A Systematic Overview of Radiation Therapy Effects in Breast Cancer

Rutqvist, Lars Erik; Rose, Carsten; Cavallin‐Ståhl, Eva

doi:10.1080/02841860310014444

Cited by 87 publications

(48 citation statements)

References 28 publications

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“…Based on these, and similar studies, there are now clear guidelines regarding the indications for postmastectomy radiation which are; large tumour size, direct involvement of the skin, and 4 or more metastatic axillary lymph nodes [6][7][8]. However, despite reducing loco-regional recurrences and increasing disease-free survival [9], post mastectomy radiotherapy may negatively affect reconstruction outcome.…”

Section: Introductionmentioning

confidence: 98%

Radiotherapy and breast reconstruction: a meta-analysis

Barry

Kell

2011

Breast Cancer Res Treat

237

126

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To cite this version:M Barry, M. R. Kell. Radiotherapy and breast reconstruction: a meta-analysis. Breast Cancer Research and Treatment, Springer Verlag, 2011, 127 (1) databases were searched and cross-referenced for appropriate studies where morbidity following BR was the primary outcome measured.. Results:1,105 patients were identified from 11 appropriately selected studies.Patients undergoing PMRT and BR are more likely to suffer morbidity compared to patients not receiving PMRT ((OR) = 4.2; 95% CI, 2.4-7.2(no PMRT vs. PMRT)). Reconstruction technique was also examined with outcome whenPMRT was delivered after BR and this demonstrated that autologous reconstruction is associated with less morbidity in this setting ((OR) = 0.21; (95% CI, 0.1-0.4 (autologous vs. implant based)). Delaying BR until after PMRT had no significant effect on outcome ((OR) =0.87; 95% CI, 0.47-1.62 (delayed vs. immediate)).Conclusions: PMRT has a detrimental effect on BR outcome. These results suggest that where immediate reconstruction is undertaken with the necessity of PMRT, an autologous flap results in less morbidity when compared to implant based reconstruction. 3 INTRODUCTION:Breast Eligibility CriteriaAll trials whether randomized or non-randomized, prospective or retrospective were eligible that examined the effects of radiotherapy on immediate or delayed breast reconstruction using either a prosthesis or autologous tissue (Latissimus Dorsi (LD) or Trasversus Rectus Abdominis Muscle (TRAM). Case series orreports were not included. Studies where the data could not be accurately extracted were also excluded. Data Extraction and OutcomesThe following information regarding each eligible trial was recorded: authors' names, journal, patient numbers, timing and method of reconstruction, addition of radiotherapy and the post-operative complication rate. The primary end point of 7 this meta-analysis was postoperative morbidity including capsular contracture, fibrosis, fat necrosis, surgical site infections requiring removal of prosthesis/reoperation (see tables 2, 4 and 6). Statistical AnalysisFor post-operative complications in each study, the odds ratio (O.R.) of the simple proportions of events was estimated with its variance and 95% CI.Heterogeneity between the O.R.s for the same outcome between studies was assessed by use of the X 2 -based Q statistic [24]. Data were then combined across studies by the use of general variance methods with fixed and random effects models [14]. Analyses were conducted using StatsDirect version 2.5.6(StatsDirect Ltd, Chesire, United Kingdom) and SPSS version 12.0 (SPSS, Inc, Chicago, IL). All statistical tests were two tailed. 8 RESULTS:Eligible Studies 20 potentially eligible studies were identified that examined the effects of radiotherapy on immediate or delayed breast reconstructions. 9 studies were excluded from the meta-analysis due to low numbers (e.g. n < 15) or incomplete data set regarding postoperative morbidity. Of the 11 studies selected, 4 were studies that examined the effects of RT...

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Section: Introductionmentioning

confidence: 98%

Radiotherapy and breast reconstruction: a meta-analysis

Barry

Kell

2011

Breast Cancer Res Treat

237

126

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“…Even though there have been correlations between pulmonary function and fatigue, the reduction of values such as volume, capacities and respiratory muscle strength can also influence the appearance of fatigue 26 . The symptoms of lack of energy, tiredness, and intolerance to effort can be a reflex of the RT itself, of psychological factors, of the need to sleep/rest during the day 8,15,21,26 , and they can even be increased by the negative repercussions of RT on the respiratory function 26 . Clinically, it is expected that when the pulmonary function is compromised, even if temporarily or without great repercussions, the patients can experiment situations of indisposition or exhaustion.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the decreased pulmonary function and the reduction of more than 20% of FVC and FEV1, the values remained within normality, according to weight, age and height of the studied sample 18,19 . Changes in lung capacity and volume are expected after RT 11,[21][22][23][24][25] , since there are potential risks of damaging the pulmonary parenchyma, losing type ii pneumocytes, losing surfactant and edema in the basement membrane 26 . But there is also the possibility that the patient can remain asymptomatic or never present any changes, be it in the parenchyma or in the pulmonary function, due to the "compensation in relation to the health lung", which did not receive radiation 24 .…”

Section: Discussionmentioning

confidence: 99%

Efeito da radioterapia na função pulmonar e na fadiga de mulheres em tratamento para o câncer de mama

Santos¹,

Rett²,

Mendonça³

et al. 2013

Fisioter. Pesqui.

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O presente estudo comparou a função pulmonar e a fadiga de mulheres antes e após a radioterapia (RT) adjuvante para tratamento do câncer de mama, e correlacionou a função pulmonar com a dose de radiação e fadiga. Foi conduzido um estudo observacional longitudinal envolvendo 20 mulheres. A função pulmonar foi avaliada pela espirometria (ClementClarke®) e manovacuometria (GlobalMed®, modelo MVD 300), e a fadiga pelo Functional Assessment of Cancer Therapy Fatigue (FACT-F). Todas as avaliações foram realizadas antes da primeira sessão e uma semana após o término da RT adjuvante. Para a análise estatística foram utilizados os testes Wilcoxon Signed Rank Test e correlação de Spearman, adotando-se nível de significância p<0,05. Na espirometria, encontrou-se redução significativa da capacidade vital forçada (23,52%), do volume expiratório forçado no primeiro segundo (26,23%) e do pico de fluxo expiratório (10,12%) (p=0,001). As pressões expiratórias e inspiratórias máximas também diminuíram significativamente (25,45 e 32,92%, respectivamente). Observou-se diminuição significativa do bem-estar físico e do bem-estar funcional, e um aumento significativo da fadiga no FACT-F (p=0,001). Não foram observadas correlações entre as variáveis da função pulmonar com a dose de radiação e fadiga. Em curto prazo, a RT promoveu redução na função pulmonar, mas a mesma permaneceu próxima à normalidade para a amostra estudada. Observou-se aumento significativo da fadiga e diminuição dos escores dos domínios bem-estar físico e funcional.

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“…An overview recently described the benefit of adjuvant radiotherapy in terms of reduction in loco-regional failure, disease-free survival, and breast cancer-specific survival (40). However, it is also apparent from the data that this benefit is achieved at the expense of significant over-treatment, and future studies should be directed at a better selection of patients to receive radiotherapy.…”

Section: Adjuvant Treatment Of Primary Breast Cancermentioning

confidence: 99%