Radiation Therapy for Breast Cancer Patients Who Undergo Oncoplastic Surgery

Pezner, Richard D.; Tan, Mark C.; Clancy, Sharon; Chen, Yi Jen; Joseph, Thomas; Vora, Nayana

doi:10.1097/coc.0b013e318256efba

Cited by 39 publications

(29 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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%

“…The concern with OPM and boost radiotherapy relates to the architectural distortion in local breast tissue and the implications this has on tumor (and tumor cavity) localization. Several studies have investigated ducial placement within the tumor cavity at the time of OPM in order to aid in boost delineation at the time of radiotherapy, and results have shown that clip location can be outside the original tumor quadrant in up to 50% of cases [16,17]. Several other localization devices, such as radioopaque gels and lms, have also been investigated as intra-operative markers to aid in future radiation boost planning [19,20].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Gladwish

Sauve²,

DiDiodato³

et al. 2020

Preprint

View full text Add to dashboard Cite

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.

show abstract

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

View full text Add to dashboard Cite

show abstract

“…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

View full text Add to dashboard Cite

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.

show abstract

“…Various ideas to solve the problem of relocation of inadequate resection margins have been described, but none of them seems to be efficient. For the wound bed‐driven assessment, the use of surgical clips in the wound bed is frequently reported, as well as systematic cavity shavings, in which tissue is sampled for frozen sections by shaving the wall of the surgical cavity . For specimen‐driven assessment, Mohs' surgery or mapping of the margins (e.g.…”

Section: Introductionmentioning

confidence: 99%

Relocation of inadequate resection margins in the wound bed during oral cavity oncological surgery: A feasibility study

et al. 2019

View full text Add to dashboard Cite

Background Specimen‐driven intraoperative assessment of the resection margins provides immediate feedback if an additional excision is needed. However, relocation of an inadequate margin in the wound bed has shown to be difficult. The objective of this study is to assess a reliable method for accurate relocation of inadequate tumor resection margins in the wound bed after intraoperative assessment of the specimen. Methods During oral cavity cancer surgery, the surgeon placed numbered tags on both sides of the resection line in a pair‐wise manner. After resection, one tag of each pair remained on the specimen and the other tag in the wound bed. Upon detection of an inadequate margin in the specimen, the tags were used to relocate this margin in the wound bed. Results The method was applied during 80 resections for oral cavity cancer. In 31 resections an inadequate margin was detected, and based on the paired tagging an accurate additional resection was achieved. Conclusion Paired tagging facilitates a reliable relocation of inadequate margins, enabling an accurate additional resection during the initial surgery.

show abstract

Radiation Therapy for Breast Cancer Patients Who Undergo Oncoplastic Surgery

Cited by 39 publications

References 18 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

Relocation of inadequate resection margins in the wound bed during oral cavity oncological surgery: A feasibility study

Contact Info

Product

Resources

About