetic outcome (excellent vs less than excellent) in a univariate model. In the multivariate analysis, only the total excision volume remained significant (P = .032). The mean total excision volume ± SD in patients with excellent cosmetic outcome (81.8 cm3 ± 84.0) was significantly less than that in patients with less than excellent cosmetic outcome (120 cm3 ± 84). The probability of excellent cosmetic outcome linearly increased with an increase in DHI. The mean DHI was 0.74 ± 0.12 for the cases with excellent cosmetic outcome and 0.68 ± 0.10 for those with less than excellent cosmetic outcome.

CONCLUSION: To achieve optimal cosmesis, DHI should be maximized. The volume of tissue removed, however, remains the most significant determinant.

Index terms: Breast neoplasms, therapeutic radiology, 00.1299, 00.32 • Dosimetry, 00.1299 • Iridium, radioactive, 00.1299 • Therapeutic radiology, complications, 00.4532, 00.4533, 00.458, 00.47 • Treatment planning, 00.1299