How do you apply the concept of a lumpectomy bed boost in the setting of oncoplastic surgery?

This is a very common and often frustrating issue in patients I absolutely feel the need to boost (younger, larger tumors, high grade).

I now consistently request my surgeons place a 3D tissue marker (brand name Biozorb) which preserves the location of the lumpectomy despite oncoplastic reconstruction. The device itself is a PDS lactate polymer that is resorbed over 12 months leaving six titanium fiducials behind permanently marking the prior lumpectomy. I also use Biozorb for my pbi cases.

Fo...

We see a significant number of patients undergoing oncoplastic reduction at our hospital. Our surgeons have not been placing clips for cavity definition given the significant tissue manipulation during the procedure (Belief is that clips would not paint an accurate picture of the cavity). Given the lack of demonstrated survival benefit from a boost and difficulty with cavity definition, we have not been boosting these patients.

I have to agree with all the above. Oncoplastic surgery is generally associated with a bigger specimen than a lumpectomy, which may give one some assurance. If clips are used, there should be a regular system of placing them - probably at the 6 margins - and they probably should be placed before tissue manipulation. However, they could fall off and be useless.

Most data suggest that the improvement in local control is small and, as noted above, rarely associated with a survival benefit. I would...

I've ended up having to do (reluctantly) mini-tangent boosts. I am not at all comfortable with doing this routinely and am in active discussions with our surgeons.

Oncoplastics has resulted in a much better cosmetic outcome for patients, but a much more difficult boost localization issue for radiation oncologists. I communicate more with the surgeon (actually review the CT sim contouring with the surgeon) and also ask that they place markers as per our consensus recommendations on oncoplastic tumor bed localization.

Tse et al., PMID 32669940

Even when they clip these cases (as surgeons should always do for the lumpectomy cavity anyways), my experience has been the clips are shifted all over the place without a clear target to boost. Maybe others have different experiences. If there is a situation where a boost is warranted, as many of the contributors to this thread have mentioned in separate threads (age, ER-, high grade, etc.), oncoplastic reduction should not be done. We typically discuss planned oncoplastic reductions at all our...