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

April 30, 2015

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