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Purpose To test clinical feasibility, safety, and toxicity of prone hypofractionated breast, chest wall, and nodal radiation therapy. Methods and materials Following either segmental or total mastectomy with axillary node dissection, patients were treated in an institutional review board–approved prospective trial of prone radiation therapy to the breast, chest wall, and supraclavicular and level III axillary lymph nodes. A dose of 40.5 Gy/15 fractions with a concomitant daily boost to the tumor bed of 0.5 Gy (total dose, 48 Gy) was prescribed. In postmastectomy patients, the same treatment was prescribed, but without a tumor bed boost. The primary endpoint was incidence of >grade 2 acute skin toxicity. The secondary endpoints were feasibility of treatment using prone set-up, compliance with protocol-defined dosimetric constraints, and incidence of late toxicity. A dosimetric comparison was performed between protocol plans (prone) and nonprotocol plans (supine), targeting the same treatment volumes. Results Sixty-nine patients with stage IB-IIIA breast cancer enrolled in this trial. Surgery was segmental mastectomy (n = 45), mastectomy (n = 23), and bilateral mastectomy (n = 1), resulting in 70 cases. None experienced >grade 2 acute skin toxicity according to the Common Terminology Criteria for Adverse Events, v 3.0, meeting our primary endpoint. Ninety-six percent of patients could be treated with this technique prone. However, 17 plans (24%) exceeded protocol constraints to the brachial plexus. Maximum long-term toxicity was 1 grade 2 arm lymphedema, 1 grade 3 breast retraction, and no occurrence of brachial plexopathy. Dosimetric comparison of protocol with nonprotocol plans demonstrated significantly decreased lung and heart doses in prone plans. Conclusions Prone hypofractionated breast, chest wall, and nodal radiation therapy is safe and well tolerated in this study. Although the initial pattern of local and regional control is encouraging, longer follow-up is warranted for efficacy and late toxicity assessment, particularly to the brachial plexus.

Oncoplastic breast conserving surgery (BCS) has emerged as a third option between conventional BCS and mastectomy. Oncoplastic BCS includes two fundamentally different approaches: volume replacement and volume displacement. The former involves partial mastectomy and immediate reconstruction of the breast with the transposition of autologous tissue from elsewhere, while the latter involves partial mastectomy and using the remaining breast tissue to fill the defect resulting from extirpation of the tumor. There are several benefits associated with oncoplastic BCS. First, it allows partial mastectomy without cosmetic penalties, and can achieve better cosmetic outcomes than total mastectomy with immediate breast reconstruction. Second, it avoids the need for total mastectomy in an increasing number of patients without compromising local control. Third, partial breast reconstruction is less extensive and has fewer complications than conventional procedures. Partial mastectomy and partial breast reconstruction can be carried out either simultaneously as a one-stage procedure, or using a two-stage approach. Although patients prefer a one-stage procedure, it requires intraoperative confirmation of complete tumor excision using frozen-section analysis. Moreover, oncoplastic BCS requires combined skills, knowledge, and understanding of both oncological and plastic surgeries, which may be optimally achieved by an oncoplastic surgeon.

We present a case of a 63 year-old Caucasian female who developed a right breast skin lesion discrete from the nipple that was subsequently diagnosed as Paget's Disease of the breast (PDB). Imaging did not reveal an underlying breast cancer or involvement of the nipple. The patient underwent a segmental mastectomy preserving the nipple and final pathology demonstrated residual Paget's disease of the skin and did not reveal any additional underlying breast carcinoma. To our knowledge, this case represents the first reported diagnosed case of isolated PDB without nipple involvement.

Introduction The success of breast-conservation therapy (BCT) for patients with multiple ipsilateral invasive breast cancers (MIBC) is sparsely documented. Methods A retrospective review of single-institution experience. Patients with 2 or more invasive cancers separated by normal breast tissue were included; patients with 1 invasive cancer with additional in situ lesions and those receiving neoadjuvant therapy were excluded. Results One hundred forty-nine patients were treated over 19 years. Fifty-eight (39%) patients underwent BCT. Preoperatively, multiple tumors were suspected in more mastectomy patients than BCT patients (75% versus 62%). Most patients had 2 tumors and 1 histology. Fifty-five percent of patients with tumors within 1 quadrant underwent BCT versus 10% of patients with tumors in more than 1 quadrant. One hundred eight patients underwent sentinel lymph node (SLN) biopsy. Twenty-seven percent (34) were SLN positive. There were no regional recurrences among the SLN-negative patients. Six patients recurred: 1 nodal, 1 local, and 4 distant. The locoregional BCT recurrence rate was 3.4%. Discussion MIBC patients can safely undergo BCT with low recurrence risk. SLNB can be performed with minimal risk of regional recurrence.

