Daily Cosmetic Research Analysis
Three clinically-oriented studies reshape cosmetic and quality-of-life outcomes in oncology and scar care. Level II oncoplastic breast surgery reduced re-excisions and improved BREAST-Q scores versus conventional BCS; long-term data support APBI via multicatheter interstitial brachytherapy as a safe alternative to WBI with better QoL; and prolonged follow-up of postoperative HDR brachytherapy for keloids identifies ear lesions as optimal candidates.
Summary
Three clinically-oriented studies reshape cosmetic and quality-of-life outcomes in oncology and scar care. Level II oncoplastic breast surgery reduced re-excisions and improved BREAST-Q scores versus conventional BCS; long-term data support APBI via multicatheter interstitial brachytherapy as a safe alternative to WBI with better QoL; and prolonged follow-up of postoperative HDR brachytherapy for keloids identifies ear lesions as optimal candidates.
Research Themes
- Oncoplastic techniques to optimize cosmesis and oncologic safety
- Accelerated partial breast irradiation and long-term quality of life
- Radiation-based strategies for keloid scar control
Selected Articles
1. Comparative analysis of level II oncoplastic surgery and conventional breast-conserving surgery in breast cancer with a ductal carcinoma in situ component.
In a 163-patient retrospective comparative cohort, level II oncoplastic surgery achieved a significantly lower re-excision rate (10% vs 30%, p=0.035) than conventional BCS and yielded higher BREAST-Q scores for satisfaction, psychosocial, and sexual well-being. No significant differences were noted in key tumor or demographic variables.
Impact: Demonstrates simultaneous oncologic and cosmetic advantages of level II oncoplastic techniques, directly informing surgical planning for tumors with a DCIS component.
Clinical Implications: Surgeons should consider level II oncoplastic approaches to reduce re-excision and optimize patient-reported cosmetic and psychosocial outcomes when BCS is indicated for invasive cancer with DCIS.
Key Findings
- Re-excision rate was 10% with level II OBS vs 30% with conventional BCS (p=0.035).
- BREAST-Q showed higher satisfaction, psychosocial, and sexual well-being in OBS patients (p<0.001).
- No significant differences in tumor laterality, menopausal status, ER/PR/HER2 positivity, or E-cadherin expression between groups.
- Donut mastopexy was the most common level II technique (50%).
Methodological Strengths
- Comparative cohort with clear inclusion period and group definitions
- Use of validated patient-reported outcome measures (BREAST-Q)
Limitations
- Retrospective, non-randomized design with potential selection bias
- Short and unspecified follow-up duration; single-center experience
Future Directions: Prospective multicenter studies or randomized designs assessing margin status, long-term local recurrence, and cost-effectiveness of level II oncoplastic techniques.
2. Long-term outcomes of accelerated partial breast irradiation with multicatheter interstitial brachytherapy versus whole breast irradiation: an 11-Year clinical practice follow-up study.
Across two prospectively collected cohorts (n=76) with median 11-year follow-up, APBI via multicatheter interstitial brachytherapy provided comparable OS/DFS and late clinical toxicity to WBI, while sustaining superior patient-reported quality of life. Mammographic architectural distortion was more frequent after APBI.
Impact: Provides rare long-term, real-world evidence that APBI matches WBI for tumor control while improving quality of life, informing patient-centered radiotherapy decisions.
Clinical Implications: For appropriately selected stage I–II patients meeting GEC-ESTRO criteria, APBI with multicatheter interstitial brachytherapy is a safe, effective alternative to WBI, offering QoL advantages without compromising survival.
Key Findings
- Median follow-up 11 years; APBI maintained significantly better patient-reported QoL.
- No significant differences in late clinical toxicity or cosmetic outcomes between APBI and WBI.
- Higher rates of mammographic architectural distortion/tissue retraction after APBI.
- 5- and 10-year OS: 94.7% and 81.1%; DFS: 92.1% and 79.7%; no group differences.
Methodological Strengths
- Prospectively collected cohorts with extended long-term follow-up
- Use of validated QoL instruments (QLQ-BR23, S-BIS) and standardized eligibility (GEC-ESTRO)
Limitations
- Non-randomized design and modest sample size (n=76)
- Single-center real-world data may limit generalizability
Future Directions: Randomized trials or larger multicenter prospective registries to refine patient selection for APBI and to correlate imaging changes with clinical endpoints.
3. Treatment of refractory keloid by postoperative HDR brachytherapy: An 89-month median follow-up retrospective study.
In 87 keloids with a median 89.7-month follow-up, postoperative HDR brachytherapy yielded 39% recurrences overall; however, ear keloids had a significantly lower recurrence risk (HR 0.38, p=0.02). One- and five-year recurrence-free survival were 0.89 and 0.67, respectively.
Impact: Provides long-term, site-specific evidence to refine indications for postoperative HDR brachytherapy in keloid management, directly impacting aesthetic scar care.
Clinical Implications: Consider postoperative HDR brachytherapy especially for ear keloids, where recurrence risk is lower; counsel male and previously treated patients regarding higher recurrence tendency and the need for close follow-up.
Key Findings
- Median follow-up 89.7 months; overall recurrence rate 39%.
- Recurrence-free survival: 0.89 at 1 year and 0.67 at 5 years.
- Ear keloids had significantly lower recurrence risk vs other sites (HR 0.38, 95% CI 0.17–0.85, p=0.02).
- Male sex and prior treatment trended toward higher recurrence risk.
Methodological Strengths
- Long median follow-up with time-to-event analysis
- Defined inclusion/exclusion criteria with histologic confirmation
Limitations
- Retrospective single-center design without a non-brachytherapy control group
- Potential confounding by lesion site, sex, and prior treatments
Future Directions: Prospective, controlled studies stratified by anatomical site to validate risk modifiers and optimize dose/fractionation for keloid HDR brachytherapy.