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Tumor Bed Boost Omission After Negative Re-Excision in Breast-Conservation Treatment

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Abstract

Background

We evaluated the necessity of a tumor bed boost after whole-breast radiotherapy for early-stage breast cancer after breast-conserving surgery and negative re-excision.

Methods

Of patients treated at the Virginia Commonwealth and Tufts Universities with breast-conservation therapy for early-stage breast cancer between 1983 and 1999, 205 required re-excision of the tumor cavity to obtain clear margins and were found to be without residual disease. Adjuvant conventionally fractionated whole-breast radiotherapy was given to a total dose of 50 Gy in 25 fractions. The tumor bed boost was omitted.

Results

The median follow-up was 98 months (range, 6–229 months). The tumor histological diagnosis was primarily infiltrating ductal carcinoma (183 cases; 89%). Nodal involvement was documented in 49 cases (24%). There were four documented recurrences at the tumor bed site. Five in-breast recurrences were documented to be in a location removed from the tumor bed. The overall Kaplan-Meier 15-year in-breast control rate was 92.4%, and the freedom from true recurrence rate was 97.6%.

Conclusions

The findings support the concept that postlumpectomy radiotherapy can be tailored according to the degree of surgical resection. There is an easily identifiable subgroup of patients who can avoid a tumor bed boost, thus resulting in a reduced treatment time and improved cosmesis, while maintaining local control rates that approach 100%. The data suggest that in patients who undergo a negative re-excision, treatment with whole-breast radiotherapy to 50 Gy is a sufficient dose to maximally reduce the risk of local recurrence.

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Authors and Affiliations

  1. Deparment of Radiation Oncology, Virginia Commonwealth University, Medical College of Virginia Campus, 401 College Street, Box 58, Richmond, Virginia, 23298

    Douglas W. Arthur MD, Laurie W. Cuttino MD, Derrick T. Koo MD & Monica M. Morris MD

  2. Radiation Oncology, New England Medical Center, Tufts University School of Medicine, 750 Washington Street, Boston, Massachusetts, 02111

    Andrew C. Neuschatz MD & David E. Wazer MD

  3. Brown University School of Medicine, Rhode Island Hospital, 593 Eddy Street, Providence, Rhode Island, 02903

    Andrew C. Neuschatz MD & David E. Wazer MD

  4. Division of Surgical Oncology, Virginia Commonwealth University, Medical College of Virginia Campus, 401 College Street, Box 11, Richmond, Virginia, 23298

    Harry D. Bear MD, PhD & Brian J. Kaplan MD

  5. Division of Biostatistics, Virginia Commonwealth University, Medical College of Virginia Campus, 401 College Street, Box 32, Richmond, Virginia, 23298

    Kathy Dawson PhD

Authors
  1. Douglas W. Arthur MD
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  2. Laurie W. Cuttino MD
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  3. Andrew C. Neuschatz MD
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  4. Derrick T. Koo MD
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  6. Harry D. Bear MD, PhD
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  7. Brian J. Kaplan MD
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  8. Kathy Dawson PhD
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  9. David E. Wazer MD
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Correspondence to Douglas W. Arthur MD.

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Arthur, D.W., Cuttino, L.W., Neuschatz, A.C. et al. Tumor Bed Boost Omission After Negative Re-Excision in Breast-Conservation Treatment. Ann Surg Oncol 13, 794–801 (2006). https://doi.org/10.1245/ASO.2006.04.002

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  • DOI: https://doi.org/10.1245/ASO.2006.04.002

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