Factors influencing cosmetic results after conservation therapy for breast cancer

Taylor, Marie E.; Pérez, Carlos A.; Halverson, Karen J.; Kuske, Robert R.; Philpott, Gordon W.; Garcia, Delia M.; Mortimer, Joanne; Myerson, Robert J.; Radford, Diane M.; Rush, Carol

doi:10.1016/0360-3016(94)00480-3

Cited by 381 publications

(260 citation statements)

References 43 publications

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“…The cosmetic outcome after BCS is strongly related to the patient's well-being. [3,6] [4,7,8] A practical guideline during surgery is to achieve a safe and cosmetically acceptable resection margin of 5-10 mm. [15,20,22] In the present study, the median resection volume was 29.0 cm³.…”

Section: Resection Volumes and Calculated Resection Ratio'smentioning

confidence: 99%

“…[1,2] The current focus is on improving the surgical accuracy of BCS, which includes a higher rate of margin clearance with smaller excision volume, thereby improving patient satisfaction and cosmetic outcome. [3][4][5][6][7][8] To this end, advances have been made in image-guided breast surgery for nonpalpable breast cancer, and several studies have shown that the use of ultrasonography (US) for intraoperative tumour localisation results in the most accurate surgical excision. [9][10][11][12][13][14] In daily practice, the excision of palpable breast cancer is guided by palpation.…”

Section: Introductionmentioning

confidence: 99%

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Optimising surgical accuracy in palpable breast cancer with intra-operative breast ultrasound – Feasibility and surgeons’ learning curve

Krekel

Cardozo

Müller³

et al. 2011

European Journal of Surgical Oncology (EJSO)

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This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. procedure, all surgeons showed proficiency in performing intra-operative breast US. Conclusion:Surgeons can easily learn the skills needed to perform intra-operative US for palpable breast tumour excision. The technique is non-invasive, simple, safe and effective for obtaining adequate resection margins. Within the first two cases, resections reached optimal volumes, thereby, presumably resulting in improved cosmetic outcomes. In a multicentre, randomised, clinical trial, intra-operative US guidance for palpable breast tumours will be evaluated for oncological ánd cosmetic outcomes. M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT Synopsis:This study evaluates the performance of surgeons during training for ultrasound-guided excision of palpable T1-T2 invasive breast cancer. Our findings reveal that surgeons can rapidly master intra-operative US, which is non-invasive, simple, safe and effective for obtaining adequate resection margins and excision volumes.

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Section: Resection Volumes and Calculated Resection Ratio'smentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Optimising surgical accuracy in palpable breast cancer with intra-operative breast ultrasound – Feasibility and surgeons’ learning curve

Krekel

Cardozo

Müller³

et al. 2011

European Journal of Surgical Oncology (EJSO)

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“…In the Danish Breast Cancer Cooperative Group 82c randomised trial, RT and TAM were associated with a lower risk of locoregional recurrence and improved survival in high-risk postmenopausal breast cancer patients after mastectomy and limited axillary dissection, after only 1 year of adjuvant TAM treatment (Overgaard et al, 1999). However, TAM has been reported to lead to worse cosmesis in women who underwent conservative surgery, RT, and had received TAM (Wazer et al, 1992) but not in others (Taylor et al, 1995;Fowble et al, 1996). Wazer et al (1997) found no adverse effect of TAM on cosmesis in an updated analysis of 498 women who were treated with breastconserving therapy.…”

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confidence: 99%

Concomitant use of tamoxifen with radiotherapy enhances subcutaneous breast fibrosis in hypersensitive patients

et al. 2004

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Concomitant use of adjuvant tamoxifen (TAM) and radiation therapy (RT) is not widely accepted. We aim to assess whether this treatment is associated with an increased risk of developing subcutaneous fibrosis after conservative or radical surgery in breast cancer patients. We analysed 147 women with breast cancer treated with adjuvant RT, and who were included in the KFS 00539-9-1997/SKL 00778-2-1999 prospective study aimed at evaluating the predictive value of CD4 and CD8 T-lymphocyte apoptosis for the development of radiation-induced late effects. TAM (20 mg day À1 ) with concomitant RT was prescribed in 90 hormone receptorpositive patients. There was a statistically significant difference in terms of complication-relapse-free survival (CRFS) rates at 3 years, 48% (95% CI 37.2 -57.6%) vs 66% (95% CI 49.9 -78.6%) and complication-free survival (CFS) rates at 2 years, 51% (95% CI 40 -61%) vs 80% (95% CI 67 -89%) in the TAM and no-TAM groups, respectively. In each of these groups, the CRFS rates were significantly lower for patients with low levels of CD8 radiation-induced apoptosis, 20% (95% CI 10 -31.9%), 66% (95% CI 51.1 -77.6%), and 79% (95% CI 55 -90.9%) for CD8 p16, 16 -24, and 424%, respectively. Similar results were observed for the CFS rates. The concomitant use of TAM with RT is significantly associated with an increased incidence of grade 2 or greater subcutaneous fibrosis; therefore, caution is needed for radiosensitive patients.