Background: Patients with locally recurrent breast cancer can also harbor regional nodal disease. Sentinel lymph node (LN; SLN) surgery is an accepted method for LN evaluation in early-stage breast cancer. We sought to evaluate the feasibility of SLN surgery in patients with locally recurrent breast cancer. Patients and Methods: Patients undergoing SLN surgery at the time of treatment for recurrent breast cancer were identified. Clinical, pathologic, and operative details of initial and recurrent breast cancer events were analyzed. Results: From 2001 to 2005, 21 patients underwent SLN surgery for locally recurrent breast cancer. Previous breast procedures included segmental mastectomy in 17 patients and mastectomy in 4 patients. Previous axillary procedures included axillary LN dissection in 12 patients, SLN surgery in 5 patients, and no axillary surgery in 4 patients. Twelve patients had received breast irradiation. The SLN was identified and excised in 13 patients (62%). Six patients had drainage to nodal basins outside of the axilla (internal mammary and/or contralateral axilla). As the number of axillary nodes removed at primary surgery increased, the incidence of alternative lymphatic drainage increased: no previous axillary surgery, 0; 1-10 LNs removed, 30%; > 10 LNs removed, 50%. Conclusion: Sentinel LN surgery is feasible in patients with locally recurrent breast cancer regardless of previous axillary node surgery or radiation. The incidence of alternative lymphatic drainage is increased in patients with > 10 axillary LNs removed at original operation or when radiation was part of the previous treatment. Sentinel LN surgery is a tool for guiding local-regional management of patients with locally recurrent breast cancer.

Breast-conserving therapy (BCT) consists of segmental mastectomy followed by postoperative radiation therapy (RT) to the whole breast. At least 6 prospective randomized trials have proven the equivalence of BCT to mastectomy. However, BCT remains underused and, most importantly, a sizable proportion of patients with invasive breast cancer fail to complete the recommended protocol of breast preservation by omitting postoperative RT. The inconvenience of complying with the standard 6-week radiation regimen, which includes approximately 30 daily visits, at least partially explains this lack of adherence. New clinical studies have generated preliminary evidence that more convenient, shorter radiation regimens might reveal equivalence to the current standard. Moreover, the availability of modern technology to deliver and target ionizing radiation by improving homogeneity of radiation dose has made it possible to safely explore the use of greater radiation doses per fraction. Finally, currently ongoing research trials will enable the identification of specific subsets of patients who are likely to be safely treated by partial-breast radiation (instead of radiation to the whole breast) with more accelerated regimens. This article reviews the available data and the current ongoing research on novel RT techniques and fractionation schedules in BCT for early-stage breast cancer.

The historic milestones that have brought the surgical management of breast cancer to its current state are recounted. The Halsted radical mastectomy, once considered the ideal cancer operation, no longer has a place in the routine management of patients with breast cancer. Breast conservation in the form of segmental mastectomy, axillary node dissection, and radiation is often chosen over the modified radical mastectomy, popular in the 1980s. Axillary lymphadenectomy, shown to be of questionable therapeutic value in breast cancer, is certainly of prognostic significance. Studies are ongoing to establish the validity of the less-invasive sentinel node biopsy in determining axillary nodal status. Perhaps the most significant change in today's approach to breast cancer is the reliance on well-controlled prospective studies to evaluate outcome and determine the appropriate surgical procedure.

Purpose: To analyze the long-term outcome of breast conservation therapy in patients with ductal carcinoma in situ (DCIS) in a single institution and to analyze the prognostic importance, if any, of young patient age. Methods and Materials: The hospital records of 150 patients with DCIS treated with surgical excision and radiotherapy at our institution between 1980 and 1997 were retrospectively reviewed. For most of the patients, intraoperative specimen radiographs or postoperative mammograms were available for use in assessing that an adequate surgical resection had been performed. The median patient age was 53 years (range 32–81), with 13% of patients ≤40 years old. Results: At a median follow-up of 63 months, 12 patients had local disease recurrence. The actuarial rate of local recurrence-free survival at 5 and 10 years was 96% and 88%, respectively. Local recurrence correlated with nuclear grade ( p = 0.002) but was not associated with patient age at diagnosis ( p = 0.39). In all cases of local recurrence, patients underwent surgery with or without chemotherapy, and disease control was achieved. Conclusion: The results of this study demonstrate high rates of long-term overall survival, disease-specific survival, and local control in patients with DCIS of the breast treated conservatively with segmental mastectomy and radiotherapy. On the basis of the excellent long-term local control and 100% disease-specific survival rates, we found that patient age does not affect the outcome if the margins are clear. Continued studies in young patients treated with breast conservative therapy for DCIS are needed.

