[Cosmetic results of breast conserving therapy for breast carcinoma. Treatment results from the Heidelberg Radiation Clinic in the years 1984 to 1992].

PURPOSE: In this study we retrospectively analyzed local control, survival rate and late cosmetic results of women with early breast cancer receiving breast conserving therapy.

PATIENTS AND METHODS: All patients (1984 through 1992) of the Department of Radio-Oncology (University of Heidelberg), who received breast conserving therapy consisting of conservative surgery followed by radiotherapy, were interviewed and asked to come. Subjective estimation of the cosmetic results of therapy was evaluated by means of a questionnaire. Cosmesis, circumferences and temperatures of different mammary regions were assessed and measured. Side effects and late sequelae were valued by the EORTC/RTOG-score.

RESULTS: Mean follow-up time of 192 women (pT1: 71.9%, pT2: 28.1%) was 4.5 years (median: 4.0 years). 26.6% of them were nodal positive. Positive nodal status correlated with high tumor grading (p = 0.0001). Ten patients developed distant metastases; one of them subsequent to having suffered a loco-regional failure. Eight loco-regional failures occurred, 3 of them before radiotherapy (salvage). Following radiotherapy altogether 5 loco-regional failures (= 2.6%) were found; 3 women concerning were pre-, 2 postmenopausal. Three of these patients died, in 1 case occurred distant metastasis. Seventeen patients died, 3 of them presenting loco-regional failure, 8 of them showing distant metastasis. Sixty-four women were examined for cosmesis with the following result: a poor result was observed twice, a fair result 13 times, a good result 34 and an excellent result 15 times. Self-assessment was significantly better than observer's assessment. Third-degree late sequelae were found once, second-degree was seen 11 times, first-degree 38 times and no visible late sequelae were observed 14 times. The use of wedges was followed with borderline significance (p = 0.06) either by a better cosmesis and fewer late sequelae. Neither the type of surgery nor the width of the fields nor the quality of radiation (Co60 or 6 MVX) nor boost-application influenced the cosmetic result. Measured circumferences and distances showed no significant differences in the groups of the patients with poor or fair and good or excellent cosmesis. The temperature of the seized and contralateral breast showed no significant difference as well. With increasing distance from primary therapy the cosmetic results deteriorated.

CONCLUSION: Breast conserving therapy consisting of conservative surgery followed by radiotherapy causes predominantly excellent to good cosmetic results combined with an acceptable amount of late side effects. The decreased rate of good and excellent cosmetic long-term results is biological interesting and requires further studies.