Top

Published in:

01-04-2013 | Radiation Oncology

Lumpectomy Closure Technique Does Not Affect Dosimetry in Patients Undergoing External-Beam-Based Accelerated Partial Breast Irradiation

Authors: Talha Shaikh, MD, Venkat Narra, PhD, Sharad Goyal, MD, Stuti Ahlawat, MD, Laurie Kirstein, MD, Thomas Kearney, MD, Bruce G. Haffty, MD, Atif J. Khan, MD

Published in: Annals of Surgical Oncology | Issue 4/2013

Abstract

Background

During the breast lumpectomy procedure, surgeons traditionally elect to use either a superficial or full-thickness closure when sealing the wound depending on surgeon preference as well as desired outcomes. The purpose of this study was to examine dosimetric endpoints in patients with superficial versus full-thickness closures with accelerated partial breast irradiation (APBI).

Methods

Patients who underwent breast conservation surgery followed by 3D conformal external-beam APBI were identified (n = 45) and were separated according to the type of cavity closure performed: superficial and full thickness. Data gathered from the retrospective review of patient charts was analyzed according to criteria in the NSABP B-39 protocol in order to quantify the amount of radiation delivered to organs at risk. The patient seroma cavity was further given a cavity visualization score to assess the impact of wound closure on treatment planning.

Results

There was no significant difference in the mean CVS score for the 2 groups. There were no statistical differences in all dosimetric endpoints compared for the 2 types of closure, and both groups met NSABP B-39 guidelines for the ipsilateral breast, heart, and ipsilateral lung dosimetry.

Conclusions

We found no significant difference in dosimetric outcomes in either the superficial or deep closure treatment groups. Breast surgeons should not alter their preferred closure strategy in anticipation of 3D-CRT APBI.

Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–41.PubMedCrossRef

Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347:1227–32.PubMedCrossRef

Khan AJ, Vicini F, Beitsch P, Haffty B, Quiet C, Keleher A, et al. Local control, toxicity, and cosmesis in women younger than 50 enrolled onto the American Society of Breast Surgeons MammoSite Radiation Therapy System registry trial. Ann Surg Oncol. 2009;16:1612–8.PubMedCrossRef

Vicini FA, Kestin L, Chen P, Benitez P, Goldstein NS, Martinez A. Limited-field radiation therapy in the management of early-stage breast cancer. J Natl Cancer Inst. 2003;95:1205–10.PubMedCrossRef

Landis DM, Luo W, Song J, Bellon JR, Punglia RS, Wong JS, et al. Variability among breast radiation oncologists in delineation of the postsurgical lumpectomy cavity. Int J Radiat Oncol Biol Phys. 2007;67:1299–308.PubMedCrossRef

Agrawal A, Ayantunde AA, Cheung KL. Concepts of seroma formation and prevention in breast cancer surgery. ANZ J Surg. 2006;76:1088–95.PubMedCrossRef

Bonnema J, Ligtenstein DA, Wiggers T, van Geel AN. The composition of serous fluid after axillary dissection. Eur J Surg. 1999;165:9–13.PubMedCrossRef

Ellis LM, Bland KI. Techniques for obtaining the diagnosis of malignant breast lesions. Surg Clin North Am. 1990;70:815–30.PubMed

Indelicato D, Grobmyer SR, Newlin H, Morris CG, Haigh LS, Copeland EM 3rd, et al. Association between operative closure type and acute infection, local recurrence, and disease surveillance in patients undergoing breast conserving therapy for early-stage breast cancer. Surgery. 2007;141:645–53.PubMedCrossRef

10.

Indelicato DJ, Grobmyer SR, Newlin H, Morris CG, Haigh LS, Copeland EM 3rd, et al. Delayed breast cellulitis: an evolving complication of breast conservation. Int J Radiat Oncol Biol Phys. 2006;66:1339–46.PubMedCrossRef

11.

Holmberg L, Zaren E, Adami HO, Bergstrom R, Burns T. The patient’s appraisal of the cosmetic result of segmental mastectomy in benign and malignant breast disease. Ann Surg. 1988;207:189–94.PubMedCrossRef

12.

Wapnir IL, Alden-Corbett S, Zicherman B, Greco RS. Mammographic changes following biopsy and lumpectomy-breast irradiation. N J Med. 1993;90:55–9.PubMed

13.

