scholarly journals 104: Implications of Oncoplastic Partial Mastectomy on Radiation Boost Delivery in Localized Breast Cancer

2020 ◽  
Vol 150 ◽  
pp. S46
Author(s):  
Adam Gladwish ◽  
Carly Sauve ◽  
Giulio Didiodato ◽  
Jessica Conway ◽  
Christiaan Stevens ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Partial Mastectomy ◽  
Radiation Boost

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

2020 ◽  
Author(s):  
Adam Gladwish ◽  
Carly Sauve ◽  
Giulio Didiodato ◽  
Jessica Conway ◽  
Christiaan Stevens ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Surgical Technique ◽  
Tumor Size ◽  
Radiation Treatment ◽  
Average Treatment Effect ◽  
Partial Mastectomy ◽  
Oncoplastic Breast Surgery ◽  
Radiation Boost ◽  
Whole Breast Radiotherapy ◽  
Secondary Outcomes

Abstract 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.

Deep-inspiration breath hold radiotherapy in patients with left-sided breast cancer after partial mastectomy

2021 ◽  
Vol 100 (4) ◽  
Keyword(s):  
Breast Cancer ◽  
Radiation Dose ◽  
Organs At Risk ◽  
Left Lung ◽  
Free Breathing ◽  
Partial Mastectomy ◽  
Breath Hold ◽  
Deep Inspiration ◽  
Deep Inspiration Breath Hold ◽  
Dose Volume Histograms

Introduction: The purpose of this study was to compare the radiation dose to organs at risk for deep-inspiration breath hold (DIBH) and free-breathing (FB) radiotherapy in patients with lef-sided breast cancer undergoing adjuvant radiotherapy after partial mastectomy. Methods: One hundred patients with left-sided breast cancer underwent DIBH and FB planning computed tomography scans, and the 2 techniques were compared. Dose-volume histograms were analyzed for heart, left anterior descending coronary artery (LAD), and left lung. Results: Radiation dose to heart, LAD, and left lung was significantly lower for DIBH than for free breathing plans. The median mean heart dose for DIBH technique in comparison with FB was 1.21 Gy, and 3.22 Gy respectively; for LAD, 4.67 versus 24.71 Gy; and for left lung 8.32 Gy versus 9.99 Gy. Conclusion: DIBH is an effective technique to reduce cardiac and lung radiation exposure.

Factors Affecting Time to Surgery in Breast Cancer Patients

2021 ◽  
pp. 000313482110547
Author(s):  
Anees B. Chagpar ◽  
Marissa Howard-McNatt ◽  
Akiko Chiba ◽  
Edward A. Levine ◽  
Jennifer S. Gass ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Stage ◽  
Community Setting ◽  
Partial Mastectomy ◽  
Community Practice ◽  
Breast Cancer Patients ◽  
Factors Affecting ◽  
Time To Surgery ◽  
Modifiable Factors ◽  
Timeliness Of Care

Background We sought to determine factors affecting time to surgery (TTS) to identify potential modifiable factors to improve timeliness of care. Methods Patients with clinical stage 0-3 breast cancer undergoing partial mastectomy in 2 clinical trials, conducted in ten centers across the US, were analyzed. No preoperative workup was mandated by the study; those receiving neoadjuvant therapy were excluded. Results The median TTS among the 583 patients in this cohort was 34 days (range: 1-289). Patient age, race, tumor palpability, and genomic subtype did not influence timeliness of care defined as TTS ≤30 days. Hispanic patients less likely to have a TTS ≤30 days ( P = .001). There was significant variation in TTS by surgeon ( P < .001); those practicing in an academic center more likely to have TTS ≤30 days than those in a community setting (55.1% vs 19.3%, P < .001). Patients who had a preoperative ultrasound had a similar TTS to those who did not (TTS ≤30 days 41.9% vs 51.9%, respectively, P = .109), but those who had a preoperative MRI had a significantly increased TTS (TTS ≤30 days 25.0% vs 50.9%, P < .001). On multivariate analysis, patient ethnicity was no longer significantly associated with TTS ≤30 ( P = .150). Rather, use of MRI (OR: .438; 95% CI: .287-.668, P < .001) and community practice type (OR: .324; 95% CI: .194-.541, P < .001) remained independent predictors of lower likelihood of TTS ≤30 days. Conclusions Preoperative MRI significantly increases time to surgery; surgeons should consider this in deciding on its use.

