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Radiation Therapy for Breast Cancer Patients Who Undergo Oncoplastic Surgery: Localization of the Tumor Bed for the Local Boost

Pezner, Richard D. MD*; Tan, Mark C. MD; Clancy, Sharon L. MD; Chen, Yi-Jen MD, PhD*; Joseph, Thomas CMD*; Vora, Nayana L. MD*

American Journal of Clinical Oncology: December 2013 - Volume 36 - Issue 6 - p 535–539
doi: 10.1097/COC.0b013e318256efba
Original Articles: Breast

Introduction: Oncoplastic reconstructive surgery is performed in select patients with breast cancer to allow conservation treatment when the lumpectomy would be expected to have a poor cosmetic outcome. These techniques not only rearrange the breast tissue but may also shift the position of the tumor bed. The oncoplastic incision may have no relationship to the tumor bed. Although use of whole-breast radiation therapy (RT) is straightforward, difficulties in localization of the tumor bed for the local RT boost have not been investigated.

Materials and Methods: A retrospective review was performed of 25 patients with 26 cancers who received RT after breast conservation surgery with oncoplastic reconstruction.

Results: Among 11 patients with a minimum of 4 surgical clips placed at tumor resection, 8 (73%) had the final tumor bed extend beyond the original breast quadrant or be completely relocated into a different region. In 3 (27%) cases, the clinical treatment volume was 2 to 3 separated regions within the breast.

Discussion: For breast cancer patients who have had oncoplastic surgery, the tumor bed is frequently more extensive and possibly relocated compared with original presentation. Placement of surgical clips after tumor resection and before oncoplastic reconstruction may be the most accurate method to localize the RT local boost field.

*Department of Radiation Oncology

Division of Plastic and Reconstructive Surgery, City of Hope Medical Center, Duarte, CA

The authors declare no conflicts of interest.

Reprints: Richard D. Pezner, MD, Department of Radiation Oncology, City of Hope Medical Center, 1500 E. Duarte Rd, Duarte, CA 91010. E-mail:

© 2013 by Lippincott Williams & Wilkins, Inc