<p>Patterns of Chest Wall Recurrence and Suggestions on the Clinical Target Volume of Breast Cancer: A Retrospective Analysis of 121 Postmastectomy Patients</p>

Abstract

Radiotherapy is a powerful strategy to prevent chest wall recurrence (CWR) of postmastectomy breast cancer (BC). This retrospective study aims at analyzing patterns of CWR to explore the delineation of clinical target volume. Patients and Methods: Detailed clinicopathological information of postmastectomy BC patients with CWR was collected from our single cancer center based on clear criteria. To describe recurrent positions more accurately, the chest wall was divided into three layers: skin layer (skin and subcutaneous tissues), pectoralis layer (pectoralis major and minor), and rib layer (rib and intercostal muscle). The frequency distribution of recurrence location and its association with clinical pathological factors were analyzed. Results: A total of 121 postmastectomy BC with CWR were included in this study. The percentages of breast tumor located in the upper outer quadrant, upper inner quadrant, lower inner quadrant, lower outer quadrant, overlapping quadrant, and areola area were 31.0% (35/ 113), 26.5% (30/113), 12.4% (14/113), 5.3% (6/113), 21.1% (25/113), and 2.7% (3/113), respectively. HER2-positive BC (51/113, 45.1%) is the most common BC subtype. Analysis on the patterns of CWR showed that recurrences locating in the skin layer, pectoralis layer, rib layer, mixed layers, and incision periphery accounted for 58.6% (68/116), 9.5% (11/116), 1.7% (2/116), 30.2% (35/116), and 60.5% (46/76), respectively. Rates of recurrences located in the skin and/or pectoralis layers for all BC patients, patients with concomitant distance metastasis, and patients without concomitant distance metastasis were 82.8% (96/116), 85.9% (49/57), and 81.0% (47/58), respectively. Conclusion: For BC patients receiving mastectomy, skin, subcutaneous tissues, pectoralis, and area around incision have a high risk of recurrence, which should be paid more attention in chest wall radiotherapy.

Redefining postmastectomy radiation contouring in the era of immediate breast reconstruction: An accurate assessment of local recurrence risk

“…Full manuscripts could not be obtained or did not specify the location of recurrences in 74 publications. A total of 14 relevant articles were identified and were included in our meta-analysis [9][10][11][12][13][14][15][16][17][18][19][20][21][22].…”

“…Table 3 outlines recurrence locations for each study. Only Gerber et al [12], Gilliland et al [13] and Wang et al [22] reported recurrences in the deep chest wall. Wang et al did not clearly differentiate their subcutaneous and pectoralis recurrences and these are reported together in Table 3 to reflect this, which did not impact our analysis.…”

“…The availability of acellular dermal matrix products has allowed for significant increases in one-stage immediate implant-based reconstruction [31], however concern regarding whether patients may require post-mastectomy chest wall radiation based on final pathological nodal status has led to conservative recommendations [10] 14 (200%) 0 0 14 Farras et al [11] 8 (80%) 2 (20%) 0 10 Gerber et al [12] 4 (66.7%) 0 2 (33.3%) 6 Gilliland et al [13] 50 (80%) 0 10 (20%) 60 Johnson et al [14] 7 (100%) 0 0 7 Meretoja et al [15] 8 (100%) 0 0 8 Noone et al [16] 12 (75.0%) 4 (25.0%) 0 (0%) 16 Pifer et al [17] 11 (64.7%) 6 (35.3%) 0 (0%) 17 Slavin et al [18] 17 (100%) 0 (0%) 0 (0%) 17 Sood et al [19] 6 (100%) 0 0 6 Stanec et al [20] 15 (100%) 0 0 15 Uriburu et al [21] 3 (100%) 0 0 3 Wang et al [22] 96 against immediate reconstruction in patients who may require radiation [32], despite improved cosmetic outcome and quality of life among patients who undergo immediate reconstruction at the time of their mastectomy [33].…”

Unusual sonographic appearance of breast cancer metastasis to the pectoralis muscle

“…11,12 Enhanced CT or enhanced magnetic resonance imaging or PET/CT shows new nodules or masses in the chest wall. 13 In half of the patients with chest wall recurrences, lesions appear within 2 years after the initial diagnosis. 13 In our case, the time elapsed between mastectomy and recurrence was 12 years.…”

“…13 In half of the patients with chest wall recurrences, lesions appear within 2 years after the initial diagnosis. 13 In our case, the time elapsed between mastectomy and recurrence was 12 years. In summary, invasive lobular carcinoma of the breast can metastasize to the pectoralis muscles, presenting on ultrasound as a marked enlargement of these muscles with preserved fibrillar echotexture and without discrete masses or nodules.…”