A study of margin width and local recurrence in breast conserving therapy for invasive breast cancer

J. M. Dixon (Lead / Corresponding author), J. Thomas, G. R. Kerr, L. J. Williams, C. Dodds, I. H. Kunkler, E. J. Macaskill

    Research output: Contribution to journalArticle

    7 Citations (Scopus)

    Abstract

    Purpose: Debate continues on what is an adequate margin width to define a clear margin and whether there is a need to excise pectoral fascia or remove skin in breast conserving surgery. This study set out to provide answers to these questions.

    Patients and methods: 1411 patients with invasive breast cancer were treated by breast conserving surgery and post-operative whole breast radiotherapy from January 2000 to December 2005. Distance from each margin to any in situ or invasive cancer was measured and recorded. If full thickness of breast tissue was removed no re excision of anterior and posterior margins was performed even if disease was <1 mm from a margin. Patients ≤50 years of age and those with anterior or posterior margins <1 mm to invasive cancer had a radiation boost. Median follow-up time was 6.4 years.

    Results: Local in breast tumour relapse (IBTR) occurred in 50 patients. The overall actuarial IBTR rate at 5 years was 2.2%. There was no difference in IBTR when comparing patients with radial margins of 1-5 mm or 5-10 mm. Anterior and posterior margins <1 mm or with ink on tumour cells were not associated with an increase in IBTR.

    Conclusion: There is no justification for radial margins of greater than 1 mm. If the anterior or posterior margin is <1 mm and full thickness of breast tissue has been removed, then re excision of these margins is unnecessary if boost radiotherapy is delivered.

    Original languageEnglish
    Pages (from-to)657-64
    Number of pages8
    JournalEuropean Journal of Surgical Oncology
    Volume42
    Issue number5
    Early online date18 Feb 2016
    DOIs
    Publication statusPublished - May 2016

    Fingerprint

    Breast
    Breast Neoplasms
    Recurrence
    Segmental Mastectomy
    Radiotherapy
    Therapeutics
    Neoplasms
    Ink
    Fascia
    Radiation
    Skin

    Keywords

    • Margin width
    • Local recurrence
    • Breast conserving surgery
    • Invasive breast cancer

    Cite this

    Dixon, J. M., Thomas, J., Kerr, G. R., Williams, L. J., Dodds, C., Kunkler, I. H., & Macaskill, E. J. (2016). A study of margin width and local recurrence in breast conserving therapy for invasive breast cancer. European Journal of Surgical Oncology, 42(5), 657-64. https://doi.org/10.1016/j.ejso.2016.02.008
    Dixon, J. M. ; Thomas, J. ; Kerr, G. R. ; Williams, L. J. ; Dodds, C. ; Kunkler, I. H. ; Macaskill, E. J. / A study of margin width and local recurrence in breast conserving therapy for invasive breast cancer. In: European Journal of Surgical Oncology. 2016 ; Vol. 42, No. 5. pp. 657-64.
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    abstract = "Purpose: Debate continues on what is an adequate margin width to define a clear margin and whether there is a need to excise pectoral fascia or remove skin in breast conserving surgery. This study set out to provide answers to these questions.Patients and methods: 1411 patients with invasive breast cancer were treated by breast conserving surgery and post-operative whole breast radiotherapy from January 2000 to December 2005. Distance from each margin to any in situ or invasive cancer was measured and recorded. If full thickness of breast tissue was removed no re excision of anterior and posterior margins was performed even if disease was <1 mm from a margin. Patients ≤50 years of age and those with anterior or posterior margins <1 mm to invasive cancer had a radiation boost. Median follow-up time was 6.4 years.Results: Local in breast tumour relapse (IBTR) occurred in 50 patients. The overall actuarial IBTR rate at 5 years was 2.2{\%}. There was no difference in IBTR when comparing patients with radial margins of 1-5 mm or 5-10 mm. Anterior and posterior margins <1 mm or with ink on tumour cells were not associated with an increase in IBTR.Conclusion: There is no justification for radial margins of greater than 1 mm. If the anterior or posterior margin is <1 mm and full thickness of breast tissue has been removed, then re excision of these margins is unnecessary if boost radiotherapy is delivered.",
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    Dixon, JM, Thomas, J, Kerr, GR, Williams, LJ, Dodds, C, Kunkler, IH & Macaskill, EJ 2016, 'A study of margin width and local recurrence in breast conserving therapy for invasive breast cancer', European Journal of Surgical Oncology, vol. 42, no. 5, pp. 657-64. https://doi.org/10.1016/j.ejso.2016.02.008