scholarly journals 75 Permanent Breast Seed Implant for Partial Breast Radiotherapy Following Partial Mastectomy for Favorable Breast Cancer: Results for 67 Patients

2019 ◽  
Vol 139 ◽  
pp. S34
Author(s):  
Juanita Crook ◽  
Michelle Hilts ◽  
Deidre Batchelar ◽  
Marie-Pierre Milette ◽  
Martin Korzeniowski ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Partial Mastectomy ◽  
Breast Radiotherapy ◽  
Partial Breast Radiotherapy

Relationship between patient costs and patient pathways

2019 ◽  
Vol 32 (1) ◽  
pp. 246-261
Author(s):  
Sara Dahlin ◽  
Hendry Raharjo
Keyword(s):  
Breast Cancer ◽  
Qualitative Methods ◽  
Lower Cost ◽  
Partial Mastectomy ◽  
Common Belief ◽  
Patient Cost ◽  
Content Type ◽  
Patient Pathway ◽  
Patient Pathways ◽  
The Cost

Purpose The purpose of this paper is to identify actual (as-is) patient pathway variation among breast cancer patients and to investigate the relationship between pathways and the cost incurred by patients. Design/methodology/approach Both quantitative and qualitative methods were employed to analyze data from four Swedish hospital groups. Quantitative methods include event-log data mining and statistical analyses on the related patient cost from the Swedish breast cancer quality registry and case-costing system. Qualitative methods included collaboration with and interviewing domain experts. Findings Unique pathways, followed by only one patient, were generally costlier than the most and less frequent pathways. Earlier study findings are confirmed for mastectomy patients, with more frequent pathways having a lower cost, whereas contradicting and inconclusive results emerged for the partial mastectomy patient groups. Highest variation in pathways was identified for patients receiving chemotherapy. Practical implications The common belief – if one follows a standardized patient pathway, then the cost will be lower – should be re-examined based on the actual pathways that occur in reality. Originality/value The relationships between patient pathways and patient cost allow more complex insights, beyond the general causal relationship between successfully implementing a “to-be” care pathway and lower cost. This highlights data-driven research’s importance, where actual pathways (as-is) provide more useful information than to-be care pathways.

scholarly journals Trending Towards Safer Breast Cancer Surgeries? Examining Acute Complication Rates from A 13-Year NSQIP Analysis

Cancers ◽  
2019 ◽  
Vol 11 (2) ◽  
pp. 253 ◽  
Author(s):  
Michael Jonczyk ◽  
Jolie Jean ◽  
Roger Graham ◽  
Abhishek Chatterjee
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Breast Cancer Surgery ◽  
Partial Mastectomy ◽  
Complication Rates ◽  
Acute Complication ◽  
Younger Age ◽  
History Of ◽  
Muscular Flap ◽  
Predictive Risk

As breast cancer surgery continues to evolve, this study highlights the acute complication rates and predisposing risks following partial mastectomy (PM), mastectomy(M), mastectomy with muscular flap reconstruction (M + MF), mastectomy with implant reconstruction (M + I), and oncoplastic surgery (OPS). Data was collected from the American College of Surgeons NSQIP database (2005–2017). Complication rate and trend analyses were performed along with an assessment of odds ratios for predisposing risk factors using adjusted linear regression. 226,899 patients met the inclusion criteria. Complication rates have steadily increased in all mastectomy groups (p < 0.05). Cumulative complication rates between surgical categories were significantly different in each complication cluster (all p < 0.0001). Overall complication rates were: PM: 2.25%, OPS: 3.2%, M: 6.56%, M + MF: 13.04% and M + I: 5.68%. The most common predictive risk factors were mastectomy, increasing operative time, ASA class, BMI, smoking, recent weight loss, history of CHF, COPD and bleeding disorders (all p < 0.001). Patients who were non-diabetic, younger (age < 60) and treated as an outpatient all had protective OR for an acute complication (p < 0.0001). This study provides data comparing nationwide acute complication rates following different breast cancer surgeries. These can be used to inform patients during surgical decision making.

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