Abbas M Hassan, Carson Park, Kathryn Borders, Rachel M Danforth, Ravinder Bamba, R Jason VonDerHaar, Ivan Hadad, Mary E Lester, Carla S Fisher, Aladdin H Hassanein
{"title":"Association of Adjuvant Radiotherapy De-Escalation With Outcomes Following Oncoplastic Breast-Conserving Surgery.","authors":"Abbas M Hassan, Carson Park, Kathryn Borders, Rachel M Danforth, Ravinder Bamba, R Jason VonDerHaar, Ivan Hadad, Mary E Lester, Carla S Fisher, Aladdin H Hassanein","doi":"10.1002/jso.70425","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Adjuvant radiotherapy (RT) following breast-conserving surgery reduces local recurrence but can introduce reconstructive morbidity. Although recent trials support the safe omission of RT in selected patients, its impact on surgical and patient-reported outcomes following oncoplastic breast-conserving surgery (OPBCS) remains poorly defined. We evaluated surgical and long-term patient-reported outcomes in patients undergoing OPBCS, stratified by receipt of RT.</p><p><strong>Methods: </strong>We retrospectively studied consecutive patients who underwent OPBCS between 2017 and 2024 for stage 0-3 breast cancer. Patients were stratified based on receipt of RT. Postoperative complications, unplanned reoperation, and revision procedures were compared between cohorts. Long-term patient-reported outcomes were assessed using the validated BREAST-Q Reconstruction Module. Multivariable regression was used to evaluate the independent association between RT status and outcomes.</p><p><strong>Results: </strong>We identified 257 patients; 210 patients received RT (81.7%) and 47 underwent RT de-escalation (18.3%). Surgical site infection (p = 0.100), delayed wound healing (p = 0.300), and skin flap necrosis rates (p = 0.0300) were similar between cohorts. Seroma (30% vs. 13%; p = 0.006) and unplanned reoperation (21% vs. 7.1%; p = 0.006) were more frequent with RT omission. Patients who did not receive RT demonstrated significantly higher mean Satisfaction with Breasts scores compared with those who received RT (57 ± 25 vs. 23 ± 24; p = 0.001). In adjusted models, RT de-escalation was associated with a 36-point increase in Satisfaction with Breasts scores (β = 36.0; 95% CI, 18.0-54.0; p < 0.001).</p><p><strong>Conclusions: </strong>RT omission was independently associated with higher patient-reported satisfaction with breasts, though patients had higher seroma and reoperation rates. These data support balanced shared decision-making for RT de-escalation in appropriately selected patients.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9000,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Surgical Oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/jso.70425","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Adjuvant radiotherapy (RT) following breast-conserving surgery reduces local recurrence but can introduce reconstructive morbidity. Although recent trials support the safe omission of RT in selected patients, its impact on surgical and patient-reported outcomes following oncoplastic breast-conserving surgery (OPBCS) remains poorly defined. We evaluated surgical and long-term patient-reported outcomes in patients undergoing OPBCS, stratified by receipt of RT.
Methods: We retrospectively studied consecutive patients who underwent OPBCS between 2017 and 2024 for stage 0-3 breast cancer. Patients were stratified based on receipt of RT. Postoperative complications, unplanned reoperation, and revision procedures were compared between cohorts. Long-term patient-reported outcomes were assessed using the validated BREAST-Q Reconstruction Module. Multivariable regression was used to evaluate the independent association between RT status and outcomes.
Results: We identified 257 patients; 210 patients received RT (81.7%) and 47 underwent RT de-escalation (18.3%). Surgical site infection (p = 0.100), delayed wound healing (p = 0.300), and skin flap necrosis rates (p = 0.0300) were similar between cohorts. Seroma (30% vs. 13%; p = 0.006) and unplanned reoperation (21% vs. 7.1%; p = 0.006) were more frequent with RT omission. Patients who did not receive RT demonstrated significantly higher mean Satisfaction with Breasts scores compared with those who received RT (57 ± 25 vs. 23 ± 24; p = 0.001). In adjusted models, RT de-escalation was associated with a 36-point increase in Satisfaction with Breasts scores (β = 36.0; 95% CI, 18.0-54.0; p < 0.001).
Conclusions: RT omission was independently associated with higher patient-reported satisfaction with breasts, though patients had higher seroma and reoperation rates. These data support balanced shared decision-making for RT de-escalation in appropriately selected patients.
期刊介绍：
The Journal of Surgical Oncology offers peer-reviewed, original papers in the field of surgical oncology and broadly related surgical sciences, including reports on experimental and laboratory studies. As an international journal, the editors encourage participation from leading surgeons around the world. The JSO is the representative journal for the World Federation of Surgical Oncology Societies. Publishing 16 issues in 2 volumes each year, the journal accepts Research Articles, in-depth Reviews of timely interest, Letters to the Editor, and invited Editorials. Guest Editors from the JSO Editorial Board oversee multiple special Seminars issues each year. These Seminars include multifaceted Reviews on a particular topic or current issue in surgical oncology, which are invited from experts in the field.
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