RESEARCH ARTICLE Interrogating a Multifactorial Model of Breast Conserving Therapy with Clinical Data

Most women with early stage breast cancer do not require removal of the entire breast to treat their cancer; instead, up to 70 % of women can be effectively and safely treated by breast conserving therapy (BCT) with surgical removal of the tumor only (lumpectomy) fol-lowed by radiation treatment of the remaining breast tissue. Unfortunately, the final contour and cosmesis of the treated breast is suboptimal in approximately 30 % of patients. The abil-ity to accurately predict breast contour after BCT for breast cancer could significantly im-prove patient decision-making regarding the choice of surgery for breast cancer. Our overall hypothesis is that the complex interplay among mechanical forces due to gravity, breast tis-sue constitutive law distribution, inflammation induced by radiotherapy and internal stress generated by the healing process play a dominant role in determining the success or failure of lumpectomy in preserving the breast contour and cosmesis. We have shown here from a first patient study that even in the idealistic situation of excellent cosmetic outcome this problem requires multiscale modeling. We propose a method to decide which component of the model works best for each phase of healing and what parameters should be considered dominant and patient specific. This patient study is part of a clinical trial registered on Clini-calTrial.gov, identifier NCT02310711