Practical consensus recommendations for tumor margins and breast conservative surgery

Sarin, Ramesh; Somsekhar, SP; Kumar, Rajeev; Gupta, Parikshaa; Sumeet, Jain; Jindal, Pramoj; Zamre, Vaishali; Firoz, Pasha; Parikh, PM; Aggarwal, Sandeep; Koul, Rakesh

doi:10.4103/sajc.sajc_105_18

Cited by 10 publications

(5 citation statements)

References 50 publications

(49 reference statements)

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“…To reduce the risk of LR, it is important to treat positive margins either by re-excision or mastectomy. 56 The RR rate in our study was 9.8%. This is comparable with the rate of re-excision reported by de la Cruz et al who conducted the largest comprehensive literature review assessing oncologic safety in OBCS.…”

Section: Discussionsupporting

confidence: 39%

Oncoplastic Breast-Conserving Surgery in African Women: A Systematic Review

Adesunkanmi,

Wuraola,

Fagbayimu

et al. 2024

JCO Glob Oncol

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PURPOSE Breast cancer is the most frequently diagnosed cancer in women worldwide. Surgery is a major treatment modality for breast cancer, and over the years, breast-conserving surgeries with breast radiation have shown similar outcomes with mastectomy. Not much is known about the frequency and outcome of breast-conserving surgery in Africa. This systematic review provides a comprehensive summary of the evidence evaluating cosmetic and oncologic outcomes after oncoplastic breast-conserving surgery (OBCS) for breast cancer in African women. METHODS This review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Databases were systematically searched for studies on African women undergoing OBCS. The oncologic and cosmetic outcomes, as well as the localization and reconstruction techniques, were evaluated. Descriptive statistics were used to summarize the frequency and proportions of the extracted variables. RESULTS The literature search yielded 266 articles but only 26 of these were included in the review. Majority of the studies were from Egypt and South Africa. These studies collectively evaluated 1,896 patients with a mean age of 48.2 years and a mean follow-up period of 36.9 months. The most common histopathology was T2 (71.4%) invasive ductal carcinoma. Hook wire localization was the most common technique used for nonpalpable lesions in 85.3% of patients. Of the studies reporting oncoplastic technique, the latissimus dorsi volume replacement technique was the most reported (15%). Most patients were satisfied with their cosmetic outcome. Seroma was the most common postoperative complication (44.6%). Among studies that reported oncologic outcome data, the crude overall survival and disease-free survival were 93.1% and 89.4%, respectively. CONCLUSION This systematic review revealed that the outcome of OBCS in African women compares with that in developed countries.

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Section: Discussionsupporting

confidence: 39%

Oncoplastic Breast-Conserving Surgery in African Women: A Systematic Review

Adesunkanmi,

Wuraola,

Fagbayimu

et al. 2024

JCO Glob Oncol

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“…Although absence of tumor at the inked margin is the current recommendation from clinical consensus guidelines, there has been a considerable variation in practice patterns among surgeons regarding the decision to re-excise or postoperative radiotherapy based on margin distance. 6 For carotid artery invasion in patients with head and neck cancer, the overall and disease-free survival rates for patients with tumors >1.8 mm from the elastic lamina were better than for patients with tumors <1.8 mm from the elastic lamina. 7 Therefore, in this study, ICA invasion needed to meet the following 2 conditions: enhanced magnetic resonance imaging (MRI) showed that the distance between the ICA and the tumor was <2 mm; and enhanced computed tomography (CT) showed that the ICA was not separated from the tumor by a thin bony wall, for example, the posterolateral wall of the sphenoid sinus.…”

Section: Patient Demographicsmentioning

confidence: 88%

“…GTR is independently associated with survival in patients with malignant tumor. Although absence of tumor at the inked margin is the current recommendation from clinical consensus guidelines, there has been a considerable variation in practice patterns among surgeons regarding the decision to re-excise or postoperative radiotherapy based on margin distance 6 . For carotid artery invasion in patients with head and neck cancer, the overall and disease-free survival rates for patients with tumors >1.8 mm from the elastic lamina were better than for patients with tumors <1.8 mm from the elastic lamina 7 .…”

Section: Methodsmentioning

confidence: 99%

Assessment of Internal Carotid Artery Invasion With the Endoscopic Endonasal Approach: Implications of a New Grading System and Security Strategy

