Hypofractionated whole breast radiotherapy in breast conservation for early-stage breast cancer: a systematic review and meta-analysis of randomized trials
66
Citation
41
Reference
10
Related Paper
Citation Trend
Keywords:
Lumpectomy
Cosmesis
Lumpectomy
Cosmesis
CLIPS
Inframammary fold
Cite
Citations (49)
Lumpectomy
Surgical oncology
Breast-conserving surgery
Cite
Citations (26)
The traditional approach to breast cancer has been the surgical mastectomy. The cosmetic deformity resulting from this procedure has led to the development of our current methods of breast reconstruction. The inherent attraction of lumpectomy and radiotherapy has been its equation with improved cosmesis. This procedure may be an effective alternative to surgery from the cancer perspective and does produce, in the majority of patients, an acceptable cosmetic result. However, this paper demonstrates that it may produce a result that is less optimal than mastectomy with postoperative breast reconstruction. The etiology of the increased deformity can either be the localized lumpectomy with marked internal derangement of breast volume or the radiation therapy itself. In addition, those who develop a combination require a solution to both. We describe three patients who illustrate these problems and believe that a greater awareness of these potential complications should be available to aid patients in choosing their cancer treatment.
Lumpectomy
Cosmesis
Cite
Citations (48)
Most women with early stage breast cancer do not require removal of the entire breast to treat their cancer; instead, up to 70% of women can be effectively and safely treated by breast conserving therapy (BCT) with surgical removal of the tumor only (lumpectomy) followed by radiation treatment of the remaining breast tissue. Unfortunately, the final contour and cosmesis of the treated breast is suboptimal in approximately 30% of patients. The ability to accurately predict breast contour after BCT for breast cancer could significantly improve patient decision-making regarding the choice of surgery for breast cancer. Our overall hypothesis is that the complex interplay among mechanical forces due to gravity, breast tissue constitutive law distribution, inflammation induced by radiotherapy and internal stress generated by the healing process play a dominant role in determining the success or failure of lumpectomy in preserving the breast contour and cosmesis. We have shown here from a first patient study that even in the idealistic situation of excellent cosmetic outcome this problem requires multiscale modeling. We propose a method to decide which component of the model works best for each phase of healing and what parameters should be considered dominant and patient specific. This patient study is part of a clinical trial registered on ClinicalTrial.gov, identifier NCT02310711.
Lumpectomy
Cosmesis
Breast-conserving surgery
Surgical oncology
Cite
Citations (7)
This study was undertaken to determine the aesthetic changes inherent in partial mastectomy followed by radiation therapy in the treatment of stage I and stage II breast cancer. A retrospective analysis of breast cancer patients treated according to the National Surgical Adjuvant Breast Project Protocol B-06 was undertaken in 57 patients from 1984 to the present. The size of mastectomy varied between 2 × 1 cm and 15 × 8 cm. Objective aesthetic outcome, as determined by physical and photographic examination, was influenced primarily by surgical technique as opposed to the effects of radiation. These technical factors included orientation of resections, breast size relative to size of resection, location of tumor, and extent and orientation of axillary dissection. Regarding cosmesis, 80 percent of patients treated in this study judged their result to be excellent or good, in comparison to 50 percent excellent or good as judged by the plastic surgeon. Only 10 percent would consider mastectomy with reconstruction for contralateral disease. Asymmetry and contour abnormalities are far more common than noted in the radiation therapy literature. Patient satisfaction with lumpectomy and radiation, however, is very high. This satisfaction is not necessarily based on objective criteria defining aesthetic parameters, but is strongly influenced by retainment of the breast as an original body part.
Cosmesis
Lumpectomy
Total Mastectomy
Cite
Citations (78)
To determine the treatment that offered the best local control for isolated local recurrences of breast cancer after lumpectomy without radiotherapy, the authors reviewed 355 patients initially treated by lumpectomy (with or without axillary dissection) without radiotherapy. Local breast cancer recurred in 79 patients. They underwent either repeat partial mastectomy (PM) or completion total mastectomy (TM). Twenty-four patients (5 TM, 19 PM) received radiotherapy. Local control was defined as the absence of further recurrence of breast or chest-wall cancer. The 19 patients treated with repeat PM and radiotherapy had an actuarial local control rate of 82% at 5 years. Those treated with TM (28 patients) [corrected] or TM plus radiation (5 patients) had rates of local control of 60% and 52% respectively. Although there were no significant differences between the TM and PM plus radiotherapy groups, the 27 patients who had a repeat PM without radiotherapy had a significantly lower rate of local control (32%, p < 0.005). Treatment of recurrent breast cancer with PM and radiotherapy is a viable alternative to TM for enhancing local control. Repeat PM alone gave much poorer results. The authors conclude that local cancer recurrences after lumpectomy alone do not necessarily require TM and can often be treated with repeat excision and radiotherapy.
Lumpectomy
Axillary Dissection
Cite
Citations (12)
Journal Article Aesthetic Outcomes in Breast Conservation Therapy Get access Howard T. Wang, MD, Howard T. Wang, MD Department of Surgery, University of Texas Health Science Center at San Antonio, TX.Drs. Wang, Barone, and Steigelman and Mr. Berger, Ms. Daum, and Mr. Ortegon are from the Division of Plastic and Reconstructive Surgery. Reprint requests: Howard T. Wang, MD, Division of Plastic and Reconstructive Surgery, University of Texas Health Science Center at San Antonio, Mail Code 7844, 7703 Floyd Curl Dr, San Antonio, Texas 78229-3900. E-mail: wanght@uthscsa.edu. Search for other works by this author on: Oxford Academic PubMed Google Scholar Constance M. Barone, MD, Constance M. Barone, MD Department of Surgery, University of Texas Health Science Center at San Antonio, TX.Drs. Wang, Barone, and Steigelman and Mr. Berger, Ms. Daum, and Mr. Ortegon are from the Division of Plastic and Reconstructive Surgery. Search for other works by this author on: Oxford Academic PubMed Google Scholar Megan B. Steigelman, MD, Megan B. Steigelman, MD Department of Surgery, University of Texas Health Science Center at San Antonio, TX.Drs. Wang, Barone, and Steigelman and Mr. Berger, Ms. Daum, and Mr. Ortegon are from the Division of Plastic and Reconstructive Surgery. Search for other works by this author on: Oxford Academic PubMed Google Scholar Morton Kahlenberg, MD, Morton Kahlenberg, MD Department of Surgery, University of Texas Health Science Center at San Antonio, TX.Dr. Kahlenberg and Dr. Rousseau are from the Division of Surgical Oncology. Search for other works by this author on: Oxford Academic PubMed Google Scholar Dennis Rousseau, MD, Dennis Rousseau, MD Department of Surgery, University of Texas Health Science Center at San Antonio, TX.Dr. Kahlenberg and Dr. Rousseau are from the Division of Surgical Oncology. Search for other works by this author on: Oxford Academic PubMed Google Scholar Jamie Berger, Jamie Berger Department of Surgery, University of Texas Health Science Center at San Antonio, TX.Drs. Wang, Barone, and Steigelman and Mr. Berger, Ms. Daum, and Mr. Ortegon are from the Division of Plastic and Reconstructive Surgery. Search for other works by this author on: Oxford Academic PubMed Google Scholar Allison Daum, Allison Daum Department of Surgery, University of Texas Health Science Center at San Antonio, TX.Drs. Wang, Barone, and Steigelman and Mr. Berger, Ms. Daum, and Mr. Ortegon are from the Division of Plastic and Reconstructive Surgery. Search for other works by this author on: Oxford Academic PubMed Google Scholar Delio P. Ortegon, MD Delio P. Ortegon, MD Department of Surgery, University of Texas Health Science Center at San Antonio, TX.Drs. Wang, Barone, and Steigelman and Mr. Berger, Ms. Daum, and Mr. Ortegon are from the Division of Plastic and Reconstructive Surgery. Search for other works by this author on: Oxford Academic PubMed Google Scholar Aesthetic Surgery Journal, Volume 28, Issue 2, March 2008, Pages 165–170, https://doi.org/10.1016/j.asj.2007.12.001 Published: 01 March 2008 Article history Accepted: 19 November 2007 Published: 01 March 2008
Cosmesis
Lumpectomy
Adjuvant Therapy
Cite
Citations (77)
Objective: To evaluate our mature follow-up data in women who have developed IBTR following conservation surgeryand post-operative external radiotherapy retreated by lumpectomy followed by interstitial brachytherapy in lieu of salvagemastectomy.Methods: Between 1/1998 and 10/2006, twenty-two patients with TIS or T1 IBTR were offered interstitial low-dose ratebrachytherapy following tumor re-excision as an alternative to salvage mastectomy. All patients had failed lumpectomyfollowed by standard postoperative external beam radiotherapy (range 5000-6480cGy). The recurrent tumors were excisedwith final margins of resection free of residual disease. Tumor bed implantation was then carried out with an interstitialtechnique utilizing 192Iridium with the target volume consisting of the tumor bed plus a minimum 1.0 centimeter margin(minimum standard dose 4500cGy).Results: With a mean follow up of 67.5 months (range 17-115 months) Twenty-one of 22 patients maintained localcontrol at the time of last follow-up or at the time of their death. The single patient who developed a second localrecurrence was treated successfully with mastectomy. Three patients succumbed to systemic disease. Two patientsdeveloped localized skin breakdown. One patient developed a contralateral breast cancer. Long-term cosmetic results asdefined by the Harvard cosmesis scale and the Allegheny General modification were acceptable.Conclusions: These long-term data suggest that lumpectomy followed by brachytherapy is feasible and may be anacceptable alternative to salvage mastectomy in patients who locally fail conservation breast therapy. The upcomingRTOG retreatment trial (RTOG 1014) should help define the role of repeat conservation therapy in IBTR.
Lumpectomy
Cosmesis
Breast-conserving surgery
Cite
Citations (4)
【Objective】To assess the efficacy and safety of Tongxinluo Capsules for cerebrovascular disorders by meta analysis.【Methods】Randomized controlled trials(RCT) of Tongxinluo Capsules for cerebrovascular disorders were got by searching China Journal Full-text Database(from 1996 to May,2006),China Best Doctoral and Master's Dissertations(from 1996 to May,2006),MEDLINE(from 1996 to May,2006),and Cochrane Library with computer,and were screened by manual search.RevMan 4.2 software and SAS were used in Meta-analysis.【Results】Thirty seven RCT were included,in which involved 2791 patients.Among them,1764 patients were treated with Tongxinluo Capsules,and other 1572 served as the controls. Meta-analysis results showed that the difference of the total efficacy in 31 RCT was significant(P0.01),and the difference of neurological deficit in 7 RCT of Tongxinluo Capsules for cerebral infarction was also significant(P0.05).Adverse reactions were scarcely found,and no obvious toxic and side effect was found.【Conclusion】The present evidence indicates that Tongxinluo Capsules exert a higher therapeutic effect rate for cerebrovascular disorders.However,to obtain more profound evidences,more high-quality,large-sized and double blind RCT are still required to prove the efficacy and the safety.
Cochrane collaboration
Cite
Citations (1)
Tissue rearrangement after an oncoplastic breast reduction may complicate identification of margins during reexcision. Little is known about outcomes of reoperation in this setting.This is a single-institution, retrospective analysis of outcomes of margin reexcisions after lumpectomy with concurrent oncoplastic Wise-pattern reduction from 2015 to 2020. Outcomes assessed were the rate of successful breast conservation, in-breast recurrence, wound issues or complications, effect on cosmesis, and delay to onset of adjuvant therapy.From 2015 to 2020, 649 patients underwent lumpectomy with oncoplastic Wise-pattern reduction. Forty-seven patients (7.2%) had greater than or equal to one positive margin(s); of these, 28 went directly to mastectomy, and 19 underwent margin reexcision. Residual disease was found in seven of 19 patients (37%) at reexcision. The rate of successful breast-conserving therapy was 95% with a mean follow-up of 31 months. There was one (5%) in-breast recurrence (invasive ductal carcinoma [IDC] occurring 30 months after the original operation); this patient had a mastectomy for treatment of her recurrence. The overall complication rate was 37%. Radiation was administered to 18 patients (95%), and two patients (11%) had delay of radiation past 6 weeks due to wound complications. Of the 14 patients with photographs available, 12 of 14 patients (86%) were blindly assessed to have equivalent or better cosmesis after margin reexcision (versus initial lumpectomy).Margin reexcision after oncoplastic breast reduction with Wise-pattern is feasible and effective, and can be done without compromising the initial cosmetic results.
Breast reduction
Margin (machine learning)
Oncoplastic Surgery
Cite
Citations (6)