Plastic surgery for breast conservation therapy: How to define the volume of the tumor bed for the boost?

Furet, E.; Peurien, D.; Fournier-Bidoz, N.; Servois, Vincent; Reyal, Fabien; Fourquet, A.; Rouzier, Roman; Kirova, Youlia

doi:10.1016/j.ejso.2014.03.009

Cited by 34 publications

(21 citation statements)

References 21 publications

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“…The favorable oncologic and aesthetic and oncologic outcomes associated with OPM have led to an increase in uptake of these procedures [7,13]. There have been well described concerns in the literature about radiation boost delivery and accurate localization for these patients [14][15][16]. This study aimed to identify if there was a propensity to omit boost radiotherapy as a result of surgical technique, presumably for concern regarding localization.…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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: 99%

Section: Discussionmentioning

confidence: 99%

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

Gladwish

Sauve²,

DiDiodato³

et al. 2020

Preprint

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“…Other clinical outcomes such as pain and infection were difficult to compare as there was little head to head comparison. From a cavity marking perspective, there were reports noted by Furet et al and Pezner et al noting tumor bed shifts with fewer clips (Pezner et al, 2013;Furet et al, 2014). This seemed to improve if there were more clips placed.…”

Section: Incremental Cost-utility Ratio (Icur) and Dominancementioning

confidence: 98%

Cost-Effectiveness of the Biozorb Device for Radiation Planning in Oncoplastic Surgery

Rashad¹,

Huber²,

Chatterjee³

2018

CCO

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Purpose: With the extent of breast tissue manipulation using oncoplastic surgical techniques, there lies a challenge in marking the tumor bed for adjuvant radiation therapy planning. Two competing techniques in doing so exist and involve the traditional placement of surgical clips in the surgical tumor bed or the newer technique of placing a Biozorb marker in the tumor bed. Our goal was to perform a cost-utility assessment to see which tumor bed marking approach is more cost-effective. Based on device list prices and clinical outcomes from a comprehensive literature review, we assessed if an approach either dominated or had an incremental cost-utility ratio of less than $50,000/QALY since either would signify cost-effectiveness. Results: From a cost comparison, the Biozorb marker ($1250) was far costlier than the clip applier device ($50). Our PRISMA search (Figure 1) reviewed 133 articles for clip placement and 42 articles for Biozorb placement in oncoplastic surgery with 2 clip placement articles and 3 Biozorb articles meeting criteria. The available data for either marking technique suggests reasonable tumor bed identification for adjuvant radiation treatment without clear clinical advantages supporting one technique over the other. Overall clinical equivalence in the setting of a clear cost advantage suggests dominant cost-effectiveness in favor of clips. Conclusion: Using surgical clips to identify the tumor bed in oncoplastic surgery is dominant and more cost-effective over the Biozorb technique as clips are relatively inexpensive while both techniques reasonably identify the tumor bed.

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“…[17] The authors also pointed out that the volume of tissue removed during OPS is higher than that removed during other surgical methods; therefore, the BV should be kept to a minimum to not diminish cosmetic outcomes. In another study, it has been of stated that preoperative PET-CT images processed via deformable fusion can be used for RT planning.…”

Section: Discussionmentioning

confidence: 99%

Does Preoperative Positron Emission Tomography Help Delineate the Boost Volume After Oncoplastic Surgery for Breast Cancer?

Altinok¹

2017

TJ Oncol

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OBJECTIVEThe tumor bed within the breast shifts during oncoplastic surgery (OPS) for breast cancer (BC). Preoperative imagery is used to determine the boost volume (BV) for patients not implanted with surgical clips. This prospective study was conducted to geometrically compare BVs determined using preoperative imagery and BVs determined utilizing surgical clips. METHODSPatients diagnosed with BC were scanned using PET-CT during 2013-2015. Twenty patients who had undergone OPS but who did not have metastasis underwent CT prior to radiotherapy. Their preoperative images were fused with planning CT images. The tumor volume (CTVboost-pet), as determined from the preoperative PET-CT images, was contoured. Next, CTVboost-clips was determined using surgical clips. Geometric relationships between these two volumes were statistically compared. RESULTSPlanar projections of CTVboost-pet and CTVboost-clips were evaluated. Displacements between CTVboost-pet and CTVboost-clips in the axial (XZ) and coronal (XY) planes were 1.17 cm (min-max: 0.03-3.64 cm) and 1.67 cm (min-max: 0.38-4.14 cm), respectively, and were statistically significant (p<0.001), whereas the displacement in the sagittal (YZ) plane was 1.07 cm (min-max: 0.04-4.45 cm) and was not significant (p>0.7). CONCLUSIONPreoperative imaging alone was not reliable when determining the BV in patients who had undergone OPS and had no clips. Large PTV margins can be an option to overcome this issue. Surgical clips need to be inserted during OPS.

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Plastic surgery for breast conservation therapy: How to define the volume of the tumor bed for the boost?

Cited by 34 publications

References 21 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

Cost-Effectiveness of the Biozorb Device for Radiation Planning in Oncoplastic Surgery

Does Preoperative Positron Emission Tomography Help Delineate the Boost Volume After Oncoplastic Surgery for Breast Cancer?

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