Comparison of Mammographic Changes Across 3 Different Fractionation Schedules for Early Stage Breast Cancer

Publication date: Available online 4 February 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Sibo Tian, Lina F. Paster, Sinae Kim, Laurie Kirstein, Bruce G. Haffty, Adam Ferro, Judith Amorosa, Sharad Goyal
PurposeAs utilization of hypofractionated breast radiotherapy (RT) grows, so does the need for long-term data on post-RT mammographic changes. The purpose of this study was to longitudinally compare the incidence of common mammographic sequelae seen after breast conserving surgery (BCS) and RT in patients treated with accelerated partial breast irradiation (APBI), hypofractionated whole breast irradiation (HWBI) and conventionally fractionated whole breast irradiation (WBI).Materials and MethodsPatients treated with either APBI or HWBI after BCT and had at least 3 mammograms of the treated breast were identified. They were matched 1:1 on age ±5 years to patients treated with WBI. Mammograms were evaluated for common post-RT breast findings by a mammographer blinded to treatment. Outcomes were analyzed using a cumulative logistic regression model; a p < 0.05 considered statistically significant.ResultsOf 89 patients treated with RT between 2006-2011, 29 received APBI, 30 received HWBI and 30 WBI; their median age was 60 years (range 33-83). A total of 605 mammograms were evaluated with a median follow-up of 48 months. Treatment technique did not affect the severity of architectural distortion when groups were evaluated longitudinally. The likelihood of finding skin thickening decreased with follow-up (OR = 0.6; p < 0.001) adjusted for fractionation schemes. No differences were seen with respect to changes in skin thickening, fluid collections, or calcifications when comparing between treatment groups adjusted for follow-up time. Clinical characteristics, including age, race, T stage and chemotherapy use were not linked to the likelihood of finding several mammographic phenomena over time.ConclusionsAlthough specific post-treatment imaging findings evolved over time, RT fractionation did not alter the relative incidence or severity of architectural distortion, skin thickening, fluid collections or calcifications. These findings are useful to both radiologists and radiation oncologists when counseling patients regarding follow-up studies after RT.

Teaser

The purpose of this study was to longitudinally compare the incidence of common mammographic sequelae seen after breast conserving surgery (BCS) in patients treated with accelerated partial breast irradiation (APBI), hypofractionated whole breast irradiation (HWBI) and conventionally fractionated whole breast irradiation (WBI). We found that RT fractionation and technique did not alter the relative incidence or severity of common mammographic sequelae.


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