Clinical outcomes following immediate reconstruction and post-mastectomy radiation therapy

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10560-10560
Author(s):  
J. D. Jhaveri ◽  
I. Savetsky ◽  
J. L. Bosworth ◽  
S. C. Rush
Keyword(s):  
Radiation Therapy ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Tissue Expander ◽  
Muscle Flap ◽  
Complete Removal ◽  
Immediate Breast Reconstruction ◽  
Surgical Revision ◽  
Immediate Reconstruction

10560 Background: Post-mastectomy radiation therapy (PMRT) is an important component of the treatment for locally advanced breast cancer. Some patients opt for immediate breast reconstruction (IR) to cope with the aesthetic consequences of mastectomy. A small number of series have reported mixed results with IR using a tissue expander/implant (TE/I) followed by PMRT. We sought to determine the outcome of patients receiving PMRT after IR with either TE/I or autologous tissue reconstruction (ATR), with respect to both complications and cosmesis. Methods: We retrospectively reviewed the charts of 47 women who underwent PMRT in our practice after IR. All follow-up information was obtained by reexamination or by telephone interview. Contracture/fibrosis results were scored on a scale as follows: 0- no complaints, 1- mild discomfort, not affecting activities of daily life (ADLs), 2- moderate discomfort, affecting ADLs, or biopsy-proven fat necrosis, 3- complications requiring surgical revision, 4- reconstruction failure, requiring removal. For cosmesis, results were recorded as: 1- acceptable, 2- unacceptable. Results: A total of 47 patients were identified as having undergone PMRT after IR. 35 underwent TE/I and 12 underwent ATR, most commonly transverse rectus abdominus muscle flap reconstruction. Median follow-up was 36 months (range: 26 - 96 months). All patients were treated with 50.4 Gy in 25 fractions to the chest wall, and seven patients received an additional electron boost to high risk areas. All patients received 45 Gy in 25 fractions to a supraclavicular field. Of the patients who underwent TE/I and PRMT, twenty-one of 35 (60%) described unacceptable cosmesis, as opposed to two of 12 ATR patients (17%) (p = .02). Similarly, 13 patients in the TE/I (37%) group required either surgical revision (n = 3) or complete removal of their implant (n = 10), as compared to none of the patients in the ATR group (p = .02). Conclusion: Immediate TE/I reconstruction with PMRT was associated with high rates of complications and poor cosmetic results in our experience. ATR resulted in significantly higher rates of functional and cosmetic success. Thus, if IR is planned in the setting of PMRT, ATR should be recommended. No significant financial relationships to disclose.

scholarly journals Oncological safety of immediate rectus abdominis myocutaneous breast reconstruction in patients with locally advanced disease (stage IIb and III)

2013 ◽  
Vol 02 (04) ◽  
pp. 239-242
Author(s):  
Mushtaq Mir ◽  
Muddassir Shahdhar ◽  
Khurshid Ganaie ◽  
Quibtiya Syed
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Breast Reconstruction ◽  
Systemic Therapy ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Immediate Breast Reconstruction ◽  
Rectus Abdominis ◽  
Reconstructed Breast

Abstract Background: The management of locally advanced (Stage IIb and III) breast cancer is challenging. It often includes multimodal treatment with systemic therapy and/or radiation therapy and surgery. Immediate breast reconstruction has not traditionally been performed in these patients. We review the results of immediate rectus abdominis musculo-cutaneous (TRAM/VRAM) flap in 60 patients treated for Stage IIb and III breast cancer. Materials and Methods: Data were collected prospectively on 60 patients diagnosed with Stage IIb (32 patients) and Stage III (28 patients) breast cancer between May 2008 and May 2012. All patients had mastectomy and immediate rectus abdominis myocutaneous reconstruction (TRAM in 40 patients and VRAM in 20 patients). All patients received primary systemic therapy, and all patients received postoperative radiotherapy to the operative site. Results: Mean age was 40.13 (range 28-53) years, mean hospital stay was 8.86 days and mean follow-up for the group was 28 months. Neither of them developed local disease recurrence in the operative site till the last follow-up. Eight (13.3%) patients had some delay in chemo-radiation therapy due to flap-related complications. Flap-related complications were present in eight patients (partial flap failure in four and superficial skin necrosis in four). There was no adverse effect of chemo-radiation therapy on reconstructed breast. Conclusion: Immediate TRAM/VRAM breast reconstruction for locally advanced breast cancer is not associated with a significant delay in adjuvant therapy or an increased risk of local relapse. Radiation therapy can be delivered to the reconstructed breast when indicated without difficulty. Breast reconstruction facilitates surgical resection of locally advanced breast cancer with primary closure and should be considered if the patient desires immediate breast reconstruction.

