Quantifying the Impact of Immediate Reconstruction in Postmastectomy Radiation: A Large, Dose-Volume Histogram-Based Analysis

Ohri, Nisha; Cordeiro, Peter G.; Keam, Jennifer; Ballangrud, Åse M.; Shi, Wei; Zhang, Zhigang; Nerbun, Claire T.; Woch, Katherine M.; Stein, Nicholas F.; Zhou, Ying; McCormick, Beryl; Powell, Simon N.; Ho, Alice Y.

doi:10.1016/j.ijrobp.2012.03.026

Cited by 51 publications

(22 citation statements)

References 12 publications

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“…For the non‐RT group, 12 complications requiring surgery occurred in nine patients before placement of a PI. Reasons for surgery included necrosis/dehiscence , TE exposure in two patients with one requiring TE removal and replacement, hematoma/seroma drainage , asymmetry in two patients with one having exchange for a larger TE, and infection . Only one of these patients eventually had removal of their PI.…”

Section: Resultsmentioning

confidence: 99%

“…However, the potential for less morbidity and shorter operative and recovery time make implants an appealing choice to many patients. Although there has been concern in the past for suboptimal dosimetry when radiating breast implants , subsequent dosimetric evaluations and clinical outcome studies support the safety of such practices . Since implant‐based reconstruction accounts for the majority of reconstructions performed post‐mastectomy , an increase in the sparse data available regarding expected aesthetic and clinical outcomes after RT is essential.…”

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confidence: 99%

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The Effect of Radiation on Complication Rates and Patient Satisfaction in Breast Reconstruction using Temporary Tissue Expanders and Permanent Implants

et al. 2015

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PURPOSE The optimal method of reconstruction following mastectomy for breast cancer patients receiving radiation (RT) is controversial. This study evaluated patient satisfaction and complication rates among patients who received implant-based breast reconstruction. METHODS AND MATERIALS The specific treatment algorithm analyzed included patients receiving mastectomy and immediate temporary tissue expander (TE), followed by placement of a permanent breast implant (PI). If indicated, radiation therapy (RT) was delivered to the fully expanded TE. Records of 218 consecutive patients with 222 invasive (85%) or in-situ (15%) breast lesions from the Salt Lake City region treated between 1998 and 2009 were retrospectively reviewed, 28% of whom received RT. Median RT dose was 50.4 Gy, and 41% received a scar boost at a median dose of 10 Gy. Kaplan-Meier analyses were performed to evaluate the cumulative incidence of surgical complications, including permanent PI removal. Risk factors associated with surgical events were analyzed. To evaluate cosmetic results and patient satisfaction, an anonymous survey was administered. RESULTS Mean follow-up was 44 months (range, 6 – 144). Actuarial five-year PI removal rates for Non-RT and RT patients were 4% and 22%, respectively. On multivariate analysis (MVA), the only factor associated with PI removal was RT (p=0.009). Surveys were returned describing the outcomes of 149 breasts. For the Non-RT and RT groups, those who rated their breast appearance as good or better were 63% vs. 62%, respectively. Under 1/3 of each group was dissatisfied with their reconstruction. CONCLUSIONS RT did not significantly affect patient satisfaction scores, but on MVA RT was the only factor associated with increased PI removal. This reconstruction technique may be considered an acceptable option even if RT is needed, but the increased complication risk with RT must be recognized.

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Section: Resultsmentioning

confidence: 99%

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confidence: 99%

The Effect of Radiation on Complication Rates and Patient Satisfaction in Breast Reconstruction using Temporary Tissue Expanders and Permanent Implants

et al. 2015

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“…Thirdly, our definition of target volume is different from others as we classified radiation plans into two subsets: chest wall only and chest wall plus lymph nodes. Finally, irradiation of intramammary nodes that has been shown to correlate with higher doses to risk organs [14,24] is negligible in our cohort due to the differences in guidelines and intramammary nodes targeting. This issue, therefore, was not specifically addressed in this study.…”

Section: Discussionmentioning

confidence: 95%

“…Notably, the target volumes for IBR- plans were not delineated and all ipsilateral lung and heart structures were delineated for study purposes de novo . The interpretation of the study results is difficult due to the fact that different radiation techniques were utilized in the two disparate groups of IBR+ and IBR- patients [14]. …”

Section: Discussionmentioning

confidence: 99%

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No difference in dose distribution in organs at risk in postmastectomy radiotherapy with or without breast implant reconstruction

et al. 2014

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The aim of this study was to quantify the variation in doses to organs at risk (ipsilateral lung and heart) and the clinical target volume (CTV) in the presence of breast implants. In this retrospective cohort study, patients were identified through the National Breast Cancer Register. Consecutive breast cancer patients undergoing mastectomy between 2009 and 2011 and completing a full course of postmastectomy radiotherapy (PMRT) were eligible. All included patients (n = 818) were identified in the ARIA© oncology information system and further stratified for immediate breast reconstruction (IBR+, n = 162) and no immediate breast reconstruction (IBR-, n = 656). Dose statistics for ipsilateral lung, heart and CTV were retrieved from the system. Radiation plans for patients with chest wall (CW) only (n = 242) and CW plus lymph nodes (n = 576) irradiation were studied separately.The outcome variables were dichotomized as follows: lung, V20Gy ≤ 30% vs. V20Gy > 30%; heart, Dmean ≤ 5 Gy vs. Dmean > 5 Gy; CTV, V95% ≥ median vs. V95% < median.In the univariate and multivariate regression models no correlation between potential confounders (i.e. breast reconstruction, side of PMRT, CW index) and the outcome variables was found. Multivariate analysis of CW plus lymph nodes radiation plans, for example, showed no association of breast reconstruction with dosimetric outcomes in neither lung nor heart- lung V20Gy (odds ratio [OR]: 0.6, 95%CI, 0.4 to 1.0, p = 0.07) or heart Dmean (OR: 1.2, 95%CI, 0.5 to 3.1, p = 0.72), respectively.CTV was statistically significantly larger in the IBR+ group (i.e. included breast implant), but no correlation between the implant type and dosimetric characteristics of the organs at risk was revealed.In the current study, the presence of breast implants during postmastectomy radiotherapy was not associated with increased doses to ipsilateral lung and heart, but CTV definition and its dosimetric characteristics urge further evaluation.

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Postmastectomy Radiation Therapy and Breast Reconstruction—Marching Forward Together or Apart?

Recht

2016

JAMA Oncol

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Quantifying the Impact of Immediate Reconstruction in Postmastectomy Radiation: A Large, Dose-Volume Histogram-Based Analysis

Cited by 51 publications

References 12 publications

The Effect of Radiation on Complication Rates and Patient Satisfaction in Breast Reconstruction using Temporary Tissue Expanders and Permanent Implants

The Effect of Radiation on Complication Rates and Patient Satisfaction in Breast Reconstruction using Temporary Tissue Expanders and Permanent Implants

No difference in dose distribution in organs at risk in postmastectomy radiotherapy with or without breast implant reconstruction

Postmastectomy Radiation Therapy and Breast Reconstruction—Marching Forward Together or Apart?

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