Outcomes of immediate oncoplastic surgery and adjuvant radiotherapy in breast cancer patients

Borm, Kai Joachim; Schönknecht, Christine; Nestler, Andrea; Oechsner, Markus; Waschulzik, Birgit; Combs, Stephanie E.; Münch, Stefan; Niemeyer, Markus; Duma, Marciana Nona

doi:10.1186/s12885-019-6104-4

Cited by 21 publications

(26 citation statements)

References 20 publications

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“…This was despite the propensity of OPM to be performed in younger patients with more advanced tumors, a characteristic shared in our study as well. Similarly, a recent retrospective study of 965 patients by Borm et al showed that while there was a trend to reduced boost utilization in patients with OPM in comparison to non-OPM patients, however overall rates were still high (94.2% vs. 91% p = 0.06) [8]. Furthermore, there were no signi cant differences in IBTR between OPM and non-OPM patients, supporting similar oncologic outcomes with adoption of OPM.…”

Section: Discussionmentioning

confidence: 83%

“…We also found no signi cant difference in delays to adjuvant radiotherapy. Any potential differences in incidence of IBTR could not be estimated due to the relatively short follow-up times and very few IBTR events, which were limitations also noted in previous studies [8,11,14,15,17,18]. Finally, we evaluated the relationship between the ratio of post-operative seroma volume to tumor size and reception of BRT.…”

Section: Discussionmentioning

confidence: 99%

“…Oncoplastic partial mastectomy (OPM) procedures have become increasingly prevalent as a means to improve the quality-of-life outcome for patients [5][6][7]. Oncologic outcomes such as local recurrence and survival have been shown to be similar to standard lumpectomy techniques [8,9].…”

Section: Introductionmentioning

confidence: 99%

“…The impact of OPM on the administration of adjuvant boost radiotherapy (BRT) has not been studied. Several studies have shown favorable results of oncoplastic surgery in terms of local control rates, but were inclusive of patients with lower baseline risks of recurrence for whom boost radiotherapy would not typically be indicated [8,11]. Larger retrospective reviews have a paucity of radiation planning details [12].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Implications of Oncoplastic Breast Surgery on Radiation Boost Delivery in Localized Breast Cancer

Gladwish

Sauve²,

DiDiodato³

et al. 2020

Preprint

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Background:Oncoplastic partial mastectomy (OPM) is a technique utilized to improve aesthetic and survivorship outcomesin patients with localized breast cancer. This technique leads to breast tissue rearrangement, which can have an impact on target definition for boost radiotherapy (BRT). The aim of this study was to determine if the choice of surgical technique independently affected the decision to deliver a radiation boost.Materials and Methods: This was a retrospective study of patients treated between January 2017 and December 2018. We selected consecutive patients based on surgical procedure; 50 undergoing standard breast conserving surgery and 50 having had an OPM. The primary outcome was average treatment effect (ATE) of surgery type on reception of BRT, accounting for patient age, tumor grade, lymphovascular space invasion, margin status and ER status as potential confounding variables. Secondary outcomes included ATE of surgery type on the time to reception of radiotherapy and incidence of ipsilateral breast tumor recurrence (IBTR). The ratio of boost seroma volume to pathologic tumor size was also compared between the two groups. Treatment effects regression adjustment and inverse-probability weighted analysis was used to estimate ATEs for both primary and secondary outcomes.Results: Median age was 64 years (range 37 – 88). The median tumor size was 1.5 cm (range 0.1 – 6.5). The majority of patients were ≤ stage IIA (78%), invasive ductal subtype (80%), LVSI negative (78%), margin negative (90%) and ER/PR +ve (69%). Overall, surgical technique was not associated with differences in the proportion of patients receiving BRT (ATE 6.0% (95% CI -4.5, 16.0)). There were no differences in delays to radiation treatment between the two groups (ATE 32.8 days (95% CI -22.1, 87.7)). With a median follow-up time of 419 days (range 30 – 793), there were only 5 recurrences, with 1 case of IBTR in each group. There was no difference in the ratio of seroma volume to tumor size between the two groups (p=0.38).Conclusions: OPM did not affect the decision to offer localized BRT following standard whole breast radiotherapy, or significantly affect treatment times or radiation volumes. The decision to offer OPM should include a multi-disciplinary approach.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Implications of Oncoplastic Breast Surgery on Radiation Boost Delivery in Localized Breast Cancer

Gladwish

Sauve²,

DiDiodato³

et al. 2020

Preprint

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“…Although no long-term differences in recurrence rates and survival between BCS and OPS have been reported 13,19,22,[43][44][45] , current evidence regarding the impact of OPS on the re-excision rate is limited because the data are from single-centre studies with relatively few patients undergoing OPS (ranging from 31 to 1177), and in most studies the methodology was weak 11,13,44,[46][47][48] . The present results are in line with a meta-analysis 19 from 2018 that found a significantly lower risk of re-excision in patients who underwent OPS compared with those who had BCS (relative risk 0⋅66, 95 per cent c.i.…”

Section: Discussionmentioning

confidence: 99%

Rates of re-excision and conversion to mastectomy after breast-conserving surgery with or without oncoplastic surgery: a nationwide population-based study

Heeg

Jensen

Hølmich

et al. 2020

British Journal of Surgery

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Background: There is no consensus regarding the impact of oncoplastic surgery (OPS) on rates of re-excision and conversion to mastectomy following breast-conserving surgery (BCS). Here these two outcomes after BCS and OPS were compared in a nationwide population-based setting. Methods: In Denmark, all OPS is registered and categorized into volume displacement, volume reduction or volume replacement. Patients who underwent BCS or OPS between 2012 and 2018 were selected from the Danish Breast Cancer Group database. Multivariable analyses were performed to adjust for confounders, and propensity score matching to limit potential confounding by indication bias. Results: A total of 13 185 patients (72⋅5 per cent) underwent BCS and 5003 (27⋅5 per cent) OPS. Volume displacement was used in 4171 patients (83⋅4 per cent), volume reduction in 679 (13⋅6 per cent) and volume replacement in 153 (3⋅1 per cent). Re-excision rates were 15⋅6 and 14⋅1 per cent after BCS and OPS respectively. After adjusting for confounders, patients were less likely to have a re-excision following OPS than BCS (odds ratio (OR) 0⋅80, 95 per cent c.i. 0⋅72 to 0⋅88), specifically after volume displacement and reduction. The rate of conversion to mastectomy was similar after OPS and BCS (3⋅2 versus 3⋅7 per cent; P = 0⋅105), but with a lower risk in adjusted analysis (OR 0⋅69, 0⋅58 to 0⋅84), specifically after volume displacement and reduction procedures. Findings were similar after propensity score matching. Conclusion: A modest decrease in re-excision rate and less frequent conversion to mastectomy were observed after OPS compared with BCS.

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Oncoplastic breast-conserving surgery for women with primary breast cancer

Nanda

Hodgkinson

et al. 2021

Cochrane Database of Systematic Reviews

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Outcomes of immediate oncoplastic surgery and adjuvant radiotherapy in breast cancer patients

Cited by 21 publications

References 20 publications

Implications of Oncoplastic Breast Surgery on Radiation Boost Delivery in Localized Breast Cancer

Implications of Oncoplastic Breast Surgery on Radiation Boost Delivery in Localized Breast Cancer

Rates of re-excision and conversion to mastectomy after breast-conserving surgery with or without oncoplastic surgery: a nationwide population-based study

Oncoplastic breast-conserving surgery for women with primary breast cancer

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