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

¹ Deparment of Radiation Oncology, Virginia Commonwealth University, Medical College of Virginia Campus, 401 College Street, Box 58, Richmond, Virginia 23298
² Radiation Oncology, New England Medical Center, Tufts University School of Medicine, 750 Washington Street, Boston, Massachusetts 02111
³ Brown University School of Medicine, Rhode Island Hospital, 593 Eddy Street, Providence, Rhode Island 02903
⁴ Division of Surgical Oncology, Virginia Commonwealth University, Medical College of Virginia Campus, 401 College Street, Box 11, Richmond, Virginia 23298
⁵ Division of Biostatistics, Virginia Commonwealth University, Medical College of Virginia Campus, 401 College Street, Box 32, Richmond, Virginia 23298

Correspondence: Address correspondence and reprint requests to: Douglas W. Arthur, MD; E-mail: darthur{at}mcvh-vcu.edu.

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.

Key Words: Breast-conservation therapy • Radiotherapy • Lumpectomy • Radiation boost