The Impact Oncoplastic Reduction Has on Long-Term Recurrence in Breast Conservation Therapy

Abstract

Background: The use of oncoplastic reduction techniques have many proven benefits over lumpectomy alone in the management of women with breast cancer. The impact it has on tumor recurrence is unclear. The purpose of this review was to evaluate the incidence of recurrence in patients who underwent oncoplastic reduction techniques compared to lumpectomy alone. Methods: A prospectively maintained database of patients at Emory Hospital who underwent oncoplastic reduction techniques at the time of tumor resection was queried. These patients were compared to a series of patients who had lumpectomy alone over a similar period. For inclusion in the study, patients were at least 10 years since the time of the tumor resection. The main outcome of interest was tumor recurrence. Results: There were 97 patients in the lumpectomy-only group and 95 patients in the oncoplastic reduction group, with an average follow-up of 7.8 years and 8.5 years, respectively. Patients in the oncoplastic group were younger (lumpectomy only, 61.4 years; oncoplastic reduction, 51.6 years; p < 0.001) and had larger tumors (lumpectomy only, 1.1 cm; oncoplastic reduction, 1.6 cm; p < 0.001). Local recurrence was 13 percent in the lumpectomy-only group and 9 percent in the oncoplastic reduction group (p = 0.34), and overall recurrence rates were similar (lumpectomy only, 15 percent; oncoplastic reduction, 24 percent; p = 0.13). Overall, surgical intervention (lumpectomy alone versus oncoplastic reduction) was not associated with local recurrence or any recurrence on univariate and multivariate analyses. Conclusion: Despite the oncoplastic reduction patients having a higher risk of recurrence and a more generous tumor resection, the long-term recurrence rates were equivalent when compared to breast-conserving therapy alone. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Oncoplastic surgery for breast cancer: Global perspectives and trends

“…Of note, both studies also noted higher risk tumors in the OPS group, suggesting that the oncoplastic approach extends indications for BCT in more aggressive disease with similar recurrence rates 11,12 . A recent review and metanalysis of 31 studies further support this data, noting lower LRR rates in OPS groups when compared to standard BCS 13 …”

“…11,12 A recent review and metanalysis of 31 studies further support this data, noting lower LRR rates in OPS groups when compared to standard BCS. 13…”

Time to Radiation after Oncoplastic Reduction versus After Lumpectomy

“… 18 , 19 As for the issue of oncologic recurrence, a previous study from our institution found equivalent long-term recurrence rates between surgical techniques. 20 …”

“…18,19 As for the issue of oncologic recurrence, a previous study from our institution found equivalent long-term recurrence rates between surgical techniques. 20 The discussion of delay in radiation after reconstructive breast modalities also extends to procedures such as mastectomy with immediate breast reconstruction. One study by Shammas et al found that despite a modest delay in initiation of radiation therapy after immediate breast reconstruction, the delay did not impact overall survival.…”

Updates and Debate Concerning Margin Adequacy and Management following Breast-Conserving Surgery

“…Since the introduction of lumpectomy during the 90s, breast-conserving surgery (BCS) followed by whole breast irradiation has been demonstrated to be safe and comparable to mastectomy in terms of local recurrences [70,71].…”