Comparison of Local Recurrence and Distant Metastases between Breast Cancer Patients after Postmastectomy Radiotherapy with and without Immediate TRAM Flap Reconstruction

Huang, Chi‐Yu; Hou, Ming‐Feng; Lin, Sin-Daw; Chuang, Hung‐Yi; Huang, Ming‐Yii; Ouyang, Fusheng; Lian, Shi-Long

doi:10.1097/01.prs.0000220527.35442.44

Cited by 81 publications

(58 citation statements)

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“…More importantly for the patient, it provides enormous psychosocial benefits by restoring femininity and improving vitality, sexuality and quality of life [14]. In the absence of implants, immediate breast reconstruction has a very favourable morbidity profile even when exposed to adjuvant radiotherapy [23]. Moreover, it is oncologically safe with an acceptable local recurrence rate [23].…”

Section: Resultsmentioning

confidence: 99%

“…In the absence of implants, immediate breast reconstruction has a very favourable morbidity profile even when exposed to adjuvant radiotherapy [23]. Moreover, it is oncologically safe with an acceptable local recurrence rate [23]. Despite this, advocates of delayed breast reconstruction suggest that there are two main problems with immediate breast reconstruction in the presence of radiotherapy.…”

Section: Resultsmentioning

confidence: 99%

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Radiotherapy and breast reconstruction: a meta-analysis

Barry

Kell

2011

Breast Cancer Res Treat

236

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: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Radiotherapy and breast reconstruction: a meta-analysis

Barry

Kell

2011

Breast Cancer Res Treat

236

126

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“…27 In our study LR and RNR rates were comparable with data from the literature suggesting that our strategy does not alter the loco regional control. 28,29 Survival rates were significantly different between our 2 cohorts, mostly related to an obvious difference in prognosis factors. Taking these aspects into account, we did not observe any significant difference in terms of LR and RNR.…”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 99%

Mastectomy with immediate breast reconstruction after neoadjuvant chemotherapy and radiation therapy. A new option for patients with operable invasive breast cancer. Results of a 20 years single institution study

Monrigal

Dauplat

Gimbergues

et al. 2011

European Journal of Surgical Oncology (EJSO)

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PurposeTo evaluate the feasability of immediate breast reconstruction (IBR) following mastectomy after neoadjuvant chemotherapy (NACT) and radiation therapy (RT) for operable invasive breast cancer (OIBC), in terms of incidence of local complications, locoregional control and survival. Patients and methodsFrom 1990 to 2008, 210 patients were treated by NACT, RT and mastectomy with IBR for OIBC. One hundred and seven patients underwent a latissimus dorsi flap with implant (LDI), 56 patients a transverse rectus abdominis musculocutaneous (TRAM) flap, 25 an autologous latissimus dorsi flap (ALD) and 22, a retropectoral implant (RI) reconstruction. ResultsForty-six (21,9%) early events were recorded: 20 necrosis, 9 surgical site infections and 6 haematomas, requiring further surgery in 23 patients. More necrosis were observed with TRAM flap reconstructions (p=0,000004), requiring more surgical revision than LD reconstructions. Seromas represented 42% of early complications in LD reconstructions. Fifty-five patients presented with late complications (26,2%) with mainly implant complications (capsular contracture, infection, dislocation, deflation) (23,6%), requiring reintervention in 14 cases. There were more delayed surgical revisions in RI reconstructions (p=0,0005). The 5 years overall and disease-free survival rates were respectively 86,7% and 75,6%. Sixty-four patients presented at least one recurrence (30,5%) with 5 local , 9 locoregional and 54 distant relapses. ConclusionThis therapeutic sequence does not seem to increase the IBR morbidity nor alter disease-free and overall survival.

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“…It is to a greater extent possible to preserve the inframammary fold and to adjust the placement of the scar, in order to achieve the most aesthetic result [1,2]. Immediate breast reconstruction reduces the overall cost compared to delayed reconstruction [3]. Furthermore it has been shown to have psychological advantages for the patients [4].…”

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confidence: 99%