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“…Many of the studies reviewed have not accounted for other confounding factors including extent of surgical excision, total delivered dose, dose fractionation, post-operative complications and brachytherapy dose inhomogeneity, e.g. surgical excision volume and baseline surgical cosmesis are significant factors affecting cosmesis 15,[66][67][68] . Larger surgical excision would also imply larger brachytherapy boost and/or target volume and a larger applicator size for IORT.…”

Section: Limitations Of This Reviewmentioning

confidence: 99%

A multicentre observational study evaluating image-guided radiotherapy for more accurate partial-breast intensity-modulated radiotherapy: comparison with standard imaging technique

Harris

Mukesh

Jena

et al. 2014

Efficacy and Mechanism Evaluation

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Background Whole-breast radiotherapy (WBRT) is the standard treatment for breast cancer following breast-conserving surgery. Evidence shows that tumour recurrences occur near the original cancer: the tumour bed. New treatment developments include increasing dose to the tumour bed during WBRT (synchronous integrated boost) and irradiating only the region around the tumour bed, for patients at high and low risk of tumour recurrence, respectively. Currently, standard imaging uses bony anatomy to ensure accurate delivery of WBRT. It is debatable whether or not more targeted treatments such as synchronous integrated boost and partial-breast radiotherapy require image-guided radiotherapy (IGRT) focusing on implanted tumour bed clips (clip-based IGRT). Objectives Primary – to compare accuracy of patient set-up using standard imaging compared with clip-based IGRT. Secondary – comparison of imaging techniques using (1) tumour bed radiotherapy safety margins, (2) volume of breast tissue irradiated around tumour bed, (3) estimated breast toxicity following development of a normal tissue control probability model and (4) time taken. Design Multicentre observational study embedded within a national randomised trial: IMPORT-HIGH (Intensity Modulated and Partial Organ Radiotherapy – HIGHer-risk patient group) testing synchronous integrated boost and using clip-based IGRT. Setting Five radiotherapy departments, participating in IMPORT-HIGH. Participants Two-hundred and eighteen patients receiving breast radiotherapy within IMPORT-HIGH. Interventions There was no direct intervention in patients’ treatment. Experimental and control intervention were clip-based IGRT and standard imaging, respectively. IMPORT-HIGH patients received clip-based IGRT as routine; standard imaging data were obtained from clip-based IGRT images. Main outcome measures Difference in (1) set-up errors, (2) safety margins, (3) volume of breast tissue irradiated, (4) breast toxicity and (5) time, between clip-based IGRT and standard imaging. Results The primary outcome of overall mean difference in clip-based IGRT and standard imaging using daily set-up errors was 2–2.6 mm (p < 0.001). Heterogeneity testing between centres found a statistically significant difference in set-up errors at one centre. For four centres (179 patients), clip-based IGRT gave a mean decrease in the systematic set-up error of between 1 mm and 2 mm compared with standard imaging. Secondary outcomes were as follows: clip-based IGRT and standard imaging safety margins were less than 5 mm and 8 mm, respectively. Using clip-based IGRT, the median volume of tissue receiving 95% of prescribed boost dose decreased by 29 cm3 (range 11–193 cm3) compared with standard imaging. Difference in median time required to perform clip-based IGRT compared with standard imaging was X-ray imaging technique dependent (range 8–76 seconds). It was not possible to estimate differences in breast toxicity, the normal tissue control probability model indicated that for breast fibrosis maximum radiotherapy dose is ...

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Factors influencing cosmetic results after conservation therapy for breast cancer

Cited by 381 publications

References 43 publications

Optimising surgical accuracy in palpable breast cancer with intra-operative breast ultrasound – Feasibility and surgeons’ learning curve

Optimising surgical accuracy in palpable breast cancer with intra-operative breast ultrasound – Feasibility and surgeons’ learning curve

Concomitant use of tamoxifen with radiotherapy enhances subcutaneous breast fibrosis in hypersensitive patients

A multicentre observational study evaluating image-guided radiotherapy for more accurate partial-breast intensity-modulated radiotherapy: comparison with standard imaging technique

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