    A study of margin width and local recurrence in breast conserving therapy for invasive breast cancer. / Dixon, J. M. (Lead / Corresponding author); Thomas, J.; Kerr, G. R.; Williams, L. J.; Dodds, C.; Kunkler, I. H.; Macaskill, E. J.

    In: European Journal of Surgical Oncology, Vol. 42, No. 5, 05.2016, p. 657-64.

    Research output: Contribution to journalArticle

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    AU - Dixon, J. M.

    AU - Thomas, J.

    AU - Kerr, G. R.

    AU - Williams, L. J.

    AU - Dodds, C.

    AU - Kunkler, I. H.

    AU - Macaskill, E. J.

    N1 - Copyright © 2016 Elsevier Ltd. All rights reserved.

    PY - 2016/5

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    N2 - Purpose: Debate continues on what is an adequate margin width to define a clear margin and whether there is a need to excise pectoral fascia or remove skin in breast conserving surgery. This study set out to provide answers to these questions.Patients and methods: 1411 patients with invasive breast cancer were treated by breast conserving surgery and post-operative whole breast radiotherapy from January 2000 to December 2005. Distance from each margin to any in situ or invasive cancer was measured and recorded. If full thickness of breast tissue was removed no re excision of anterior and posterior margins was performed even if disease was <1 mm from a margin. Patients ≤50 years of age and those with anterior or posterior margins <1 mm to invasive cancer had a radiation boost. Median follow-up time was 6.4 years.Results: Local in breast tumour relapse (IBTR) occurred in 50 patients. The overall actuarial IBTR rate at 5 years was 2.2%. There was no difference in IBTR when comparing patients with radial margins of 1-5 mm or 5-10 mm. Anterior and posterior margins <1 mm or with ink on tumour cells were not associated with an increase in IBTR.Conclusion: There is no justification for radial margins of greater than 1 mm. If the anterior or posterior margin is <1 mm and full thickness of breast tissue has been removed, then re excision of these margins is unnecessary if boost radiotherapy is delivered.

    AB - Purpose: Debate continues on what is an adequate margin width to define a clear margin and whether there is a need to excise pectoral fascia or remove skin in breast conserving surgery. This study set out to provide answers to these questions.Patients and methods: 1411 patients with invasive breast cancer were treated by breast conserving surgery and post-operative whole breast radiotherapy from January 2000 to December 2005. Distance from each margin to any in situ or invasive cancer was measured and recorded. If full thickness of breast tissue was removed no re excision of anterior and posterior margins was performed even if disease was <1 mm from a margin. Patients ≤50 years of age and those with anterior or posterior margins <1 mm to invasive cancer had a radiation boost. Median follow-up time was 6.4 years.Results: Local in breast tumour relapse (IBTR) occurred in 50 patients. The overall actuarial IBTR rate at 5 years was 2.2%. There was no difference in IBTR when comparing patients with radial margins of 1-5 mm or 5-10 mm. Anterior and posterior margins <1 mm or with ink on tumour cells were not associated with an increase in IBTR.Conclusion: There is no justification for radial margins of greater than 1 mm. If the anterior or posterior margin is <1 mm and full thickness of breast tissue has been removed, then re excision of these margins is unnecessary if boost radiotherapy is delivered.

    KW - Margin width

    KW - Local recurrence

    KW - Breast conserving surgery

    KW - Invasive breast cancer

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    DO - 10.1016/j.ejso.2016.02.008

    M3 - Article

    VL - 42

    SP - 657

    EP - 664

    JO - European Journal of Surgical Oncology

    JF - European Journal of Surgical Oncology

    SN - 0748-7983

    IS - 5

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