title: Tumor bed boost omission after negative re-excision in breast-conservation treatment.
abstract: BACKGROUND
  We evaluated the necessity of a tumor bed boost after whole-breast radiotherapy for early-stage breast cancer after breast-conserving surgery and negative re-excision.
  
  
  METHODS
  Of patients treated at the Virginia Commonwealth and Tufts Universities with breast-conservation therapy for early-stage breast cancer between 1983 and 1999, 205 required re-excision of the tumor cavity to obtain clear margins and were found to be without residual disease. Adjuvant conventionally fractionated whole-breast radiotherapy was given to a total dose of 50 Gy in 25 fractions. The tumor bed boost was omitted.
  
  
  RESULTS
  The median follow-up was 98 months (range, 6-229 months). The tumor histological diagnosis was primarily infiltrating ductal carcinoma (183 cases; 89%). Nodal involvement was documented in 49 cases (24%). There were four documented recurrences at the tumor bed site. Five in-breast recurrences were documented to be in a location removed from the tumor bed. The overall Kaplan-Meier 15-year in-breast control rate was 92.4%, and the freedom from true recurrence rate was 97.6%.
  
  
  CONCLUSIONS
  The findings support the concept that postlumpectomy radiotherapy can be tailored according to the degree of surgical resection. There is an easily identifiable subgroup of patients who can avoid a tumor bed boost, thus resulting in a reduced treatment time and improved cosmesis, while maintaining local control rates that approach 100%. The data suggest that in patients who undergo a negative re-excision, treatment with whole-breast radiotherapy to 50 Gy is a sufficient dose to maximally reduce the risk of local recurrence.
authors.affiliation: Deparment of Radiation Oncology, Virginia Commonwealth University, Medical College of Virginia Campus, 401 College Street, Box 58, Richmond, Virginia 23298, USA. darthur@mcvh-vcu.edu
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Arthur
authors.forename: Laurie W
authors.initials: LW
authors.lastname: Cuttino
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Neuschatz
authors.forename: Derrick T
authors.initials: DT
authors.lastname: Koo
authors.forename: Monica M
authors.initials: MM
authors.lastname: Morris
authors.forename: Harry D
authors.initials: HD
authors.lastname: Bear
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Kaplan
authors.forename: Kathy
authors.initials: K
authors.lastname: Dawson
authors.forename: David E
authors.initials: DE
authors.lastname: Wazer
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant