PV 01 - Poster Viewing Q&A - Session 1
SU_4_2035 - Impact of Reduction Mammoplasty on Cosmetic Outcomes and Delivery of Hypofractionated Radiotherapy for Breast Cancer Patients Undergoing Reduction Mammoplasty as a Component of Breast Conserving Surgery
Sunday, September 15
1:15 PM - 2:30 PM
Location: ASTRO Innovation Hub
Impact of Reduction Mammoplasty on Cosmetic Outcomes and Delivery of Hypofractionated Radiotherapy for Breast Cancer Patients Undergoing Reduction Mammoplasty as a Component of Breast Conserving Surgery
A. Avant1, J. W. Ridings2, M. DeWing3, L. Pomerenke3, I. Sharon3, F. Deleyiannis4, G. Liebscher4, N. Wong4, and J. R. Olsen5; 1University of Colorado School of Medicine, Denver, CO, 2Department of Radiation Oncology, University of Colorado School of Medicine, Colorado Springs, CO, 3Memorial Hospital, University of Colorado Health, Colorado Springs, CO, 4Memorial Hospital University of Colorado Health, Colorado Springs, CO, 5Washington University School of Medicine, St. Louis, CO
Purpose/Objective(s): Hypofractionated radiotherapy (HFRT) is the standard of care for whole breast radiotherapy administered as a component of breast-conserving therapy (BCT) for early stage breast cancer. Cosmetic outcomes following HFRT in the setting of reduction mammoplasty (RM) are not well characterized. In this study, we report outcomes for HFRT following breast conserving Surgery (BCS) with RM in a cohort of early stage breast cancer patients with evaluation of cosmesis, surgical complication rate, time to radiotherapy start, and impact on delivery of lumpectomy cavity boost (LCB).
Materials/Methods: Under an IRB-approved protocol, the records of 49 patients treated for AJCC 8th edition Stage 0-IIB breast cancer with HFRT following BCS with RM were reviewed. All patients received HFRT utilizing a tangent technique without regional nodal irradiation to a dose of 40.05 Gy, 42.56 Gy, or 42.72 Gy in 15-16 fractions. 32/49 (65%) patients also received LCB (dose range 10-13.35 in 4-5 fractions). Patients were evaluated at follow-up as per the Harvard/NSABP/RTOG Breast Cosmesis grading scale, which was used routinely to assess patient cosmesis. Surgical complications were assessed and the time from surgery to radiation start was recorded. The impact of RM anatomy on the decision to include a LCB as a component of therapy was recorded. Chi square testing was used to assess differences in cosmesis according to delivery of LCB and presence of surgical complications.
Results: All patients completed the prescribed treatment. The median age at diagnosis was 56. The median follow-up time was 396 days from date of diagnosis, and 177 days from the end of treatment. No local recurrences occurred during the follow-up period. At Last follow-up, patient cosmesis included excellent (n=36, 73%), good (n=8, 16%), fair (n=3, 6%), and poor (n=2, 4%) outcomes. Surgical complications or delayed wound healing was observed in 8 patients (16%). Among the patients who did not receive adjuvant chemotherapy between surgery and HFRT, the median time from surgery to HFRT start was 49 days. No statistically significant difference in cosmesis was observed among patients who received a LCB versus those who did not (p=.958). Among 17 patients who did not receive a LCB, boost would have been given based on clinical risk features for 47% (8/17) of patients, but was not possible due to absence of a definable target following RM. Cosmesis was significantly worse among patients with post-operative complications (p=.012).
Conclusion: RM with HFRT results in acceptable cosmetic outcomes and may be a reasonable option for selected patients as a component of BCT. Given the potential for RM to obscure a lumpectomy cavity boost target and/or delay time to treatment start, early multidisciplinary evaluation is recommended to aid appropriate selection of patients for RM with BCT.
Author Disclosure: A. Avant: None. J. Ridings: workig under contract between uchealth and CUMedicine; UCHealth. M. DeWing: None. L. Pomerenke: None. F. Deleyiannis: None. G. Liebscher: self; Gregory J Liebscher, MD, PC. N. Wong: None. J.R. Olsen: Honoraria; Viewray, Inc. My wife received licensing fees from Varian resulting from development of intellectual property relating to knowledge based treatment planning; Varian Medical Systems. Research Grant; Viewray, Inc, Radiomed. Speaker's Bureau; Viewray, Inc. Travel Expenses; Viewray, Inc. Senior Associate Editor; International Journal of Radiation Oncology Biolog.