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.
BACKGROUND: To investigate the pathological outcomes, re-excision rates, local recurrence, patient satisfaction, and cosmetic results associated with level II oncoplastic surgery (OBS) techniques compared to conventional breast-conserving surgery (BCS) in the treatment of breast cancer with a ductal carcinoma in situ (DCIS) component. METHODS: Between January 2020 and December 2023, 163 patients with invasive carcinoma associated with DCIS were deemed suitable for breast-conserving surgery. The patients were divided into two groups: those who underwent conventional BCS and those who underwent level II OBS. RESULTS: Forty patients underwent level II OBS, while 123 patients underwent conventional BCS. The median age was 50 (range 29-65) years for the patients in the level II OBS group and 52 (range 25-68) years for those in the conventional BCS group. Re-excision was performed in three patients (10%) in the level II OBS group compared
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.
PURPOSE: To compare the long-term outcomes of accelerated partial breast irradiation (APBI) using multicatheter interstitial brachytherapy versus whole breast irradiation (WBI), in terms of late toxicity, cosmetic results, quality of life, and survival, in a real-world clinical setting. METHODS: Updated analysis of two prospectively collected cohorts comprising 76 patients with stage I-II breast cancer treated with breast-conserving surgery followed by adjuvant radiotherapy. Patients who underwent APBI met the GEC-ESTRO eligibility criteria. We assessed follow-up and additional analyses of late toxicity, quality of life (assessed using the validated QLQ-BR23 and S-BIS questionnaires), cosmetic outcomes (via Visual Analog Scale), overall survival (OS), and disease-free survival (DFS), providing a more comprehensive evaluation of long-term outcomes. RESULTS: At a median follow-up of 11 years, patient-reported quality of life remained significantly better in the APBI group, particularly in both physical and psychological domains, consistent with previous findings.
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.
BACKGROUND: Between 2009 and 2022, a homogenous cohort of patients at Saint-Louis hospital affected by keloid scars undergone excision surgery followed by HDR brachytherapy on the same day. PURPOSE: To assess the percentage of long-term recurrence and look for the presence of influencing factors. MATERIALS AND METHODS: Inclusion criteria included the presence of one or more keloid scars and histological confirmation of the diagnosis. Exclusion criteria comprised a history of keloid surgery other than simple excision, and the absence of intraoperative direct suturing of the scar. RESULTS: A total of 87 keloids scare were eligible for the analysis. Median follow-up was 89,7 months (IQR: 60.2-120.2). 34 recurrences (39%) were observed. Of these recurrences, 41% (14 of 34) showed a significant reduction in keloid volume, 29% (10 of 34) returned to the original keloid volume, and 29% (10 of 34) demonstrated an increase in volume. The recurrence-free survival for all cheloid was 0.89 [0.45;0.98] at one year and 0.67 [0.28;0.89] at 5 years. Keloid of the ear compared to other sites (HR = 0.38, 95% CI: 0.17-0.85, p = 0.02) was significantly associated with a lower recurrence risk. Male sex (HR = 2.13, 95% CI: 0.88-5.14, p = 0.09) and prior treatment (HR = 3.44, 95% CI: 0.85-13.89, p = 0.08) were associated with an increased recurrence risk. CONCLUSION: With a prolonged follow-up and a rigorous methodology compared to previous studies, our results lead us to preferentially recommend postoperative brachytherapy for keloid located in the ears, especially for women without any previous treatment.