The Impact of Radiotherapy Delay in Breast Conservation Patients Not Receiving Chemotherapy and the Rationale for Dichotomizing the Radiation Oncology Time-Dependent Standard into Two Quality Measures

Bleicher, Richard J.; Moran, Meena S.; Ruth, Karen; Edge, Stephen B.; Dietz, Jill M; Wilke, Lee G.; Stearns, Vered; Kurtzman, Scott H.; Klein, Jonah D.; Yao, Katharine

doi:10.1245/s10434-021-10512-1

Cited by 7 publications

(9 citation statements)

References 20 publications

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“…In our study population, the majority of patients started RT within 12 weeks after the last cycle of adjuvant chemotherapy or within 16 weeks after surgery when no adjuvant chemotherapy is given, which is consistent with previous reports (21)(22)(23). In a recent retrospective study of the impact of TTR on survival, among 95 patients treated with NAC without adjuvant chemotherapy, Xie et al (21) reported that 25 (26.3%), 54 (56.8%), and 16 (16.8%) started RT at <8 weeks, 8-16 weeks, and > 16 weeks from surgery, respectively.…”

Section: Discussionsupporting

confidence: 92%

“…Compared with early BC patients treated with breast conservation with no indication of adjuvant chemotherapy, TTR is, in general, longer and more heterogenous in the NAT population. In a large sample study of the impact of RT delay in early-stage patients with no adjuvant chemotherapy, only 24.9% of 186,650 patients started RT >8 weeks after surgery (22).…”

Section: Discussionmentioning

confidence: 99%

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Influence of Adjuvant Radiotherapy Timing on Survival Outcomes in High-Risk Patients Receiving Neoadjuvant Treatments

Cao

Wang

et al. 2022

Front. Oncol.

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PurposeTo determine the relationship between time to radiotherapy (TTR) and survival outcomes in breast cancer (BC) patients treated with neoadjuvant treatments (NATs).MethodsContinuous non-metastatic BC patients receiving NAT and adjuvant radiotherapy (RT) from 2009 to 2016 were retrospectively reviewed. A multivariable Cox model with restricted cubic splines (RCSs) was used to determine the panoramic relationship between TTR and survival outcomes. Multivariable analysis was used to control for confounding factors between the groups of TTR.ResultsA total of 315 patients were included. The RCS modeling demonstrated a non-linear relationship between TTR and survival outcomes. The lowest risk for distant metastasis-free survival (DMFS) and recurrence-free survival (RFS) was observed at the TTR of 12 weeks, and the lowest risk of BC-specific survival (BCSS) at 10 weeks. TTR was accordingly transformed into categorical variables as ≤10, 11–20, and >20 weeks. Multivariable analysis revealed that the TTR of ≤10 weeks was an independent prognostic factor for worse DMFS (HR = 2.294, 95% CI 1.079–4.881) and RFS (HR = 2.126, 95% CI 1.038–4.356) compared with the TTR of 10–20 weeks, while the is no difference in DMFS, RFS, and BCSS between TTR >20 weeks and TTR of 10–20 weeks.ConclusionThere exists a non-linear relationship between TTR after surgery and survival outcomes in patients treated with NAT. Early initiation of RT following surgery does not seem to be associated with a better therapeutic outcome. A relatively flexible recommendation of TTR could be adopted in clinical practice.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Influence of Adjuvant Radiotherapy Timing on Survival Outcomes in High-Risk Patients Receiving Neoadjuvant Treatments

Cao

Wang

et al. 2022

Front. Oncol.

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“…This finding is consistent with studies that did not find survival differences to twelve, 24 sixteen, 25 or twenty weeks 26 for this interval, but poorer survival has been reported for longer intervals 24,26 . However, one recent study found that survival was better for women who commenced radiotherapy within eight weeks of lumpectomy 27 . Our finding regarding the surgery‐to‐radiotherapy interval may have been influenced by unrecognised confounders, but we included a broad variety of factors in our model.…”

Section: Discussionsupporting

confidence: 88%

Treatment intervals and survival for women diagnosed with early breast cancer in Queensland: the Breast Cancer Outcomes Study, a population‐based cohort study

