Abstract 198P
Background
There is dearth of literature on CA, LE in high-risk BC. Since breast conservation is now feasible even in women with high-risk BC, we investigated the CE and LE in this cohort. Table: 198P
| Variables | Arm edema P-value (HR) | Brachial plexopathy p-value, HR | Shoulder stiffness P-value, HR | Global cosmesis P-value, HR |
| Premenopausal (R) (n=26) Postmenopausal, (n=56) | 0.4 (0.2) | 0.3 (2) | 0.1 (3) | 0.3 (0.5) |
| T <3cm (R) (n=59) T>3cm, (n=23) | 0.09 (7.2) | 0.2 (0.3) | 0.6 (1.3) | 0.3(2.3) |
| Resected volume <100 cc (R) (n=32) >100cc, (n=41) | 0.6(0.5) | 0.3(2) | 0.8 (0.8) | 0.005(4.6) |
| NACT (yes),(n=25) NACT (n=57) | 0.3(7.9) | 0.9 (0) | 0.4 (0.5) | 0.009(6.5) |
| Breast Volume receiving 107% dose <10cc (n=67) >10cc (n=15) | 0.9 (0) | 0.03(6.1) | 0.07(4) | 0.1(5) |
| Breast Volume receiving 100% dose <120cc (n =43) >120 cc (n =39) | 0.3(4.9) | 0.2(2.7) | 0.8 (1) | 0.6(5) |
| SCF RT (yes) (n=35) SCF RT(No) (n=47) | 0.3(0.28) | 0.6 (1.4)) | 0.4 (0.5) | 0.5(0.7) |
Methods
Women with BC who underwent BCS during the period 2013-2017 were selected for this study. CA and LE were evaluated physically by 2 physicians (using EORTC and RTOG grading, and PROM was evaluated with BR23 questionaire. Patient, tumour and treatment related factors were corelated with CA, LE using cox-proportional hazards model (spss v.20).
Results
Out of 186 women who underwent BCS, only 82 could attend clinic (majority were not contactable on phone and few could not come due to pandemic). At a median follow-up of 5 years, 56% patients had adverse global cosmesis due to higher incidence of high risk features ( tumour size more than 3cm [37%, HR 2.3], node positive [50%], chemotherapy (CT) (100%, HR 6.5), large resection volumes (HR 4.6), large breast volume [50%, HR 1], supraclavicular RT[43%, HR 0.7], or tumor boost (100%). The dosimetric factors significant for adverse cosmesis were volume of breast receiving 107% dose (more than 10cc, HR 5) and volume of breast receiving 100% dose (more than 120cc, HR 5). Arm edema: 9%, shoulder stiffness:20%, brachial plexopathy: 14% and factors found significant were tumour size (HR 9), volume of breast receiving 107% (HR 6), and co-morbidity (HR 3). Based on BR23 questionaire, 69% patients had poor body image, 35% breast pain, and 47% women were sexually active. Patients reported more LE than physicians (15% vs 7.4 % arm edema, 35% vs 10% brachial plexopathy).
Conclusions
BC with high-risk features have high risk of adverse cosmesis which is influenced by large resection volume, CT and residual dose inhomogeneity. LE was also influenced by large resection volume and residual dose inhomogeneity. Two-third were dissatisfied with their body image and half were sexually inactive.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
SGPGI, Ethics Committee.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.