Background: Intracystic papillary carcinoma (IPC) of the breast is a rare form of noninvasive breast cancer. An appreciation of associated pathology with IPC may be critical in surgical decision-making. Methods The medical records of all patients with IPC treated between 1985 and 2001 were retrospectively reviewed. Three patient groups were identified according to the pathologic features of the primary tumor: IPC alone, IPC with associated ductal carcinoma in situ (DCIS), and IPC with associated invasion with or without DCIS. Types of treatment and outcomes were compared between groups. Results: Forty patients were treated for IPC during the study period. Fourteen had pure IPC, 13 had IPC with DCIS, and 13 had IPC with invasion. The incidence of recurrence and the likelihood of dying of IPC did not differ between the three groups regardless of the type of surgery (mastectomy or segmental mastectomy) performed and whether radiation therapy was administered. The disease-specific survival rate was 100%. Conclusions When IPC is identified, it is frequently associated with DCIS and or invasion. Standard therapy should be based on associated pathology. The role of radiation therapy in pure IPC remains to be determined.

Introduction: Breast-conserving surgery for early breast cancer is now routinely used as an alternative to mastectomy. Despite post-operative radiotherapy, early local recurrence of tumour remains a concern. It has been reported that invasive and in-situ ductal carcinoma spread locally through the ductal tree in a segmental distribution, however, there is no consensus as to the best surgical method to maximize tumour clearance whilst leaving a good cosmetic result.Aim: We aimed to measure the effectiveness of segmental mastectomy (excision of tumour plus associated segmental ductal tissue) in the clearance of different tumour types. Bed biopsy of the excision cavity was employed to assess the rate of incomplete excision or the multifocality of certain breast cancers. Methods: One hundred and one patients with breast cancers underwent segmental mastectomy and cavity bed biopsies. Specimens were assessed for tumour type and completeness of excision. An excision of the cancer was considered incomplete if the margins were involved or if any of the bed biopsies showed residual or multifocal tumour. Results: A total of 24 patients had incomplete tumour excision. Invasive ductal carcinoma was more likely to be completely excised by segmental mastectomy than invasive lobular carcinoma (P

We retrospectively reviewed the microscopic findings in 32 histologically confirmed radial scars in 31 women diagnosed in our unit during 1994–1998. The median age at diagnosis was 53 years (range 47–63 years). Thirty–one (97%) of 32 lesions presented as screen detected mammographic abnormalities (28 stellate lesions, 2 microcalcifications and only 1 architectural distortion). One lesion presented as a palpable breast mass. Stereotactic or ultrasound-guided fine needle aspiration cytology (FNAC) was performed in 28 cases. Cytological analysis of FNAs revealed malignant cells (C5) in 8 (29%) cases, highly suspicious cells (C4) in 3 (11%) cases, atypical benign cells (C3) in 7 (25%) cases and benign epithelial cells (C2) in 10 (35%) cases. All non-palpable lesions were surgically excised following wire localization. Histological examination of the breast specimens (mean weight = 16 g) demonstrated, in addition to a radial scar, 6 invasive carcinomas (2 infiltrating ductal, 2 tubular, 1 mixed ductal/lobular and 1 secretory carcinoma) and 4 ductal carcinoma in situ lesions (2 high grade, 1 high grade with micro-invasion and 1 low grade) arising in the radial scar. Of the remaining cases the radial scar was associated with atypical epithelial hyperplasia in 2 cases and regular epithelial hyperplasia in 17 cases (4 florid and 13 mild to moderate). In the 10 cases associated with malignancy, 9 had FNAC and was reported as malignant (C5) in 6 (67%) cases, highly suspicious (C4) in 2 (22%) cases and atypical (C3) in 1 (11%). False positive FNAC (C5) occurred in two patients, one of whom presented with pleomorphic microcalcifications suggestive of ductal carcinoma in situ. This patient was treated with a wire guided segmental mastectomy. All invasive tumours were less than 20 mm in size (T1) and of these 4 were grade I and 2 were grade II. Axillary dissection was performed in 4 patients none of whom had axillary node metastases. Our study demonstrates a significant incidence of malignancy associated with radial scars (31%) suggesting that radial scars may be premalignant lesions. This is supported by detecting various stages of mammary carcinogenesis (atypical epithelial hyperplasia, ductal carcinoma in situ, and early invasive malignancy) in these lesions. Fine needle aspiration cytology seems to be unreliable in the diagnosis of radial scar associated malignancy (67% sensitivity and 91% specificity). Stellate lesions, therefore, should be excised to obtain an histological diagnosis regardless of cytological findings. Further studies examining the biology of radial scars are required.

