Evaluation of an in Situ Polymerizing Hydrogel Applied in Tumor Excision Cavities during Breast Conservation Surgery

Abstract

Study Objective: To evaluate the imaging characteristics and healing following application of an absorbable biocompatible hydrogel into the excision cavity following breast conservation surgery. Design: Non-randomized study evaluating hydrogel application feasibility, post-operative hydrogel imaging characteristics, cavity healing following hydrogel absorption and the resulting breast cosmesis. Setting: Teaching hospital University of Essen, Germany. Patients: Seven (7) patients underwent unilateral or bilateral breast conservation surgery to remove cancerous or benign tumors. Interventions: All patients received hydrogel application following primary tumor excision. Imaging performed in the first postoperative week included ultrasound, MRI and CT. Breast cosmesis scores were obtained at one and three months following surgery. Measurements and Main Results: While preliminary, a relationship between percent cavity filling and drainage was observed, with 30% or more cavity filling resulting in decreased drainage. Additionally, the hydrogel was readily visible under ultrasound, MRI and CT imaging modalities. Finally, patients were satisfied and surgeons felt that patient cosmesis was improved relative to their prior experience. Conclusion: Initial data suggest that hydrogel filling may reduce excision cavity drainage, which may reduce seroma or hematoma formation. Additionally, these gels may improve cavity visibility and stability, furthering the use of partial breast irradiation. Finally, while more studies are required, these materials may have a role in improving long term patient cosmesis.

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M. Korell, F. Brassel and J. Pagels, "Evaluation of an in Situ Polymerizing Hydrogel Applied in Tumor Excision Cavities during Breast Conservation Surgery," Surgical Science, Vol. 4 No. 10, 2013, pp. 464-468. doi: 10.4236/ss.2013.410091.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] W. C. Dooley, “Breast Cancer: Surgical Therapy,” In: J. L. Cameron, Ed., Current Surgical Therapy, 3rd Edition, Mosby, St. Louis, 1995.
[2] B. Fisher, S. Anderson, C. K. Redmond, et al., “Reanalysis and Results after 12 Years of Follow-Up in a Randomized Clinical Trial Comparing Total Mastectomy with Lumpectomy or without Irradiation in the Treatment of Breast Cancer,” New England Journal of Medicine, Vol. 333, No. 22, 1995, pp. 1456-1461. http://dx.doi.org/10.1056/NEJM199511303332203
[3] B. Fisher, M. Bauer, R. Margolese, et al., “Five-Year Results of a Randomized Clinical Trial Comparing Total Mastectomy and Segmental Mastectomy with or without Radiation in the Treatment of Breast Cancer,” New England Journal of Medicine, Vol. 312, No. 11, 1985, pp. 665-673. http://dx.doi.org/ 10.1056/NEJM198503143121101
[4] J. A. Jacobson, O. N. Danforth, K. H. Cowan, et al., “Ten-Year Results of a Comparison of Conservation with Mastectomy in the Treatment of Stage I and II Breast Cancer,” New England Journal of Medicine, Vol. 332, No. 14, 1995, pp. 907-911. http://dx.doi.org/10.1056/NEJM 199504063321402
[5] B. Fisher, S. Anderson, J. Bryant, et al., “Twenty-Year Follow-Up of a Randomized Trial Comparing Total Mastectomy, Lumpectomy, and Lumpectomy plus Irradiation for the Treatment of Invasive Breast Cancer,” New England Journal of Medicine, Vol. 347, 2002, pp. 1233-1241. http://dx.doi.org/ 10.1056/NEJMoa022152
[6] C. Hurkmans, M. Admiraal, M. van der Sangen, et al., “Significance of Breast Boost Volume Changes during Radiotherapy in Relation to Current Clinical Interobserver Variations,” Radiotherapy & Oncology, Vol. 90, No. 1, 2009, pp. 60-65. http://dx.doi.org/10.1016/j.radonc.2007.12.001
[7] R. P. Petersen, P. T. Truong, H. A. Kader, et al., “Target Volume Delineation for Partial Breast Radiotherapy Planning: Clinical Characteristics Associated with Low Interobserver Concordance,” International Journal of Radiation Oncology · Biology · Physics, Vol. 69, No. 1, 2007, pp. 41-48.
[8] H. Struikmans, C. Warlam-Rodenhuis, T. Stam, et al., “Interobserver Variability of Clinical Target Volume Delineation of Glandular Breast Tissue and of Boost Volume in Tangential Breast Irradiation,” Radiotherapy & Oncology, Vol. 76, No. 3, 2005, pp. 293-299. http://dx.doi.org/10.1016/j. radonc.2005.03.029
[9] T. W. Flannery, E. M. Nichols, S. B. Cheston, et al., “Repeat Computed Tomography Simulation to Assess Lumpectomy Cavity Volume during Whole-Breast Irradiation,” International Journal of Radiation Oncology · Biology · Physics, Vol. 75, No. 3, 2009, pp. 751-756.
[10] G. Jacobson, V. Betts and B. Smith, “Change in Volume of Lumpectomy Cavity during External-Beam Irradiation of the Intact Breast,” International Journal of Radiation Oncology · Biology · Physics, Vol. 65, No. 4, 2006, pp. 1161-1164.
[11] K. S. Oh, F. M. Kong, K. A. Griffith, et al., “Planning the Breast Tumor Bed Boost: Changes in the Excision Cavity Volume and Surgical Scar Location after Breast-Conserving Surgery and Whole-Breast Irradiation,” International Journal of Radiation Oncology · Biology · Physics, Vol. 66, No. 3, 2006, pp. 680-686.
[12] R. Sharma, M. Spierer, S. Mutyala, et al., “Change in Seroma Volume during Whole-Breast Radiation Therapy,” International Journal of Radiation Oncology · Biology · Physics, Vol. 75, No. 1, 2009, pp. 89-93.
[13] T. J. Yang, P. H. Elkuizen, R. T. Minkema, et al., “Clinical Factors Associated with Seroma Volume Reduction in Breast-Conserving Therapy for Early-State Breast Cancer: A Multi-Institutional Analysis,” International Journal of Radiation Oncology · Biology · Physics, Vol. 76, No. 5, 2010, pp. 1325-1332.
[14] A. G. Taghian and C. Bourgier, “Counterpoint: Conformal External Beam for Accelerated Partial Breast Irradiation,” Brachytherapy, Vol. 8, No. 2, 2009, pp. 184-188.
[15] R. C. Susil, E. C. Ford, M. S. Camp, et al., “Hydrogel Fillers May Improve Visibility of Breast Lumpectomy Cavities,” Submitted for Publication.

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