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William J. Gradishar, MD, FACP, FASCO


ASTRO 2023: Nipple-Preserving Radiotherapy After Surgery for Breast Cancer

By: Lauren Velentzas
Posted: Thursday, October 5, 2023

According to a small phase I study, delayed radiotherapy to the nipple-areola complex after nipple-sparing surgery resulted in 100% nipple preservation for patients with ductal carcinoma in situ or early-stage breast cancer; these patients would otherwise not have been eligible for nipple-sparing mastectomy because of multifocality or multicentricity or a tumor smaller than 2 cm from the nipple-areola complex. The results were presented this week at the 2023 American Society for Radiation Oncology (ASTRO) Annual Meeting (Abstract 2437) by Crystal Seldon Taswell, MD, BS, of the University of Miami/Sylvester Comprehensive Cancer Center, and colleagues.

“This study supports further exploration of nipple preservation with broader inclusion criteria,” said Dr. Taswell and colleagues.

A total of 18 patients who had a biopsy confirming ductal carcinoma in situ or invasive breast cancer and a surgical recommendation for mastectomy because of extent of disease, with a tumor at least 1 cm from the nipple-areola complex, received nipple-areola complex radiotherapy 5 to 8 weeks after a nipple-sparing mastectomy. Six patients were treated with per-dose levels of 25, 30, and 35 Gy in 10 fractions, and all patients with estrogen receptor–positive breast cancer were given endocrine therapy.

After a median follow-up of 80.5 months, there was no local recurrence in the nipple-areola complex, with 100% experiencing nipple preservation with longer follow-up. The long-term results of the study did not demonstrate a compromise of local tumor control with delayed adjuvant nipple-areola complex radiotherapy. Two patients developed metastases 2 years after diagnosis, and one patient with ductal carcinoma in situ developed a second ipsilateral breast cancer away from the nipple-areola complex, later found to have a BRCA2-positive mutation. No grade 4 or higher adverse events were observed, and all reported grade 3 adverse events were related to surgery, such as infection, pain, or allergy to tape.

Disclosure: Dr. Taswell reported no conflicts of interest.

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