Eradication of breast cancer by wide local excision alone is not possible unless the clinical margins of excision exceeds 5 cm or a segmental mastectomy is performed, though recurrences may still occur after a segmental mastectomy. With inadequate excision radiotherapy to the breast is essential, but will not prevent local recurrence. In a prospective trial (1981 to 1990) to assess the value of radiotherapy to the breast when adjuvant therapy was administered, 418 patients treated by wide local excision and adjuvant chemotherapy (tamoxifen if oestrogen receptor-positive and CMF chemotherapy if oestrogen receptor-negative) were randomized to have loco-regional radiotherapy to the breast or not. At a minimum 5-year follow-up, the local recurrence rate in patients receiving radiotherapy was 13% compared to 35% in those not so treated. Local recurrence was strictly related to microscopic clearance in millimetres irrespective of clinical wide local excision, nodal, or menopausal status. Where, histologically, local excision was incomplete and patients received radiotherapy, the local recurrence rate was 17%. The criteria for wide local excision need to be strictly defined and histologically proven if post-operative radiotherapy is to achieve its effective function, that is the prevention of local recurrence. Radiotherapy cannot compensate for inadequate surgery.

Clinical trials at our institution and all over the world have proven that conservative surgery for small breast cancers is effective and safe. The aim of the procedures is to avoid, whenever possible, a useless mutilation to patients and to offer a good aesthetic outcome. In our view, the segmental mastectomy should be a locally “radical” procedure by means of a “wide” excision unlike the simple biopsy performed in the so called “tumorectomy.” For this reason about 15% of the patients present a poor cosmetic result worth improving by means of a plastic surgery procedure. Such unsatisfying cosmetic results are usually due to the extent of the excision compared with the size of the breast, the location of the cancer, and the effects of radiotherapy. Because it is our experience that delayed reconstructive procedures are limited by the effects of RT, it is preferable to achieve the best shape at the time of the primary surgical procedure (ie, to perform an immediate reconstruction). It is our philosophy that major reconstruction (ie, transfer of latissimus dorsi or rectus abdominis flaps) should be avoided whenever possible as a primary procedure. Indeed, it is unclear why a total mastectomy and a primary reconstruction should not be performed in these patients instead of having the double problem of facing the morbidity and the scars subsequent to the transfer of distant tissue and of leaving behind a good portion of potentially diseased breast tissue. A number of techniques suitable for the immediate repair of segmental mastectomy defects have been studied. They vary depending on the breast site involved and consist in rotation or advancement of dermoglandular flaps based on an inferior or superior pedicle. In selected cases, a custom-made segmental prosthesis has been used, as well as a latissimus dorsi flap.

Current problems in the pathological assessment and subclassification of ductal carcinoma in situ of the breast are reviewed, both in its pure form and in association with invasive disease. The different clinical significance of these 2 types of presentations is emphasized, with particular reference to breast-conserving surgery. Adherence to the variably defined concept of extensive intraductal component may not be necessary if completeness of excision of intraductal disease can be demonstrated. A uniform approach is presented for the examination of surgical margins around intraductal carcinoma, regardless of the presence of invasion, using radiological-pathological correlation of sliced specimens.

