Association of Adjuvant Radiotherapy De-Escalation With Outcomes Following Oncoplastic Breast-Conserving Surgery
In brief
Skipping breast radiotherapy linked to 36-point higher satisfaction after oncoplastic surgery
In this retrospective study of 257 patients, those who skipped radiotherapy reported breast satisfaction scores 36 points higher after adjustment. But seroma and unplanned reoperation were more frequent without radiotherapy: 30% versus 13% and 21% versus 7%, respectively. The findings show a tradeoff, not that omission causes better satisfaction, and support individualized decisions for selected patients.
- Journal
- Journal of surgical oncology (Q1)
- Published
- 14 October 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Abbas M Hassan, Carson Park, Kathryn Borders, Rachel M Danforth, Ravinder Bamba, R Jason VonDerHaar, et al.
- PMID
- 42876196
- DOI
- 10.1002/jso.70425
Why clinicians should know about it
- Picked for Breast and Endocrine Surgery (paper of the day, 19 October 2026): Retrospective cohort on RT de-escalation after oncoplastic breast surgery
Abstract
BACKGROUND: Adjuvant radiotherapy (RT) following breast-conserving surgery reduces local recurrence but can introduce reconstructive morbidity. Although recent trials support the safe omission of RT in selected patients, its impact on surgical and patient-reported outcomes following oncoplastic breast-conserving surgery (OPBCS) remains poorly defined. We evaluated surgical and long-term patient-reported outcomes in patients undergoing OPBCS, stratified by receipt of RT. METHODS: We retrospectively studied consecutive patients who underwent OPBCS between 2017 and 2024 for stage 0-3 breast cancer. Patients were stratified based on receipt of RT. Postoperative complications, unplanned reoperation, and revision procedures were compared between cohorts. Long-term patient-reported outcomes were assessed using the validated BREAST-Q Reconstruction Module. Multivariable regression was used to evaluate the independent association between RT status and outcomes. RESULTS: We identified 257 patients; 210 patients received RT (81.7%) and 47 underwent RT de-escalation (18.3%). Surgical site infection (p = 0.100), delayed wound healing (p = 0.300), and skin flap necrosis rates (p = 0.0300) were similar between cohorts. Seroma (30% vs. 13%; p = 0.006) and unplanned reoperation (21% vs. 7.1%; p = 0.006) were more frequent with RT omission. Patients who did not receive RT demonstrated significantly higher mean Satisfaction with Breasts scores compared with those who received RT (57 ± 25 vs. 23 ± 24; p = 0.001). In adjusted models, RT de-escalation was associated with a 36-point increase in Satisfaction with Breasts scores (β = 36.0; 95% CI, 18.0-54.0; p < 0.001). CONCLUSIONS: RT omission was independently associated with higher patient-reported satisfaction with breasts, though patients had higher seroma and reoperation rates. These data support balanced shared decision-making for RT de-escalation in appropriately selected patients.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.