Stabilised Hyaluronic Acid (sHA) gel as a novel marker for breast cancer tumour bed cavity: Surgical feasibility.

Introduction: Consistent delineation of the breast conserving surgery (BCS) tumour bed (TB) for breast cancer remains a challenge for radiation oncologists. Accurate delineation allows for better local control and reduces toxicity when planning partial breast or TB boost radiation therapy (RT). Methods: In the operating theatre (OT) breast surgeons inserted stabilised hyaluronic acid (sHA) gel as small drops approximately one cm into the walls surrounding the resection cavity. Surgical feasibility was determined by the rate of successful sHA gel insertion procedure, the ease of insertion as rated by surgeons, the time required for insertion procedure, the quantity used, and any adverse events (AE) relating to sHA gel insertion. Results: Thirty-five patients were enrolled. All patients underwent sHA gel insertion successfully. The procedure added a median of 2.8 min to the OT time and was rated as 'easy' in 89 % of patients. There were no immediate AE in OT. Five (14 %) patients experienced a grade 2 or higher AE. Three of the five patients were prescribed oral antibiotics for breast infection. Two of the five patients experienced a grade 3 AE - haematoma which required evacuation in OT day 1 post-BCS, and infected seroma which required drainage and washout in OT 2 months post-BCS. All five patients recovered and underwent the planned adjuvant therapies for their BC. The AE data reflects common risks with standard BCS and are not clearly attributed to sHA gel insertion alone. Conclusion: We show that sHA gel is surgically feasible as a marker to help define the TB cavity for post-BCS adjuvant MRI-based RT planning.

Pathologic Complete Response and Oncologic Outcomes in Locally Advanced Breast Cancers Treated With Neoadjuvant Radiation Therapy: An Australian Perspective.

PURPOSE: To assess the degree of pathologic complete response (pCR), postoperative surgical complication rates, and oncological outcomes in women with locally advanced breast cancer or high-risk breast cancers treated with neoadjuvant radiation therapy (NART). METHODS AND MATERIALS: This retrospective, multi-institutional review involved 138 clinically staged patients with 140 breast cancers treated with NART between January 2014 and February 2021. Treatments involved sequential neoadjuvant chemotherapy and NART, followed by mastectomy with or without axillary surgery and immediate autologous breast reconstruction. Descriptive statistics were used to assess patient and disease features, treatment regimens, pathologic response, and factors affecting postoperative complications. Kaplan-Meier curves were performed to assess locoregional recurrence-free, distant metastasis-free, and overall survival outcomes. RESULTS: Median age was 47 years (interquartile range, 42-52). The median follow-up was 35.2 months (interquartile range, 17.1-46.5). pCR was achieved in 36.4% (as defined by Chevallier classification) or 42.1% (as defined by Miller-Payne scores) of patients. Greater pCR rates were achieved for HER2+ (73.8%-85.7%) and triple-negative phenotypes (47.6%-57.1%). There were 21 grade 3 surgical complications including 10 grade 3B breast events and 8 grade 3B donor-site events, where surgical reintervention was required. At 3-years' follow-up, the locoregional recurrence-free survival was 98.1%, distant metastasis-free survival was 83.6%, and overall survival was 95.3%%. CONCLUSIONS: NART is feasible to facilitate a single-stage mastectomy and immediate autologous breast reconstruction. This study demonstrated comparable rates of postoperative complication to standard of care, and high rates of pCR, which translates to high rates of locoregional control, distant metastasis-free survival, and overall survival.

Diagnosing phyllodes tumours of the breast: how successful are our current preoperative assessment modalities?

BACKGROUND: To assess the efficacy of the diagnostic modalities used in the preoperative assessment of phyllodes tumours. METHODS: In this retrospective study of patients treated at Princess Alexandra Hospital, 51 phyllodes tumours in 49 patients diagnosed between 2005 and 2016 were reviewed with regard to their preoperative findings to assess which modalities, including clinical findings, mammography, ultrasound, fine needle aspiration and core biopsy, were most diagnostically discriminating. Data on demographics and management were also collected. RESULTS: While 90.2% of lesions were clinically palpable and an abnormality was seen in 86.1% of lesions subjected to mammography, the findings in relation to these two modalities were essentially those of non-discriminatory masses. Furthermore, although 100% of the phyllodes lesions were sonographically visible, suspicion of a phyllodes tumour was only noted in 21.6% of cases. Fine needle aspiration yielded results suspicious for phyllodes in 21.1% of cases while core biopsy resulted in confirmed or suspected phyllodes tumour diagnoses in 69.2% of instances. Serial measurements of phyllodes tumours yielded an average growth rate of 8.04 mm per 365 days. CONCLUSION: In the preoperative diagnosis of phyllodes tumours of the breast, ultrasound was a more discriminating imaging modality compared to mammography, and core biopsy demonstrated a superior accuracy of diagnosis over fine needle biopsy. A significant increase in lesion size over a short timeframe should also alert to the possibility of a phyllodes tumour.