Physician and Software Assessed Cosmetic Outcomes Following Whole Breast or Partial Breast Radiation Therapy for Breast Cancer.

Aim: This study aims to compare the cosmetic outcomes in early-stage breast cancer patients treated with whole breast irradiation (WBI) or partial-breast irradiation (PBI), using both subjective and objective tools, to assess clinical factors contributing to cosmesis scores, and to compare radiation toxicity outcomes.

Methods: Breast cosmesis was scored by using the physician-rated Harvard cosmesis scale at the time of consultation and at each follow-up visit and objectively using the BCCT.core software on standardized photographs.

Results: Ninety-nine patients received WBI, and thirty-six received PBI. 91% of patients treated with WBI and 86.1% with PBI scored excellent/good by physician ratings at follow-up vs. 68.4% and 72.2 % by BCCT.core software. Agreement between both tools was low (κ = 0.057 for WBI patients and κ = 0.012 for PBI patients). There was less than a 15% decline in physician-rated cosmetic scores for either WBI or PBI patients, but a 27.3% decline for WBI patients by BCCT.core software scoring. There was no association of prone vs. supine position, tumor bed boost, fractionation scheme, or addition of regional nodal irradiation with long-term cosmesis scores determined by either assessment tool, except for oncoplastic surgery which was associated with a higher score.

Conclusions: Breast cosmesis scores after either WBI or PBI are favorable; however, the agreement between physician rating and the BCCT.core software is poor. The BCCT.core software was more likely to indicate a decline in cosmetic results over time. Surgical outcomes may be the most impactful clinical factor in predicting long-term breast cosmesis.