Abstract
Introduction Breast conserving surgery (BCS) followed by radiation therapy (RT) has become the preferred alternative to mastectomy for patients with early stage breast cancer (BC). Randomized trials have confirmed equivalent locoregional control and overall survival for BCS and mastectomy. Extreme Oncoplasty (EO) extends the indications of BCS for patients who would otherwise require mastectomy, ensuring better aesthetic outcomes and oncological safety. Methods BC patients with multifocal/multicentric (MF/MC) tumors, extensive DCIS, or large tumor >50mm underwent EO at our breast unit. Therapeutic reduction mammaplasty (TRM) with wise pattern preoperative markings and dual pedicle technique involving parenchymal rearrangement was used for oncoplastic reconstructions in majority of the cases followed by RT. Patient reported outcome measures (PROMs) were assessed using the validated Breast-Q questionnaire. Results Of the 39 patients in the study, 36 had unilateral and 3 had bilateral BC. Mean age was 47.2 years. Median tumor size was 75mm. 17 (43.6%) patients received NACT; none achieved a complete clinical response. 28 (71.8%) patients were administered to adjuvant chemotherapy. 33(84.6%) patients received RT to the breast with a median dose of 50Gy in 28 fractions and a boost dose of 10Gy in 5 fractions to the tumor bed. No major complications or local recurrences were observed. Excellent Breast-Q scores were observed in patients undergoing EO after 12 months of follow-up. Conclusion EO followed by RT results in acceptable local-regional control, low rate of complications, and high patient satisfaction. In selected patients, EO could provide a safe alternative for breast conservation surgery instead of mastectomy.
Highlights
Breast conserving surgery (BCS) followed by radiation therapy (RT) has become the preferred alternative to mastectomy for patients with early stage breast cancer (BC)
Recent studies from various countries including India indicate that women treated with Breast conservation therapy (BCT) have a significant survival advantage when compared to mastectomy [5,6,7]
Breast surgeons are attempting to extend the scope of breast conservation so as to include scenarios which are otherwise contraindicated for breast conservation surgery (BCS) in multicentric (MC) or multifocal (MF) tumors
Summary
Breast conserving surgery (BCS) followed by radiation therapy (RT) has become the preferred alternative to mastectomy for patients with early stage breast cancer (BC). EO followed by RT results in acceptable local-regional control, low rate of complications, and high patient satisfaction. Breast conservation therapy (BCT) which includes breast conservation surgery (BCS) and adjuvant radiation therapy (RT) is a standard protocol to achieve high local control with acceptable aesthetic outcomes [1,2,3]. Multiple prospective randomized trials [4], some with a follow-up of 20 years, have established equivalent survival rates between mastectomy and breast conservation surgery (BCS) with negative margins. Breast surgeons are attempting to extend the scope of breast conservation so as to include scenarios which are otherwise contraindicated for BCS in multicentric (MC) or multifocal (MF) tumors. Significant local recurrence rates (2.5% to ∼ 40%) have limited the utility of mastectomy in such scenarios [11,12,13,14,15]
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