title: Effect of reduction mammoplasty on acute radiation side effects and use of lumpectomy cavity boosts.
abstract: OBJECTIVE
  Reduction mammoplasty (RM) during breast-conserving surgery is popular among women with large-volume breasts because it reduces redundant breast folds and may decrease skin-related morbidity from radiation therapy. However, RM may obscure the lumpectomy cavity (LC) and pose challenges to administering an LC boost, potentially affecting local control. We investigated the impact of RM on acute side effects and use of LC boosts.
  
  
  METHODS
  The records of 645 consecutive women treated with whole-breast irradiation at an urban university and 2 community practices between January 2012 and December 2014 were reviewed on an institutional review board-approved study. The primary endpoint was grade ≥3 radiation dermatitis; the secondary endpoint was use of LC boost. Student 2-sample t tests, Pearson χ2tests, Fisher exact tests, and univariate and multivariable logistic regression analyses were performed.
  
  
  RESULTS
  Forty-three (7%) RMs were performed in 650 treated breasts. No significant differences in grade 3 toxicities were identified among RM and non-RM patients. LC boost was delivered to 474 breasts. Fewer (16/43) RM patients received LC boosts compared with non-RM patients (458/607), P = .0001. RM patients were more likely to have neoadjuvant chemotherapy, stage III or multifocal disease, higher body mass index, larger planning treatment volumes, and conventional fractionation (P < .05).
  
  
  CONCLUSIONS
  RM was associated with decreased use of LC boost without significant differences in acute toxicities. Further investigation to delineate LCs in patients undergoing RM or identify alternative strategies for delivering LC dose is needed.
authors.affiliation: Department of Radiation Oncology, Emory University, Atlanta, Georgia. Electronic address: jolinta.lin@emory.edu.
authors.forename: Jolinta Y
authors.initials: JY
authors.lastname: Lin
authors.affiliation: Department of Plastic Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Rachel
authors.initials: R
authors.lastname: Bluebond-Langner
authors.affiliation: Department of Radiation Oncology, University of Michigan Medical Center, Ann Harbor, Michigan.
authors.forename: Enid
authors.initials: E
authors.lastname: Choi
authors.affiliation: Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Sally
authors.initials: S
authors.lastname: Cheston
authors.affiliation: Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Nichols
authors.affiliation: Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Randi J
authors.initials: RJ
authors.lastname: Cohen
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Soren M
authors.initials: SM
authors.lastname: Bentzen
authors.affiliation: Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Drogula
authors.affiliation: Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Susan
authors.initials: S
authors.lastname: Kesmodel
authors.affiliation: Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Emily
authors.initials: E
authors.lastname: Bellavance
authors.affiliation: Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Paula
authors.initials: P
authors.lastname: Rosenblatt
authors.affiliation: Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Katherine
authors.initials: K
authors.lastname: Tkaczuk
authors.affiliation: Department of Plastic Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Sheri
authors.initials: S
authors.lastname: Slezak
authors.affiliation: Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Feigenberg
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D001940:Breast / Q000000981:diagnostic imaging / Q000528:radiation effects / Q000601:surgery; D001943:Breast Neoplasms / Q000473:pathology / Q000628:therapy*; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods; D015412:Mastectomy, Segmental / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011855:Radiodermatitis / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods; D014057:Tomography, X-Ray Computed