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Evaluating the Necessity of Radiation Boost After Oncoplastic Reduction in Breast-Conserving Surgery
Juhi Amin
*, Gloria Geil, Chelsea Marin, Candice Leach, Jose Guilherme Christiano, Jessica Gooch, Daniel Kim, Kimberly Gergelis, Anna Weiss
University of Rochester Medical Center, Rochester, NY
Background: Oncoplastic surgery combines tumor resection and reconstruction using volume displacement techniques to optimize both oncologic and aesthetic outcomes in breast-conserving surgery (BCS). After BCS, a standard radiation boost extending 1 cm circumferentially from the tumor bed reduces local recurrence. However, it becomes challenging after oncoplastic reduction due to tissue rearrangement. This study evaluates whether most patients undergoing oncoplastic reduction have ≥1 cm of tumor-free tissue resected beyond the partial mastectomy cavity, a margin that may allow for omission of the radiation boost.
Methods: A retrospective chart review of 32 oncoplastic reduction patients at Wilmot Cancer Center assessed whether margin clearance in lumpectomy with oncoplastic reduction is sufficient to consider omitting the radiation boost. Data collected included patient demographics, clinical characteristics, and pathology measurements of margin widths (anterior, posterior, superior, inferior, medial, and lateral) at initial oncologic surgery and additional margins from plastic surgery.
Results: Thirty-two patients were included (median age 58.5 years). Race distribution: 84% Caucasian, 9% Hispanic, 3% Asian, and 3% Black. Median BMI was 33.6. Histology: 75% ductal, 16% lobular, 6% mixed, and 3% periductal stromal tumor. Tumor staging: 29% Tis, 34% T1, 25% T2, 3% T3, and 6% unknown. 88% were clinically node-negative, 94% ER-positive, 81% PR-positive, and 9% HER2-positive. 53% of patients had a single oncologic procedure, 41% had two, and 6% had three.
After the oncologic surgery, margins in all six directions were >1.0 cm for 34% of patients. Among the rest, 31% had >1.0 cm in five directions, 22% in four, 9% in three, and 3% in two. Median dimensions of additional tissue resected by plastic surgery were 18 cm × 13 cm × 3.7 cm.
Conclusions: Oncoplastic reduction appears to extend margin clearance beyond 1 cm in most patients, potentially reducing the oncologic benefit of radiation boost. Future studies should explore the safety of omitting the boost in this population.
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