TY - JOUR
T1 - A prospective cohort study to analyze the interaction of tumor-to-breast volume in breast conservation therapy versus mastectomy with reconstruction
AU - Dolen, Utku
AU - Thornton, Melissa
AU - Tenenbaum, Marissa M.
AU - Aripoli, Allison
AU - Patel, Amy
AU - Cyr, Amy E.
AU - Yan, Yan
AU - Appleton, Catherine M.
AU - Margenthaler, Julie A.
AU - Myckatyn, Terence M.
N1 - Funding Information:
This study was funded by an investigator-initiated grant from Allergan Inc. to Dr. Myckatyn (IIT-2017-10075). Dr. Myckatyn receives grant funding, consultant, and advisory board fees from Allergan, and investigator-initiated grant funding and consultant fees from RTI. Dr. Tenenbaum receives grant funding and consultant fees from Allergan, grant funding from Mentor, and advisory board and consulting fees from RTI. Dr. Appleton received consulting income from WhiteRabbit Inc. There are no other relevant disclosures for any of the authors. Acknowledgements
Funding Information:
The authors are grateful to Colleen Kilbourne-Glynn, Corrine Merrill, and Darlene Bird for data organization, IRB management, and administration of patient-reported outcome questionnaires throughout the study period. We are grateful to Tracey Guthrie and Annette Irving for providing compliance and administrative support and to information technology support at Washington University related to three-dimensional photography. We are grateful to Allergan Inc. for awarding the investigator-initiated grant (IIT-2017-10075) that funded this work.
Publisher Copyright:
© 2020, Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2020/6/1
Y1 - 2020/6/1
N2 - Purpose: We explored the impact of the relative volume of a tumor versus the entire breast on outcomes in patients undergoing breast conservation therapy (BCT) versus mastectomy and reconstruction (M + R). We hypothesized that there would be a threshold tumor:breast ratio (TBR) below which patient-reported outcomes (PRO) would favor BCT and above which would favor M + R. Methods: We conducted a prospective cohort study of patients with ductal carcinoma in situ (DCIS) or invasive breast cancers undergoing BCT or M + R. A prerequisite for inclusion, analysis of tumor and breast volumes was conducted from three-dimensional magnetic resonance imaging reconstructions to calculate the TBR. Three-dimensional photography was utilized to calculate pre- and postoperative volumes and assess symmetry. Oncologic, surgical, and patient-reported outcome data were obtained from relevant BREAST-Q modules administered pre- and postoperatively. Results: The BCT cohort had significantly smaller tumor volumes (p = 0.001) and lower TBRs (p = 0.001) than patients undergoing M + R overall. The M + R group, however, comprised a broader range of TBRs, characterized at lower values by patients opting for contralateral prophylactic mastectomy. Postoperative satisfaction with breasts, psychosocial, and sexual well-being scores were significantly higher in the BCT cohort, while physical well-being significantly favored the M + R cohort 480.2 ± 286.3 and 453.1 ± 392.7 days later, respectively. Conclusions: Relative to BCT, M + R was used to manage a broad range of TBRs. The relative importance of oncologic and surgical risk reduction, symmetry, and number of procedures can vary considerably and may limit the utility of TBR as a guide for deciding between BCT and M + R. Clinical Trial StatementThis study was registered with clinicaltrials.gov as “A Prospective Trial to Assess Tumor:Breast Ratio and Patient Satisfaction Following Lumpectomy Versus Mastectomy With Reconstruction”, Identifier: NCT02216136.
AB - Purpose: We explored the impact of the relative volume of a tumor versus the entire breast on outcomes in patients undergoing breast conservation therapy (BCT) versus mastectomy and reconstruction (M + R). We hypothesized that there would be a threshold tumor:breast ratio (TBR) below which patient-reported outcomes (PRO) would favor BCT and above which would favor M + R. Methods: We conducted a prospective cohort study of patients with ductal carcinoma in situ (DCIS) or invasive breast cancers undergoing BCT or M + R. A prerequisite for inclusion, analysis of tumor and breast volumes was conducted from three-dimensional magnetic resonance imaging reconstructions to calculate the TBR. Three-dimensional photography was utilized to calculate pre- and postoperative volumes and assess symmetry. Oncologic, surgical, and patient-reported outcome data were obtained from relevant BREAST-Q modules administered pre- and postoperatively. Results: The BCT cohort had significantly smaller tumor volumes (p = 0.001) and lower TBRs (p = 0.001) than patients undergoing M + R overall. The M + R group, however, comprised a broader range of TBRs, characterized at lower values by patients opting for contralateral prophylactic mastectomy. Postoperative satisfaction with breasts, psychosocial, and sexual well-being scores were significantly higher in the BCT cohort, while physical well-being significantly favored the M + R cohort 480.2 ± 286.3 and 453.1 ± 392.7 days later, respectively. Conclusions: Relative to BCT, M + R was used to manage a broad range of TBRs. The relative importance of oncologic and surgical risk reduction, symmetry, and number of procedures can vary considerably and may limit the utility of TBR as a guide for deciding between BCT and M + R. Clinical Trial StatementThis study was registered with clinicaltrials.gov as “A Prospective Trial to Assess Tumor:Breast Ratio and Patient Satisfaction Following Lumpectomy Versus Mastectomy With Reconstruction”, Identifier: NCT02216136.
KW - Lumpectomy
KW - Mammometrics
KW - Mastectomy
KW - Patient-reported outcomes
KW - Post-mastectomy reconstruction
KW - Radiation
UR - http://www.scopus.com/inward/record.url?scp=85084207295&partnerID=8YFLogxK
U2 - 10.1007/s10549-020-05639-w
DO - 10.1007/s10549-020-05639-w
M3 - Article
C2 - 32350679
AN - SCOPUS:85084207295
VL - 181
SP - 611
EP - 621
JO - Breast Cancer Research and Treatment
JF - Breast Cancer Research and Treatment
SN - 0167-6806
IS - 3
ER -