Cosmetic results of using high-output Ir-192 brachytherapy in the treatment of luminal breast cancer

Relevance. Breast cancer is the first most common cancer in women not only in Russia, but also around the world. In Russia in 2021, there were 76 000 women diagnosed with breast cancer. As a result of screening programmes, preventive examinations, and educational work, the detection rate of the disease at stages I–II has reached 72%. This determines the implementation of organ-preserving surgical interventions, but a postoperative course of radiotherapy can significantly worsen the cosmetic result. Materials and methods. In our work, we analyzed the cosmetic results in 166 patients who received surgical treatment including lumpectomy for breast cancer with cT1сN0M0 stage. All patients had a luminal, HER2 negative tumor subtype. In accordance with the treatment methods, the main clinical group A (n=80) was formed, which included women who underwent organ-preserving surgical treatment and multifractional high-dose rate brachytherapy with a dose of 1.7 Gy ×2 times a day up to a dose of 34 Gy. Group B (n=86) included patients who underwent organ-preserving surgery and standard radiation therapy with a dose of 2 Gy per day up to a dose of 50 Gy. The groups were comparable in molecular biological characteristics, age and number of patients. Results. According to the 4-scale assessment of cosmetic results, it should be noted that after 6 months, “excellent” and “good cosmetic result” was higher in group B and it was 81.4% compared to 62.5% in Group A. This was due to the defects in the area of introducers placement and additional pigmentation in this area. According to our data, at 24 months there was an increase in “satisfactory” results in the group with external beam radiation therapy, which was associated with the occurrence of late radiation injuries, and the group with interstitial radiation therapy has better cosmetic results of 87.5% compared to 77.9%, as well as fewer satisfactory results: 12.5% compared to 22.1%.To receive a subjective assessment from the patients, we used a questionnaire with a 10-point scale. When studying questionnaires, it was noted that in group A, women were more satisfied with the cosmetic results, which was associated not only with a less scope of surgical intevention (lumpectomy versus sectoral resection), which affected the shape of the mammary gland, but also in this group there was less swelling and thickening of the breast skin and changes in the breast tissue itself. Conclusions. Brachytherapy in patients with early stages of breast cancer has good cosmetic results, which has a positive effect on the emotional state of women.