Open AccessTissue Compliance Meter is a More Reproducible Method of Measuring Radiation‐Induced Fibrosis than Late Effects of Normal Tissue–Subjective Objective Management Analytical in Patients Treated with Intracavitary Brachytherapy Accelerated Partial Breast Irradiation: Results of a Prospective Trial
Author(s) -
Wernicke A. Gabriella,
Greenwood Eleni A.,
Coplowitz Shana,
Parashar Bhupesh,
Kulidzhanov Fridon,
Christos Paul J.,
Fischer Andrew,
Nori Dattatreyudu,
Chao Kun S. Clifford
Publication year - 2013
Publication title -
the breast journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.533
H-Index - 72
eISSN - 1524-4741
pISSN - 1075-122X
DOI - 10.1111/tbj.12102
Subject(s) - medicine , brachytherapy , breast cancer , nuclear medicine , intraclass correlation , univariate analysis , prospective cohort study , palpation , breast conserving surgery , lumpectomy , radiation therapy , radiology , cancer , surgery , multivariate analysis , mastectomy , clinical psychology , psychometrics
Identification of radiation‐induced fibrosis ( RIF ) remains a challenge with Late Effects of Normal Tissue–Subjective Objective Management Analytical ( LENT ‐ SOMA ). Tissue compliance meter ( TCM ), a non‐invasive applicator, may render a more reproducible tool for measuring RIF . In this study, we prospectively quantify RIF after intracavitary brachytherapy ( IB ) accelerated partial breast irradiation ( APBI ) with TCM and compare it with LENT ‐ SOMA . Thirty‐nine women with American Joint Committee on Cancer Stages 0‐I breast cancer, treated with lumpectomy and intracavitary brachytherapy delivered by accelerated partial breast irradiation ( IBAPBI ), were evaluated by two raters in a prospective manner pre‐ IBAPBI and every 6 months post‐ IBAPBI for development of RIF , using TCM and LENT ‐ SOMA . TCM classification scale grades RIF as 0 = none, 1 = mild, 2 = moderate, and 3 = severe, corresponding to a change in TCM (Δ TCM ) between the IBAPBI and nonirradiated breasts of ≤2.9, 3.0–5.9, 6.0–8.9, ≥9.0 mm, respectively. LENT ‐ SOMA scale employs clinical palpation to grade RIF as 0 = none, 1 = mild, 2 = moderate, and 3 = severe. Correlation coefficients—Intraclass ( ICC ), Pearson (r), and Cohen's kappa (κ)—were employed to assess reliability of TCM and LENT ‐ SOMA . Multivariate and univariate linear models explored the relationship between RIF and anatomical parameters [bra cup size], antihormonal therapy, and dosimetric factors [balloon diameter, skin‐to‐balloon distance ( SBD ), V150, and V200]. Median time to follow‐up from completion of IBAPBI is 3.6 years (range, 0.8–4.9 years). Median age is 69 years (range, 47–82 years). Median breast cup size is 39D (range, 34B–44DDD). Median balloon size is 41.2 cc (range, 37.6–50.0 cc), and median SBD is 1.4 cm (range, 0.2–5.5 cm). At pre‐ IBAPBI , TCM measurements demonstrate high interobserver agreement between two raters in all four quadrants of both breasts ICC ≥ 0.997 (95% CI 0.994–1.000). After 36 months, RIF is graded by TCM scale as 0, 1, 2, and 3 in 10/39 (26%), 17/39 (43%), 9/39 (23%), and 3/39 (8%) of patients, respectively. Δ TCM ≥6 mm (moderate‐severe RIF ) is statistically different from Δ TCM ≤3 mm (none‐mild RIF ) (p < 0.05). At 36 months post‐ IBAPBI , TCM measurements for two raters render ICC = 0.992 (95% CI 0.987–0.995) and r = 0.983 (p < 0.0001), whereas LENT ‐ SOMA demonstrates κ = 0.45 (95% CI 0.18–0.80). SBD and V150 are the only factors closest to 0.05 significance of contributing to RIF . This prospective study indicates that TCM is a more reproducible method than LENT ‐ SOMA in measuring RIF in patients treated with IBAPBI . This tool renders a promising future application in assessing RIF .