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

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.

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Development of a comprehensive prognostic model of lymphedema risk for breast cancer survivors.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e23083 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e23083-e23083

Author(s):

Jennifer Kwan ◽

Petra Famiyeh ◽

Jie Su ◽

Wei Xu ◽

Kenneth Yip ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Lymph Nodes ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Radiation Treatment ◽

Axillary Lymph ◽

Biological Factors ◽

Traditional Treatment ◽

Radiation Boost

e23083 Background: Lymphedema is a side-effect of cancer treatment affecting up to 1 in 5 cancer survivors. It is associated with life-threatening medical complications and higher medical costs. To facilitate early detection and treatment of lymphedema in high-risk patients, improved prognostic modeling is required. Methods: The study cohort comprised of female breast cancer survivors at the Princess Margaret Cancer Centre during 2016-18. Using lymphedema diagnosis as the end-point, the Cox proportional-hazards model was applied to patient, disease, and treatment-related parameters to assess performance of established and putative novel prognostic factors for lymphedema. Concordance index (C-index) and Kaplan-Meier analyses were used to evaluate prognostic performance. Results: A total of 176 breast cancer survivors were included in the preliminary analysis. On univariable analysis, traditional treatment-related risk factors for lymphedema (e.g. axillary lymph node dissection, number of lymph nodes dissected, use of radiotherapy) were significant (p < 0.05). Additionally, other treatment-related factors (e.g. radiation boost, supraclavicular radiation), disease factors (e.g. tumor size, number of positive lymph nodes, cancer stage), and patient/biological factors (e.g. developing a surgical seroma) were significant (p < 0.05). Multivariable analysis revealed one traditional treatment-related factor (i.e. number of lymph nodes dissected) and other treatment details (e.g. radiation boost, axillary/supraclavicular radiation) to be the most significant factors. Combining radiation treatment details with traditional treatment-related lymphedema risk factors improved the C-index from 0.609 to 0.710 and separated patients into high- and low-risk groups with 2-year lymphedema-free survivals of 26% (15-44%) and 85% (74-97%) respectively (p < 0.001). Conclusions: Prognostication of lymphedema risk can be improved by considering radiation treatment details, including use of radiation boost and site of radiotherapy. Biological factors, such as developing a surgical seroma, may reveal predisposition towards edema. Validation on an independent data set is being completed. Prospective validation is also required.

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Estrogens and Glucocorticoids in Mammary Adipose Tissue: Relationships with Body Mass Index and Breast Cancer Features

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgz268 ◽

2019 ◽

Vol 105 (4) ◽

pp. e1504-e1516 ◽

Cited By ~ 3

Author(s):

Sofia Laforest ◽

Mélissa Pelletier ◽

Nina Denver ◽

Brigitte Poirier ◽

Sébastien Nguyen ◽

...

Keyword(s):

Breast Cancer ◽

Body Mass Index ◽

Adipose Tissue ◽

Body Mass ◽

Tumor Size ◽

Breast Tumors ◽

Partial Mastectomy ◽

Negatively Associated ◽

Breast Adipose Tissue ◽

Breast Adipose

Abstract Context Adipose tissue is an important site for extragonadal steroid hormone biosynthesis through the expression and activity of P450 aromatase, 11β-hydroxysteroid dehydrogenase (HSD) 1, and 17β-HSDs. The contribution of steroid hormones produced by adjacent adipose tissue for the progression and survival of breast tumors is unknown. Objective To quantify estrogens (estradiol, estrone) and glucocorticoids (cortisol, cortisone) in breast adipose tissue from both healthy and diseased women and their relationships with adiposity indices and breast cancer prognostic markers. Design and setting Breast adipose tissue was collected at time of surgery. Patients Pre- and postmenopausal women undergoing partial mastectomy for treatment of breast cancer (n = 17) or reduction mammoplasty (n = 6) were studied. Interventions Relative estrogen and glucocorticoid amounts were determined by liquid chromatography tandem mass spectrometry. Results The targeted steroids were reliably detected and quantified in mammary adipose tissues. Women with ER+/PR+ tumor had higher relative estradiol amount than women with ER–/PR– tumor (P < .05). The ratio of estradiol-to-estrone was higher in lean women than in women with a body mass index (BMI) ≥ 25 kg/m2 (P < .05). Mixed-model analyses showed that estradiol, cortisone, and cortisol were negatively associated with tumor size (P < .05). Relationships between glucocorticoids and tumor size remained significant after adjustment for BMI. The cortisol-to-cortisone ratio was negatively associated with tumor stage (P < .05) independently of BMI. Conclusions We reliably quantified estrogens and glucocorticoids in breast adipose tissue from healthy women and women suffering from breast cancer. Our findings suggest that smaller breast tumors are associated with higher relative amounts of estradiol and cortisol in adipose tissue.

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SURGICAL TREATMENT OF BREAST CANCER: FROM THE CONCEPT OF ERADICATION TO AESTHETIC SURGERY

Tumors of female reproductive system ◽

10.17650/1994-4098-2018-14-2-42-53 ◽

2018 ◽

Vol 14 (2) ◽

pp. 42-53 ◽

Cited By ~ 1

Author(s):

I. K. Vorotnikov ◽

V. P. Letyagin ◽

I. V. Vysotskaya ◽

V. Yu. Sel’chuk ◽

D. A. Burov ◽

...

Keyword(s):

Breast Cancer ◽

Surgical Treatment ◽

Surgical Technique ◽

Historical Development ◽

Breast Surgery ◽

Aesthetic Surgery ◽

Oncoplastic Surgery ◽

Oncoplastic Breast Surgery

This article discusses the historical development of oncoplastic surgery, describes the main stages of oncoplastic breast surgery, indications and contraindications for it, and the algorithms for choosing an appropriate surgical technique for patients with breast cancer.

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