(P031) Effects of Oncoplastic Surgery on Delivery of Standard Adjuvant Radiotherapy

Publication
Article
OncologyOncology Vol 29 No 4_Suppl_1
Volume 29
Issue 4_Suppl_1

The standard patterns of care for breast conservation therapy include A-RT with a boost to the surgical bed. For the PubMed and Medline articles, 71% of the 1,180 patients without clips and clear margins did not receive a boost. These results correspond with the ROs’ survey, which showed that 65.4% of them did not give a boost to the patients systematically. While OBS was perceived by the surgeons as a technique to remove more tissue and improve cosmesis, our review demonstrated that it negatively impacts radiotherapy techniques that are proven to achieve adequate local control. OBS is clearly changing patterns of delivery of adjuvant RT, without long-term outcomes supporting its safety.

Elisabeth Arrojo, MD, Alvaro Martinez, MD, FACR, Michael Ghilezan, MD, James Fontanesi, MD, Frank Vicini, MD, FACR; 21st Century Oncology; Botsford Hospital

BACKGROUND: Oncoplastic breast surgery (OBS) is a surgical effort to remove additional breast tissue and improve cosmesis. However, local control with routine lumpectomy and cosmesis after adjuvant radiotherapy (A-RT) are both very good, questioning the need for OBS. We wanted to explore if A-RT practices have changed due to OBS.

METHODS: A search in the PubMed and Ovid MEDLINE databases was carried out from 2010 to 2014, using the keywords “therapeutic mammoplasty” and “OBS.” Use of boost and tumor bed marking in OBS were analyzed and compared with the results of the 2014 survey (Thomas et al, Pract Radiat Oncol.) reported as “Radiation practice patterns among United States (US) radiation oncologists (ROs) for postmastectomy breast reconstruction and oncoplastic breast reduction (RT.OBS).”

RESULTS: We found six studies, totaling 1,180 patients. Four studies did not reported clip-marking. Three of these four studies did not give a boost to any of the OBS patients, and the other one gave a boost only to OBS patients with +/close margins. The two studies that reported clips gave a boost to the patients. The overall analysis showed that 71% of patients did not receive a boost treatment.

A total of 271 ROs from the US completed the RT.OBS survey, showing that 65.4% of them did not give a boost to any of the patients systematically, 8.3% indicated never having utilized a boost, and 38.7% only gave a boost to patients with clips marking the tumor bed. Only 33.1% of respondents indicated that they routinely collaborated with surgeons for clip placement at the time of breast reduction or complex tissue rearrangement.

CONCLUSIONS: The standard patterns of care for breast conservation therapy include A-RT with a boost to the surgical bed. For the PubMed and Medline articles, 71% of the 1,180 patients without clips and clear margins did not receive a boost. These results correspond with the ROs’ survey, which showed that 65.4% of them did not give a boost to the patients systematically. While OBS was perceived by the surgeons as a technique to remove more tissue and improve cosmesis, our review demonstrated that it negatively impacts radiotherapy techniques that are proven to achieve adequate local control. OBS is clearly changing patterns of delivery of adjuvant RT, without long-term outcomes supporting its safety.

Proceedings of the 97th Annual Meeting of the American Radium Society - americanradiumsociety.org

Articles in this issue

(P005) Ultrasensitive PSA Identifies Patients With Organ-Confined Prostate Cancer Requiring Postop Radiotherapy
(P001) Disparities in the Local Management of Breast Cancer in the United States According to Health Insurance Status
(P002) Predictors of CNS Disease in Metastatic Melanoma: Desmoplastic Subtype Associated With Higher Risk
(P003) Identification of Somatic Mutations Using Fine Needle Aspiration: Correlation With Clinical Outcomes in Patients With Locally Advanced Pancreatic Cancer
(P004) A Retrospective Study to Assess Disparities in the Utilization of Intensity-Modulated Radiotherapy (IMRT) and Proton Therapy (PT) in the Treatment of Prostate Cancer (PCa)
(S001) Tumor Control and Toxicity Outcomes for Head and Neck Cancer Patients Re-Treated With Intensity-Modulated Radiation Therapy (IMRT)-A Fifteen-Year Experience
(S003) Weekly IGRT Volumetric Response Analysis as a Predictive Tool for Locoregional Control in Head and Neck Cancer Radiotherapy 
(S004) Combination of Radiotherapy and Cetuximab for Aggressive, High-Risk Cutaneous Squamous Cell Cancer of the Head and Neck: A Propensity Score Analysis
(S005) Radiotherapy for Carcinoma of the Hypopharynx Over Five Decades: Experience at a Single Institution
(S002) Prognostic Value of Intraradiation Treatment FDG-PET Parameters in Locally Advanced Oropharyngeal Cancer
(P006) The Role of Sequential Imaging in Cervical Cancer Management
(P008) Pretreatment FDG Uptake of Nontarget Lung Tissue Correlates With Symptomatic Pneumonitis Following Stereotactic Ablative Radiotherapy (SABR)
(P009) Monte Carlo Dosimetry Evaluation of Lung Stereotactic Body Radiosurgery
(P010) Stereotactic Body Radiotherapy for Treatment of Adrenal Gland Metastasis: Toxicity, Outcomes, and Patterns of Failure
(P011) Stereotactic Radiosurgery and BRAF Inhibitor Therapy for Melanoma Brain Metastases Is Associated With Increased Risk for Radiation Necrosis
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