A Comparative Analysis of Immediate and Delayed-immediate Breast Reconstruction after Postmastectomy Radiation Therapy

2021 ◽  
Author(s):  
Adrienne N. Christopher ◽  
Martin P. Morris ◽  
Robyn B. Broach ◽  
Joseph M. Serletti
Keyword(s):  
Radiation Therapy ◽  
Breast Reconstruction ◽  
Locally Advanced Breast Cancer ◽  
Statistical Significance ◽  
Locally Advanced ◽  
Tissue Expander ◽  
Optimal Timing ◽  
Postmastectomy Radiation ◽  
Postmastectomy Radiation Therapy

Abstract Background Postmastectomy radiation therapy (PMRT) is an important component in the treatment of locally advanced breast cancer. Optimal timing of therapy in relation to autologous breast reconstruction (ABR) remains clinically debated. Herein, we comparatively analyze short- and long-term outcomes between immediate ABR (I-ABR) and delayed-immediate ABR (DI-ABR) in the setting of PMRT. Methods Adult patients undergoing ABR with PMRT were separated into cohorts based on reconstructive timeline: I-ABR or DI-ABR. The groups were propensity matched 1:1 by age, body mass index, and comorbidities. Surgical site events and long-term clinical outcomes (readmissions, reoperations, and revision procedures) were collected. Univariate analyses were completed using Pearson's chi-squared tests and Fisher's exact tests, and statistical significance was set at p < 0.05. Results One hundred and thirty-two flaps (66 in each cohort) were identified for inclusion. Patients with I-ABR were more likely to experience fat necrosis (p = 0.034) and skin necrosis (p < 0.001), require additional office visits (p < 0.001) and outpatient surgeries (p = 0.015) to manage complications, and undergo revision surgery after reconstruction (p < 0.001). DI-ABR patients, however, had a 42.4% incidence of complications following tissue expander placement prior to reconstruction, with 16.7% of patients requiring reoperation during this time. Only one patient (I-ABR) experienced flap loss due to a vascular complication. Conclusion The complications encountered in both of these groups were not prohibitive to offering either treatment. Patients should be made aware of the specific and unique risks of these reconstruction timelines and involved throughout the entire decision-making process. Plastic surgeons should continue to strive to elucidate innovative approaches that facilitate enhanced quality of life without compromising oncologic therapy.

scholarly journals Prospective Study of Intensity-Modulated Radiation Therapy for Locally Advanced Breast Cancer

Cancers ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 3852
Author(s):  
Benoît Bataille ◽  
Bennadji Raoudha ◽  
Florence Le Tinier ◽  
Laurent Basson ◽  
Alexandre Escande ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Radiation Therapy ◽  
Lymph Node ◽  
Prospective Study ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Disease Free Survival

The objective of this study was to evaluate the acute and medium-term toxicities, the quality of life, and aesthetic results of patients with breast cancer (BC) treated with tomotherapy. This was a prospective study, including patients with BC treated by tomotherapy. Radiation therapy delivered 50 Gy in 25 fractions to the breast or chest wall and to lymph node areas, with a simultaneous integrated boost at a dose of 60 Gy at the tumor bed in cases of breast conservative surgery. We included 288 patients, 168 and 120 treated with breast-conserving surgery and mastectomy respectively. Two hundred sixty patients (90.3%) received lymph node irradiation. Median follow-up was 25 months (6–48). Acute dermatitis was observed in 278 patients (96.5%), mostly grade 1 (59.7%). The aesthetic aspect of the breast at one year was reported as “good” or “excellent” in 84.6% of patients. The patients’ quality of life improved over time, especially those treated with chemotherapy. The two-year overall survival and disease-free survival were 97.8% (95% confidence interval (CI): 94.1–99.2%), and 93.4% (95% CI: 89.2–96.0%) respectively. Tomotherapy for locally advanced BC has acceptable toxicity, supporting its use in this indication; however, longer follow-up is needed to assess long-term outcomes.

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