Permanent Breast Seed Implant for Early-stage Breast Cancer: Impact of Primary Tumour Location on the Overall Cosmetic Outcome

IntroductionPermanent breast seed implants (PBSIs) have been introduced as an alternative to whole breast irradiation with equivalent rates of tumour control but fewer associated morbidities. However, there is some suggestion that tumour location has an effect on cosmesis in patients having PBSI. Therefore, the aim of the present study was to determine whether tumour location can predict long-term cosmesis.MethodsA retrospective chart review was conducted from May 2004 to November 2009. Tumour location was categorized according to breast quadrant. Late cosmesis was scored as the presence or absence of induration, telangiectasia, and pigmentation change at 3 years after implant. Acute toxicities were also recorded as the presence or absence of induration, dryness, and radiation dermatitis at 8 weeks after implant. Additionally, the tumour size, depth of the seroma, depth of 100% isodose, and tissue thickness were collected. Descriptive statistics and Fisher exact tests were used to analyze the relationship between tumour location and both acute and late morbidities. Individual t tests were used to determine whether tumour size, depth, and tissue thickness were predictive of acute and long-term side effects.ResultsOf the 70 patients included in the study, 17 (24%) had tumours located in the upper inner quadrant (UIQ), 37 (53%) had tumours located in the upper outer quadrant, and 8 (11%) had tumours located in each of the remaining two quadrants. In general, 35% (6/17) of patients with tumours in the UIQ experienced long-term side effects compared with 34% (18/53) of patients with tumours in any other quadrant (P = .7617). Also, 82% (14/17) of patients with tumours in the UIQ experienced acute side effects compared with only 51% (27/53) of patients with tumours in any other quadrant (P = .0259). There was a significant effect of both primary tumour size (P = .004) and the depth of the 100% isodose (P = .028) on overall long-term cosmesis, but there was no significant relationship between physical factors and overall acute side effects.ConclusionsPatients with tumours in the UIQ experience acute side effects more frequently than patients with tumours in any other quadrant. However, this trend is not as obvious for long-term cosmesis. Instead, tumour size and depth may be more useful when considering late effects.