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

Lao, Nicholas; Brackstone, Muriel; Formenti, Silvia; Doherty, Christopher; Perera, Francisco; Chow, Ronald; DeLyzer, Tanya; Grant, Aaron; Boldt, Gabriel; Lock, Michael

doi:10.1016/j.ctro.2021.05.002

Cited by 5 publications

(3 citation statements)

References 31 publications

(56 reference statements)

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“…Only one relapse developed in the deep chest wall structures (pectoral minor, intercostal muscle, and rib), which is not regarded as the irradiated volume in the present guideline. Meta-analysis also reported the paucity of recurrences to deep chest wall compared with those to skin/subcutaneous and pectoral muscle ( 45 ). Joo et al.…”

Section: Discussionmentioning

confidence: 99%

The impact of the new ESTRO-ACROP target volume delineation guidelines for postmastectomy radiotherapy after implant-based breast reconstruction on breast complications

Park,

Jang,

Chang

et al. 2024

Front. Oncol.

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The European Society for Radiotherapy and Oncology–Advisory Committee in Radiation Oncology Practice (ESTRO-ACROP) updated a new target volume delineation guideline for postmastectomy radiotherapy (PMRT) after implant-based reconstruction. This study aimed to evaluate the impact on breast complications with the new guideline compared to the conventional guidelines. In total, 308 patients who underwent PMRT after tissue expander or permanent implant insertion from 2016 to 2021 were included; 184 received PMRT by the new ESTRO-ACROP target delineation (ESTRO-T), and 124 by conventional target delineation (CONV-T). The endpoints were major breast complications (infection, necrosis, dehiscence, capsular contracture, animation deformity, and rupture) requiring re-operation or re-hospitalization and any grade ≥2 breast complications. With a median follow-up of 36.4 months, the cumulative incidence rates of major breast complications at 1, 2, and 3 years were 6.6%, 10.3%, and 12.6% in the ESTRO-T group, and 9.7%, 15.4%, and 16.3% in the CONV-T group; it did not show a significant difference between the groups (p = 0.56). In multivariable analyses, target delineation is not associated with the major complications (sHR = 0.87; p = 0.77). There was no significant difference in any breast complications (3-year incidence, 18.9% vs. 23.3%, respectively; p = 0.56). Symptomatic RT-induced pneumonitis was developed in six (3.2%) and three (2.4%) patients, respectively. One local recurrence occurred in the ESTRO-T group, which was within the ESTRO-target volume. The new ESTRO-ACROP target volume guideline did not demonstrate significant differences in major or any breast complications, although it showed a tendency of reduced complication risks. As the dosimetric benefits of normal organs and comparable oncologic outcomes have been reported, further analyses with long-term follow-up are necessary to evaluate whether it could be connected to better clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

The impact of the new ESTRO-ACROP target volume delineation guidelines for postmastectomy radiotherapy after implant-based breast reconstruction on breast complications

Park,

Jang,

Chang

et al. 2024

Front. Oncol.

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“… 25 Novel emerging approaches, such as prepectoral implant-based reconstruction, where the implant is wrapped in acellular dermal matrix and placed in the subcutaneous pocket to help avoid pectoral capsular contracture, may emerge as options for minimizing radiation-related complications from immediate implant-based reconstruction given the lower reported rate of capsular contracture 26 ; however, there is currently limited experience with this approach and more research is needed. 27 Other novel adaptations to treatment include the delivery of postmastectomy radiation to the anterior aspect of the reconstruction, excluding the implant or tissue expander, such that radiation dosage is not delivered to the deep chest wall where recurrences are exceedingly rare, 28 thus avoiding circumferential full coverage of the reconstructive volume by the proscribed dose and resultant capsular contracture.…”

Section: Discussionmentioning

confidence: 99%

Complications From Postmastectomy Radiation Therapy in Patients Undergoing Immediate Breast Reconstruction: A Population-Based Study

Doherty

McClure²,

Baxter³

et al. 2023

Advances in Radiation Oncology

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“…This is important as 28%–78% of local recurrences occur within the anterior chest wall, consisting of the skin, subcutaneous tissue, and pectoralis musculature. 18 , 19 Due to the small sample size and relatively short-term follow-up available for patients undergoing prepectoral reconstruction future studies are needed to determine the clinical implications of reconstructive technique on locoregional recurrence. We also found the mean percentage volume of the pectoralis muscle receiving 100% of the prescribed dose was greater in the prepectoral than subpectoral tissue expander cohort, and that hot spots were larger in the prepectoral cohort.…”

Section: Discussionmentioning

confidence: 99%

Impact of Prepectoral vs. Subpectoral Tissue Expander Placement on Post-mastectomy Radiation Therapy Delivery: A Retrospective Cohort Study

Copeland-Halperin,

Lyatskaya,

Bellon

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: Implant-based reconstruction is the most common method of postmastectomy reconstruction. Many patients require postmastectomy radiation (PMRT). Tissue expanders (TEs), typically inserted as a first stage, have historically been placed subpectorally. More recently, prepectoral reconstruction has gained popularity, but its impact on PMRT is unknown. Prior studies focus on complication rates and aesthetic outcomes. This study examines whether there is a difference in radiation dosimetry among patients undergoing prepectoral versus subpectoral TE reconstruction. Methods: Electronic medical records and radiation plans of 50 patients (25 prepectoral, 25 subpectoral) who underwent mastectomy with immediate TE reconstruction at our institution or affiliate site were reviewed. Pectoralis major muscle and chest wall structures were contoured and mean percentage volumes of these structures receiving less than 95%, 100%, and more than 105% target radiation dose were calculated, as were heart and ipsilateral lung doses. Welch two sample t test, Fisher exact test, and Pearson chi-squared tests were performed. Results: The groups had comparable patient and tumor characteristics and underwent similar ablative and reconstructive procedures and radiation dosimetry. Subpectoral patients had larger mean areas receiving less than 95% target dose (“cold spots”); prepectoral patients had larger mean areas receiving greater than 105% (“hot spots”) and 100% target doses. There were no differences in chest wall, heart, and lung doses. Conclusions: Our results demonstrate an increased mean percentage area of pectoralis cold spots with subpectoral reconstruction and increased area of hot spots and 100% dose delivery to the pectoralis in prepectoral patients. Larger studies should analyze long-term effects of prepectoral reconstruction on radiation dosing and recurrence rates.

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

Cited by 5 publications

References 31 publications

The impact of the new ESTRO-ACROP target volume delineation guidelines for postmastectomy radiotherapy after implant-based breast reconstruction on breast complications

The impact of the new ESTRO-ACROP target volume delineation guidelines for postmastectomy radiotherapy after implant-based breast reconstruction on breast complications

Complications From Postmastectomy Radiation Therapy in Patients Undergoing Immediate Breast Reconstruction: A Population-Based Study

Impact of Prepectoral vs. Subpectoral Tissue Expander Placement on Post-mastectomy Radiation Therapy Delivery: A Retrospective Cohort Study

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