Zhang

Sun

et al. 2020

Journal of Craniofacial Surgery

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Background: Internal carotid artery (ICA) injury during the endoscopic endonasal approach (EEA) for ventral cranial base tumors is rare but fatal. Objective: The aim of this study was to investigate the relationship between ventral cranial base tumors and corresponding ICA using quantitative means to improve the safety of surgery. Material and Methods: In this retrospective study, a total of 46 patients with ventral cranial base tumors undergoing surgery with the EEA were enrolled. Preoperative imaging features and clinical data were recorded. The influencing factors of the gross total resection (GTR) rate were analyzed. A new grading system and security strategy were developed. Results: Postoperative enhanced magnetic resonance imaging showed a GTR of 61.7%. There was a significant correlation between the GTR rate and tumors surrounding the ICA, the tumor site, the involved ICA segment, and the blood supply (P < 0.05). We included preoperative radiotherapy as supplementary data in the grading system. Each variable involved the letter ''S''; (surround, site, segment, blood supply, supplementary data); hence, the system was named the 5S ICA grading scale. Conclusion:We recommend a safety assessment through the 5S ICA grading scale and the ICA grading strategy to obtain the maximum total resection rate while ensuring patient safety.

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“…The principal risk associated with BCS is local recurrence ranging between 0.6% and 1.5% per year (10), most of which occurs in close proximity to the tumor bed (TB) (11,12). Accurate delineation of the TB and clinical target volume (CTV) is therefore important (13,14).…”

Section: Purposementioning

confidence: 99%

What is the dosimetric impact of isotropic vs anisotropic safety margins for delineation of the clinical target volume in breast brachytherapy?

et al. 2021

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The purpose of the study was to report dosimetric differences for breast brachytherapy plans optimized for clinical target volume (CTV) generated using conventional isotropic expansion of tumor bed volume (TBV) and Groupe Europ een de Curieth erapieeEuropean Society for Radiotherapy and Oncology (GEC-ESTRO) recommendations to expand the TBV anisotropically to achieve a total safety margin of 2 cm (resection margin size þ added safety margin). METHODS: Institutional records of 100 patients who underwent accelerated partial breast irradiation using multicatheter interstitial brachytherapy from May 2015 to March 2020 were reviewed retrospectively. Two sets of CT-based plans were made, one with 1-cm isotropic margins around the tumor bed (CTV_ISO) and the other with anisotropic margins (CTV_GEC). Plans were evaluated and compared using the American Brachytherapy Society and GEC-ESTRO guidelines. RESULTS: The median TBV was 36.97 cc. The median margin widths were as follows: anterior 1.2, posterior 1.0, superior 1.0, inferior 0.9, medial 1.2, and lateral 1.2 cm. The mean tumor bed coverage index was 0.94; 0.93 [p.066], the CTV coverage index 0.86; 0.84 [p 0.001], the dose homogeneity index (DHI) 0.77; 0.75 [p ! 0.001] and the conformity index 0.66; 0.64 [p ! 0.001] in CTV_ISO and CTV_GEC plans, respectively. In smaller volume implants (TBV! 35 cc), the DHI was 0.76; 0.75 [p 0.008] and the conformity index was 0.66; 0.62 [p ! 0.001], whereas in larger volumes O35 cc, the CTV coverage index was 0.86; 0.84 [p 0.003] and the DHI 0.78; 0.76 [p 0.001] in CTV_ISO and CTV_GEC plans, respectively.CONCLUSIONS: In this cohort of patients who underwent accelerated partial breast irradiation, plans with anisotropic margins had lower conformity, the impact of which was predominantly seen in smaller implants. Rest of the dosimetric constraints were achieved in both the plans as per the American Brachytherapy Society and GEC-ESTRO guidelines.

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Practical consensus recommendations for tumor margins and breast conservative surgery

Cited by 10 publications

References 50 publications

Oncoplastic Breast-Conserving Surgery in African Women: A Systematic Review

Oncoplastic Breast-Conserving Surgery in African Women: A Systematic Review

Assessment of Internal Carotid Artery Invasion With the Endoscopic Endonasal Approach: Implications of a New Grading System and Security Strategy

What is the dosimetric impact of isotropic vs anisotropic safety margins for delineation of the clinical target volume in breast brachytherapy?

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