Kou,

Aitken,

Pyke

et al. 2023

Medical Journal of Australia

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ObjectivesTo assess associations between breast cancer‐specific survival and timeliness of treatment, based on 2020 Australian guidelines for the treatment of early breast cancer.DesignPopulation‐based cohort study; analysis of linked Queensland Cancer Register, patient medical record, and National Death Index data, supplemented by telephone interviews.Setting, participantsWomen aged 20–79 years diagnosed with invasive breast cancer during 1 March 2010 – 30 June 2013, followed to 31 December 2020.Main outcome measuresBreast cancer‐specific survival for women who received or did not receive treatment within the recommended timeframe, overall and for six treatment intervals; optimal cut‐points for each treatment interval; characteristics of women for whom treatment was not provided within the recommended timeframe.ResultsOf 5426 eligible women, 4762 could be invited for interviews; complete data were available for 3044 women (56% of eligible women, 65% of invited women). Incomplete compliance with guideline interval recommendations was identified for 1375 women (45%); their risk of death from breast cancer during the follow‐up period was greater than for those for whom guideline compliance was complete (adjusted hazard ratio [aHR], 1.43; 95% confidence interval [CI], 1.04–1.96). Risk of death was greater for women for whom the diagnosis to surgery interval exceeded 29 days (aHR, 1.76; 95% CI, 1.19–2.59), the surgery to chemotherapy interval exceeded 36 days (aHR, 1.63; 95% CI, 1.13–2.36), or the chemotherapy to radiotherapy interval exceeded 31 days (aHR, 1.83; 95% CI, 1.19–2.80). Treatment intervals longer than recommended were more frequent for women for whom breast cancer was detected by public facility screening (adjusted odds ratio [aOR], 1.58; 95% CI, 1.22–2.04) or by symptoms (aOR, 1.39; 95% CI, 1.09–1.79) than when cancer had been detected in private facilities, and for women without private health insurance (aOR, 1.96; 95% CI, 1.66–2.32) or living outside major cities (aOR, 1.38; 95% CI, 1.18–1.62).ConclusionsBreast cancer‐specific survival was poorer for women for whom the diagnosis to surgery, surgery to chemotherapy, or chemotherapy to radiotherapy intervals exceeded guideline‐recommended limits. Our findings support 2020 Australian guideline recommendations regarding timely care.

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“…25 It is well described that ipsilateral breast recurrence, the occurrence of distant metastases, and breast cancer-specific survival rates are all adversely affected by postoperative delays in initiating any postsurgical breast cancer treatment, including radiation therapy (RT), antiestrogen therapy, and chemotherapy. [26][27][28][29][30][31][32][33][34][35][36][37] Recently, these long-held tenets have been questioned within certain subsets of patients. 38,39 Delays in adjuvant treatments after mastectomy appear less adverse than similar delays after OBS.…”

Section: Discussionmentioning

confidence: 99%

“…26 Similar findings are reported in the analysis of invasive cancers of all biologic subtypes. [31][32][33][34] In a National Cancer Database query of 186,650 women undergoing breast conservation therapy for stage I-III invasive breast cancers, a delay of greater than 8 weeks to initiation of RT after surgery led to a decreased overall survival of 11%. 32 These results are also true for chemotherapy delays after surgery, with the effect being more pronounced in the OBS group than in the mastectomy group.…”

Section: Discussionmentioning

confidence: 99%

Oncoplastic Breast Reduction: A Systematic Review of Postoperative Complications

Benedict,

Brown,

Berry

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: Breast-conserving therapy with oncoplastic reduction is a useful strategy for partial mastectomy defect reconstruction. The most recently published systematic review of oncoplastic breast reduction outcomes from 2015 showed wound dehiscence in 4.3%, hematoma in 0.9%, infection in 2.8%, and nipple necrosis in 0.9% of patients. We performed a systematic review of oncoplastic breast reduction literature, comparing outcomes and complication rates reported over the past 8 years. Methods: Studies describing the use of oncoplastic breast reduction and discussion of postoperative complications were included. The primary outcome assessed was the postoperative complication rate; secondary outcomes analyzed were rates of margin expansion, completion mastectomy, and delays in adjuvant therapy due to complications. Results: Nine articles met inclusion criteria, resulting in 1715 oncoplastic breast reduction patients. The mean rate of hematoma was 3%, nipple necrosis was 2%, dehiscence was 4%, infection was 3%, and seroma was 2%. The need for re-excision of margins occurred in 8% of patients, and completion mastectomy in 2%. Finally, delay in adjuvant treatment due to a postoperative complication occurred in 4% of patients. Conclusions: Oncoplastic breast reduction is an excellent option for many patients undergoing breast-conserving therapy; however, postoperative complications can delay adjuvant radiation therapy. Results of this systematic literature review over the past 8 years showed a slight increase in complication rate compared to the most recent systematic review from 2015. With increased popularity and surgeon familiarity, oncoplastic breast reduction remains a viable option for reconstruction of partial mastectomy defects despite a slight increase in complication rate.

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The Impact of Radiotherapy Delay in Breast Conservation Patients Not Receiving Chemotherapy and the Rationale for Dichotomizing the Radiation Oncology Time-Dependent Standard into Two Quality Measures

Cited by 7 publications

References 20 publications

Influence of Adjuvant Radiotherapy Timing on Survival Outcomes in High-Risk Patients Receiving Neoadjuvant Treatments

Influence of Adjuvant Radiotherapy Timing on Survival Outcomes in High-Risk Patients Receiving Neoadjuvant Treatments

Treatment intervals and survival for women diagnosed with early breast cancer in Queensland: the Breast Cancer Outcomes Study, a population‐based cohort study

Oncoplastic Breast Reduction: A Systematic Review of Postoperative Complications

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