Paterson ML, Nathanson SD, Havstad S. Hematomas following excisional breast biopsies for invasive breast carcinoma: the influence of deep suture approximation of breast parenchyma. Am Surg. 1994;60:845–8.PubMed

14.

Newlin HE, Indelicato DJ, Abbitt P, Marshall J, Wymer D, Grobmyer S, et al. Does surgical closure technique affect early mammographic detection of tumor recurrence after breast-conserving therapy? Am J Clin Oncol. 2009;32:499–503.PubMedCrossRef

15.

National Surgical Adjuvant Breast and Bowel Project. Protocol B-39/RTOG 0413: A randomized Phase III study of conventional whole breast irradiation (WBI) versus partial breast irradiation (PBI) for women with stage 0, I, or II breast cancer [study protocol] NSABP, Pittsburgh, PA; 2005.

16.

Smitt MC, Birdwell RL, Goffinet DR. Breast electron boost planning: comparison of CT and US. Radiology. 2001;219:203–6.PubMed

17.

Shaikh T, Chen T, Khan A, Yue NJ, Kearney T, Cohler A, et al. Improvement in interobserver accuracy in delineation of the lumpectomy cavity using fiducial markers. Int J Radiat Oncol Biol Phys. 2010;78:1127–34.PubMedCrossRef

18.

Yue NJ, Goyal S, Zhou J, Khan AJ, Haffty BG. Intrafractional target motions and uncertainties of treatment setup reference systems in accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys. 2011;79:1549–56.PubMedCrossRef

19.

Aspegren K, Holmberg L, Adami HO. Standardization of the surgical technique in breast-conserving treatment of mammary cancer. Br J Surg. 1988;75:807–10.PubMedCrossRef

20.

Scanlon EF. The breast biopsy. Cancer. 1989;64:2671–3.PubMedCrossRef

21.

Al-Ghazal SK, Blamey RW, Stewart J, Morgan AA. The cosmetic outcome in early breast cancer treated with breast conservation. Eur J Surg Oncol. 1999;25:566–70.PubMedCrossRef

22.

Law NW, Johnson CD, Lamont PM, Ellis H. Drainage or suture of the cavity after breast biopsy. Ann R Coll Surg Engl. 1990;72:11–3.PubMed

23.

Pignatelli V, Basolo F, Bagnolesi A, Cartei F, Grassi L, Savino A, et al. Hematoma and fat necrosis of the breast: mammographic and echographic features. Radiol Med. 1995;89:36–41.PubMed

24.

Schwarz E. Hematoma in a mammogram mimicking a malignancy. Contribution to the differential diagnosis of breast carcinoma. Rofo. 1982;136:346–7.PubMedCrossRef

Title: Lumpectomy Closure Technique Does Not Affect Dosimetry in Patients Undergoing External-Beam-Based Accelerated Partial Breast Irradiation
Authors: Talha Shaikh, MD
Venkat Narra, PhD
Sharad Goyal, MD
Stuti Ahlawat, MD
Laurie Kirstein, MD
Thomas Kearney, MD
Bruce G. Haffty, MD
Atif J. Khan, MD
Publication date: 01-04-2013
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 4/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-012-2775-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Lumpectomy Closure Technique Does Not Affect Dosimetry in Patients Undergoing External-Beam-Based Accelerated Partial Breast Irradiation

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 4/2013

A Phase II, Randomized, Controlled Trial of Acupuncture for Reduction of Postcolectomy Ileus

Novel Multimodality Treatment Sequencing for Extrahepatic (Mid and Distal) Cholangiocarcinoma

Surveillance MR Imaging is Superior to Serum Tumor Markers for Detecting Early Tumor Recurrence in Patients with Appendiceal Cancer Treated with Surgical Cytoreduction and HIPEC

Should Ductal Carcinoma-in-situ (DCIS) Be Removed from the ASTRO Consensus Panel Cautionary Group for Off-protocol Use of Accelerated Partial Breast Irradiation (APBI)? A Pooled Analysis of Outcomes for 300 Patients with DCIS Treated with APBI

Blurry Boundaries: Do Epithelial Borderline Lesions of the Breast and Ductal Carcinoma In Situ Have Similar Rates of Subsequent Invasive Cancer?

Laparoscopic Hepatic Posterior Sectionectomy: A Hand-assisted Approach