Purpose/Objective(s): Currently, no biological molecular targets exist for women diagnosed with triple negative breast cancer (TNBC). In an in vitro murine breast cancer model, we have shown that radiation therapy (RT) combined with carboplatin potentiates immunogenic tumor cell death, thereby contributing to a pro-immunogenic milieu (Golden et al., Oncoimmunology 2014). Thus, we hypothesized that this regimen may not only radio-sensitize, but also trigger an adaptive anti-tumor immune response. We are conducting a phase I-II IRB-approved trial [clinicaltrials. gov NCT01289353] to test the feasibility and clinical efficacy of this combination in terms of rates of local control, distant recurrence, and overall survival. Materials/Methods: Women with Stage I e II (pT1-T2, pN0) TNBC are eligible after segmental mastectomy and axillary lymph node assessment. Weekly carboplatin (AUCZ2.0) is delivered x6 weeks with RT to the whole breast being delivered during weeks 2-4, via a 3D-CRT or IMRT technique in the prone position. The whole breast receives 40.5 Gy in 15 fractions (Monday-Friday). The tumor bed receives an additional 3 Gy boost, delivered on 2 consecutive Sundays (beginning of the 2 and 3weeks of RT). Consequently, a total of 46.5 Gy is delivered to the tumor bed in 17 fractions over 19 days. Adverse effects of treatment are assessed weekly during treatment, and once at 45-60 days, thereafter, using the Common Terminology Criteria for Adverse Events (CTCAE) v3.0. Results: A total of 33 patients have accrued so far. Acute toxicities are displayed below and never exceeded grade 3. Twenty patients received adjuvant chemotherapy. With a median follow-up of 25.9 months, 97% (32/33) of all women remain alive and without recurrent disease. One patient died with possible distant recurrence occurring at 5.6 months from beginning treatment. Conclusion: Adjuvant concurrent carboplatin and prone accelerated radiation therapy appears to be a safe and effective treatment for women diagnosed with early stage TNBC. Since approximately 50% of TNBC carriers recur within 2 years from treatment, it is encouraging that 97% of the patients in the trial have not experienced a recurrence.

combination in terms of rates of local control, distant recurrence, and overall survival. Materials/Methods: Women with stage I II (pT1-T2, pN0) TNBC are eligible after segmental mastectomy and axillary lymph node assessment. Weekly carboplatin (AUC Z 2.0) is delivered x 6 weeks with RT to the whole breast, delivered during weeks 2-4 via a 3D-CRT or an IMRT technique in the prone position. The whole breast receives 40.5 Gy in 15 fractions (Monday-Friday). The tumor bed receives an additional 3 Gy boost, delivered on 2 consecutive Sundays (beginning on the 2nd and 3rd weeks of RT). Consequently, a total of 46.5 Gy is delivered to the tumor bed in 17 fractions over 19 days. Adverse effects of treatment are assessed weekly during treatment, and once at 45-60 days, thereafter, using the Common Terminology Criteria for Adverse Events (CTCAE) v3.0. Results: A total of 27 patients have accrued so far. The median age was 56 years (range: 27-82). Reported acute skin toxicities are displayed (see Table). With a median follow-up of 26 months all of the women remain alive and without recurrent disease. Conclusions: Adjuvant concurrent carboplatin and prone accelerated radiation therapy appears to be a safe and effective treatment for women diagnosed with early stage TNBC. Since approximately 50% of TNBC carriers recur within 2 years from treatment, it is encouraging that none of the patients in the trial have experience a recurrence. The trial remains open for patient accrual. Author Disclosure: E.B. Golden: None. R.E. Vatner: None. M. FentonKerimian: None. Y. Novik: None. R. Oratz: None. J. Speyer: None. S.C. Formenti: None.

