Cavity Shaving in Breast Conserving Surgery for Breast Cancer Patients

Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University181 enrolled

Overview

This randomized controlled trial is to evaluate the impact of additional cavity shaving (CS) on pathological cavity margin (CM) status in breast cancer patients. Patients receiving standard breast-conserving surgery (BCS) will be randomized to intra-operative CM assessment versus intra-operative CS followed by CM assessment. The primary objective of this study is to assess the impact of CS on intra-operative CM status, intra-operative re-excision rate, post-operative CM status and re-excision rate, cosmetic outcomes, and on intraoperative time and medical costs.

After stratified and blocked randomization, the patients' name, admission ID and treatment assignment will be written on a slip of paper, and will be placed in a sealed envelop. A label with the patients' name and admission ID will be placed on the sealed envelop, which will be kept in a locked file. On the day of surgery, a research coordinator will bring the sealed envelope to the operation room. During the standard-of-care BCS, the tumor was excised with a rim of grossly normal tissue. Additional resections are allowed when any of the margins of the tumor-containing specimen were suspected to be inadequate on the basis of standard gross evaluation by surgeons. Prior to intra-operative CM assessment, the research co-ordinator will unseal the envelop and determine which procedure has been designated to the patient. The cosmetic outcome and the quality of life will be evaluated at the day of discharge, after completion of radiotherapy and one year by the patient herself, her partner and a research co-ordinator.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

181

Conditions

Breast Cancer

Interventions

Cavity shavingPROCEDURE

Resect the residual cavity circumferentially (superior, inferior, medial, lateral) and the thickness of the cavity shaving depends on the surgeon's discretion (Recommended 0.5-1.0cm). The principles of the cavity shaving includes: 1) do not compromise the cosmetic outcomes; 2) covers the entire cavity;

Standardized BCS+CM assessment.PROCEDURE

For standardized BCS(Chen K, et al. Ann Surg Oncol. 2012), we resect a rim of 1 cm macroscopically normal tissue around the tumor. The anterior and posterior margins of the tumor-containing specimen extended up to the subdermal plane of the skin and down to the pectoralis major fascia, respectively. The anterior and posterior CMs assessment will not be needed. A surgical blade was used for resecting the CMs (superior, inferior, medial and lateral) to render the thickness of the CMs as thin as possible. No procedures were required for distinguishing the inner and outer surface. They were then frozen and cut parallel, but not perpendicular to the largest surface area. CMs were defined as positive when in situ or invasive carcinoma was found intraoperatively by frozen-section analysis.

Eligibility

Sex: FEMALEMin age: 18 YearsMax age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Female * At least 18 years of age and no more than 65 years of age * Able to understand and willing to sign an informed consent document * Willing and planning to undergo the breast-conserving surgery * ECOG≤ 2 Exclusion Criteria: * Inflammatory breast cancer * Preference for mastectomy instead of breast-conserving surgery * Necessity to undergo oncoplastic breast surgery * Prior surgical treatment, including ultrasound-guided vacuum-assisted biopsy and excision biopsy. * Prior systemic therapy for this diagnosis, including neoadjuvant chemotherapy, neoadjuvant endocrine therapy. * History of prior breast/axillary radiation therapy * Known metastatic disease * Diagnosed as bilateral breast cancer or DCIS * History of other malignancy ≤ 5 years previous * Preoperation evaluation indicates tumor size\>5cm * Preoperation evaluation indicates multicenter or multifocal breast cancer(including suspicious calcification on mammography) * Undergoing other clinical trials * With sever liver disfunction(Child-Pugh C) * With sever cardiac insufficiency * With sever renal disfunction * Pregnancy

Locations (1)

Sun-Yat-Sen Memorial Hospital of Sun-Yat-Sen University

Guangzhou, Guangdong, China

Outcomes

Primary Outcomes

Positivity rate of CMs by intraoperative frozen section analysis.

Proportion of patients with at least one positive(invasive carcinoma or carcinoma in situ, excluding LCIS) CMs on intraoperative frozen section analysis