Radiation therapy for breast cancer patients who undergo oncoplastic surgery: localization of the tumor bed for the local boost.
BACKGROUND
Oncoplastic reconstructive surgery is performed in select patients with breast cancer to allow conservation treatment when the lumpectomy would be expected to have a poor cosmetic outcome. These techniques not only rearrange the breast tissue but may also shift the position of the tumor bed. The oncoplastic incision may have no relationship to the tumor bed. Although use of whole-breast radiation therapy (RT) is straightforward, difficulties in localization of the tumor bed for the local RT boost have not been investigated.


METHODS
A retrospective review was performed of 25 patients with 26 cancers who received RT after breast conservation surgery with oncoplastic reconstruction.


RESULTS
Among 11 patients with a minimum of 4 surgical clips placed at tumor resection, 8 (73%) had the final tumor bed extend beyond the original breast quadrant or be completely relocated into a different region. In 3 (27%) cases, the clinical treatment volume was 2 to 3 separated regions within the breast.


CONCLUSIONS
For breast cancer patients who have had oncoplastic surgery, the tumor bed is frequently more extensive and possibly relocated compared with original presentation. Placement of surgical clips after tumor resection and before oncoplastic reconstruction may be the most accurate method to localize the RT local boost field.
*Department of Radiation Oncology †Division of Plastic and Reconstructive Surgery, City of Hope Medical Center, Duarte, CA.
Richard D
RD
Pezner
Mark C
MC
Tan
Sharon L
SL
Clancy
Yi-Jen
YJ
Chen
Thomas
T
Joseph
Nayana L
NL
Vora
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015412:Mastectomy, Segmental / Q000379:methods; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D013525:Surgical Instruments