outcomes based on type of boost used (electron vs. photon vs. implant). We evaluated 4 different photon beam arrangements for treatment of tumor beds too deep to boost with electrons to determine optimal approach in regards to conformity of dose distribution and exposure of normal tissue. Materials/Methods: Thirty patients with early stage breast cancer treated with segmental mastectomy and postoperative external beam irradiation whose tumor beds (CTV) measured 3.5 cm in depth were prospectively identifi ed for a1 6 Gy photon boost following standard whole breast radiation to 45 Gy. The lumpectomy scar was wired in all patients and the tumor bed was uniformly outlined from the planning CT. The CTV included the seroma beneath the scar down to the pectoralis muscle. Four photon boost plans were generated per patient using 2, 4, 5, and 6 fields. All field apertures were generated using a 2 cm margin around the CTV, with the exception of an appositional beam in the 5 field plan, which use da1c mmargin. All plans utilized noncoplanar beam arrangements with the exception of the 2 field plan. The dose distribution was evaluated using a conformity index defined as VCTV/V95, where V95 is the volume of breast covered by the 95% isodose line and VCTV is the volume of the CTV. The amount of normal breast tissue encompassed per plan (Vnt95) was calculated by subtracting VCTV from V95. Isodose distributions and DVHs were compared for ipsilateral lung and heart in all patients. Results: Mean tumor bed depth was 5.5 cm (range, 3.5‐8.9 cm). The mean and median CTV volume were 101 cc and 84 cc. When stratified by tumor bed volume ( vs. 100 cc), Vnt95 was significantly greater for patients with larger tumor beds (p 0.0001). The mean and median conformity indices were 0.31 and 0.29 (range 0.08 - 0.68). The conformity indices of the 4 and 6 field techniques were significantly superior to the 2 field technique (p 0.0003 and p 0.0001, respectively), but the difference between the 4 and 6 field techniques was not significant (p 0.27). Treatment with a 5 field technique provided the most conformal distribution of dose, with a mean conformity index of 0.41 as compared to 0.27, 0.29, and 0.28 for 2, 4 and 6 fields respectively, (p 0.0001). The Vnt95 was also significantly reduced with the 5 field beam arrangement (p 0.0001). This technique, however, exposed more normal tissue to a low dose of radiation with a mean heart and lung dose of 43 cGy (p 0.0001) and 67 cGy (p 0.0001), respectively. Treatment with either a 2, 4, or 6 field beam arrangement produced similar DVHs in the heart and lung, with mean doses of 17, 17, and 17 cGy (p 0.75) and 41, 42, and 42 cGy (p 0.21), respectively. Conclusions: For patients whose tumor beds are too deep to treat adequately with electrons, partial breast irradiation utilizing a4 field photon technique can provide conformal coverage while minimizing exposure of normal tissue. For patients with larger tumor beds, a 5 field beam arrangement may reduce the amount of normal breast tissue encompassed within the boost, with only minimal additional dose to the heart and ipsilateral lung.

The detection of a loco-regional recurrence after primary treatment for breast cancer is a common event in clinical practice. Data from the literature are compared to those obtained from the analysis of a series of 4344 patients submitted to radical mastectomy (2948 pts., median follow-up: 15 years) or segmental mastectomy plus radiotherapy (1879 pts., median follow-up: 6 years). A total of 666 loco-regional relapses were observed: chest wall: 274, lymph-nodes: 231, breast: 79, multiple sites: 82. The incidence of synchronous metastases (28.9% in the total group) was respectively 25.5%, 36.4%, 5%, and 42.7%. Nodal involvement, pT diameter and the administration of adjuvant chemo or hormonotherapy significantly affected the appearance of chest-wall and nodal recurrences. The appearance of breast relapses mainly depended on age at surgery and by the administration of adjuvant hormonotherapy. Survival from relapse was significantly influenced by pT diameter and nodal involvement at surgery, by the length of disease-free interval and by the extention of the relapse.

A retrospective review of the outcome of treatment for primary, Stage I and II breast cancer with segmental mastectomy (SGM) alone or segmental mastectomy plus postoperative irradiation (SGM + RT) at four Rochester, New York, city hospitals is reported. Between January 1971 and March 1984, 99 women were treated with SGM and 146 with SGM + RT. Groups were similar regarding significant clinical and histologic prognostic factors; they differed, however, in that the SGM group was considerably older (means = 72) than the SGM + RT group (means = 56). Among SGM patients, local and total locoregional failure was 26.44 and 35.2%, respectively. Local and total locoregional failure (7.6 and 12.4%, respectively) was significantly reduced among patients treated with SGM + RT (p less than 0.0001). Among SGM patients, there was scant advantage in enlarging the extent of resection from local excision (29.5% local failure) to wide local excision (27.3%) to quadrantectomy (22.2%). Among women receiving SGM + RT, similar rates of local failure occurred among patients receiving local excision (15.5%) and wide local excision (12.5%). By contrast, only 2.8% of those receiving quadrantectomy failed. Results are viewed as supportive of findings of NSABP-B06. Findings suggest that SGM constitutes inadequate treatment of Stage I and II breast cancer. Locoregional failure rates of 30-40% may be reduced to around 10% with postoperative irradiation.

Experience in reducing the size of Silastic gel prostheses demonstrated the firm cohesiveness of the enclosed gel. The gel alone therefore has been used to replace breast tissue after segmental mastectomies and after the removal of oversized breast prostheses.