SECRAB (Sequencing of Chemotherapy and Radiotherapy in Adjuvant Breast Cancer) Cosmesis Results

ABSTRACT Background SECRAB, a randomised trial comparing sequential (Seq) to synchronous (Syn) chemo-radiation using a CMF or Anthracycline-CMF regimen, demonstrates reduces local recurrence rates after Syn treatment for early breast cancer (EBC) (Fernando 2011 EJC:47 S2). Cosmesis study results are presented. Methods 2296 women were randomised and cosmesis was assessed in 382. Cosmesis and telangiectasia were assessed as excellent, good, moderate and poor for patients having wide local excision (WLE) while telangiectasia alone was assessed for those having mastectomy. Photographs were taken for 301 patients for blinded independent review using a consensus method (Haviland 2008 Clin Oncol 20:497). Patient perception was assessed using EORTC BR23 quality of life questionnaire (Q 39-42). Assessments were made at baseline, 1, 2 and 5 years post surgery. Results The results of clinician assessed cosmesis and telangiectasia are shown below. There was no statistically significant difference between the arms Table: 253PD Category Odds Ratio (OR) Excellent Good Moderate/Poor (95% CI) Seq Syn Seq Syn Seq Syn Excellent/good vs moderate/poor Cosmesis, n (%) 14 (23) 15 (21) 37 (60) 37 (51) 11 (18) 21 (29) 1.87, (0.82,4.27) p = 0.1 Telangiectasia, n (%) 79 (68) 99 (62) 33 (28) 54 (34) 4 (4) 7 (4) 1.28, (0.37,4.48) p = 0.7 Data on independent assessment of change in breast appearance after WLE was available for 145 (98%) patients. Minimal, mild and marked changes were observed in 70, 29 and 1% of patients respectively for the Syn arm and 72, 28 and 0% for the Seq arm. There was no difference between treatment arms (OR, mild/marked vs minimal, 1.10, 95% CI 0.54-2.26, p = 0.8). There was no change in patient's perception of their breast appearance (baseline vs. final assessment questionnaire). Conclusions There was no significant difference in cosmesis or telangiectasia between the two arms as assessed by the clinician or by independent photographic review. There was no difference in patient perception of breast appearance. Contrary to the result of the main study, which showed a borderline significant worsening of telangiectasia in the Syn arm, no such difference was seen in the cosmesis study. Syn chemo-radiation reduces local recurrence in EBC without affecting cosmesis. Disclosure All authors have declared no conflicts of interest.