Scarred.

Despite no clear guidelines on the subject, roughly half of practicing rad oncs report routinely using a mastectomy scar radiation boost. Others only in the setting of high-risk features. But let’s not forget a scar boost doesn’t come without costs, namely increased risk of infection and skin necrosis. To add data to the void, here’s a retrospective look at outcomes following post-mastectomy radiation at the University of Mississippi. Among 140 patients, just over two-thirds received a scar boost, which numerically (but not statistically) reduced risk of local recurrence or death (HR 0.84). When looking only at those with lymphovascular space invasion (LVSI) or positive margins (n=51) and those with only T3-4 tumors, 5-year local recurrence rates were improved (but again not statistically) from roughly 71 → 80% in both cohorts. TBL: Recognizing the limited numbers, signs point to a notable absolute local recurrence advantage with mastectomy scar boost when risk of local recurrence is elevated by LVSI, involved margins, and/or large primary tumors. | Albert, Clin Breast Cancer 2019