Local Recurrence Patterns in Breast Cancer Patients Treated with Oncoplastic Reduction Mammaplasty and Radiotherapy
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The purpose of this study was to describe the incidence and location of ipsilateral breast tumor recurrence (IBTR) among breast cancer patients treated with oncoplastic reduction mammoplasty (ORM) and radiotherapy (RT).
The medical records of 86 consecutive women with ductal carcinoma in situ (DCIS) (n = 11) or invasive carcinoma of the breast (n = 75) treated with ORM at Emory University between January 1994 and December 2010 were reviewed.
Following ORM, prolonged wound healing or surgical complications led to delay of adjuvant chemotherapy or RT in 11 patients. Surgical clips were found outside the primary tumor breast quadrant in 43 % of the patients with available RT planning CT images. When the clips were found outside the primary tumor quadrant, the RT boost was more frequently delivered outside versus inside the primary tumor quadrant (67 vs. 33 %, p < 0.001). After a median follow-up period of 4.5 years (range 0.1–17.9), 6 patients developed an IBTR and only 1 IBTR occurred outside the primary tumor quadrant. The 5-year ipsilateral breast tumor control rates were 91 % (95 % CI 0.82–0.99) and 93 % (95 % CI 0.90–0.97) for patients with DCIS and invasive carcinoma, respectively.
The use of ORM yields acceptable rates of IBTR. ORM may displace breast tissue and surgical clips to breast quadrants outside of the original tumor location, but the majority of IBTRs still occur in the original tumor quadrant. This area remains at highest risk of in-breast recurrence in women treated with ORM irrespective of surgical clip location.
KeywordsIntensity Modulate Radiation Therapy Ipsilateral Breast Tumor Recurrence Breast Cancer Specific Survival Lumpectomy Cavity Diagnostic Mammogram
- 2.Losken A, Elwood ET, Styblo TM, Bostwick J, 3rd. The role of reduction mammaplasty in reconstructing partial mastectomy defects. Plast Reconstr Surg. 2002;109:968–75; discussion 976–7.Google Scholar
- 9.Bartelink H, Horiot JC, Poortmans PM, Struikmans H, Van den Bogaert W, Fourquet A, et al. Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881-10882 trial. J Clin Oncol. 2007;25:3259–65.PubMedCrossRefGoogle Scholar
- 13.National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology, 2012:42.Google Scholar
- 16.Huang E, Buchholz TA, Meric F, Krishnamurthy S, Mirza NQ, Ames FC, et al. Classifying local disease recurrences after breast conservation therapy based on location and histology: new primary tumors have more favorable outcomes than true local disease recurrences. Cancer. 2002;95:2059–67.PubMedCrossRefGoogle Scholar
- 17.Pezner RD, Tan MC, Clancy SL, Chen YJ, Joseph T, Vora NL. Radiation therapy for breast cancer patients who undergo oncoplastic surgery: localization of the tumor bed for the local boost. Am J Clin Oncol. 2012 [Epub ahead of print].Google Scholar