Timing of postmastectomy radiotherapy following adjuvant chemotherapy for high-risk breast cancer: A post hoc analysis of a randomised controlled clinical trial

Chen, Siye; Sun, Guang-Yi; Tang, Yu; Hao, Jing; Song, Yong-Wen; Jin, Jing; Liu, Yue-Ping; Zhao, Xueying; Song, Yeguang; Chen, Bin; Qi, Shunan; Tang, Yuan; Liu, Ningning; Li, Ning; Fang, Hui; Li, Yexiong; Wang, Shulian

doi:10.1016/j.ejca.2022.07.023

Cited by 6 publications

(5 citation statements)

References 20 publications

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“…Based on expert advice, the Australian guideline recommends that women commence radiation therapy within four weeks of completing adjuvant chemotherapy (interval 6). Two recent studies in China found negative associations between longer chemotherapy‐to‐radiotherapy interval and survival, estimating cut‐points of twelve weeks 28 and six weeks 29 . We found that survival was significantly better for women who underwent radiotherapy within four weeks of chemotherapy (ie, as recommended by the Australian guideline), but the optimal cut‐point analysis indicated that discrimination was better with the slightly later cut‐point of 31 days.…”

Section: Discussionmentioning

confidence: 61%

Treatment intervals and survival for women diagnosed with early breast cancer in Queensland: the Breast Cancer Outcomes Study, a population‐based cohort study

Kou,

Aitken,

Pyke

et al. 2023

Medical Journal of Australia

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ObjectivesTo assess associations between breast cancer‐specific survival and timeliness of treatment, based on 2020 Australian guidelines for the treatment of early breast cancer.DesignPopulation‐based cohort study; analysis of linked Queensland Cancer Register, patient medical record, and National Death Index data, supplemented by telephone interviews.Setting, participantsWomen aged 20–79 years diagnosed with invasive breast cancer during 1 March 2010 – 30 June 2013, followed to 31 December 2020.Main outcome measuresBreast cancer‐specific survival for women who received or did not receive treatment within the recommended timeframe, overall and for six treatment intervals; optimal cut‐points for each treatment interval; characteristics of women for whom treatment was not provided within the recommended timeframe.ResultsOf 5426 eligible women, 4762 could be invited for interviews; complete data were available for 3044 women (56% of eligible women, 65% of invited women). Incomplete compliance with guideline interval recommendations was identified for 1375 women (45%); their risk of death from breast cancer during the follow‐up period was greater than for those for whom guideline compliance was complete (adjusted hazard ratio [aHR], 1.43; 95% confidence interval [CI], 1.04–1.96). Risk of death was greater for women for whom the diagnosis to surgery interval exceeded 29 days (aHR, 1.76; 95% CI, 1.19–2.59), the surgery to chemotherapy interval exceeded 36 days (aHR, 1.63; 95% CI, 1.13–2.36), or the chemotherapy to radiotherapy interval exceeded 31 days (aHR, 1.83; 95% CI, 1.19–2.80). Treatment intervals longer than recommended were more frequent for women for whom breast cancer was detected by public facility screening (adjusted odds ratio [aOR], 1.58; 95% CI, 1.22–2.04) or by symptoms (aOR, 1.39; 95% CI, 1.09–1.79) than when cancer had been detected in private facilities, and for women without private health insurance (aOR, 1.96; 95% CI, 1.66–2.32) or living outside major cities (aOR, 1.38; 95% CI, 1.18–1.62).ConclusionsBreast cancer‐specific survival was poorer for women for whom the diagnosis to surgery, surgery to chemotherapy, or chemotherapy to radiotherapy intervals exceeded guideline‐recommended limits. Our findings support 2020 Australian guideline recommendations regarding timely care.

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Section: Discussionmentioning

confidence: 61%

Treatment intervals and survival for women diagnosed with early breast cancer in Queensland: the Breast Cancer Outcomes Study, a population‐based cohort study

Kou,

Aitken,

Pyke

et al. 2023

Medical Journal of Australia

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“…38,39 Delays in adjuvant treatments after mastectomy appear less adverse than similar delays after OBS. 27,28,[32][33][34][35] Moreover, the effect delay has on these outcomes also seems to be stratified by tumor-specific biology; least pronounced with noninvasive ductal carcinoma in situ and more pronounced with aggressive triple-negative invasive breast cancers. [26][27][28][29][30]37 In 1323 patients with ductal carcinoma in situ treated with OBS, initiation of adjuvant RT within 8-12 weeks of surgery resulted in 5.8% of 5-year and 13% of 10-year ipsilateral breast recurrence, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…27,28,[32][33][34][35] Moreover, the effect delay has on these outcomes also seems to be stratified by tumor-specific biology; least pronounced with noninvasive ductal carcinoma in situ and more pronounced with aggressive triple-negative invasive breast cancers. [26][27][28][29][30]37 In 1323 patients with ductal carcinoma in situ treated with OBS, initiation of adjuvant RT within 8-12 weeks of surgery resulted in 5.8% of 5-year and 13% of 10-year ipsilateral breast recurrence, respectively. However, when adjuvant RT was started after 12 weeks, ipsilateral breast recurrence increased to 8.8% and 23% at 5 and 10 years, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…25 It is well described that ipsilateral breast recurrence, the occurrence of distant metastases, and breast cancer-specific survival rates are all adversely affected by postoperative delays in initiating any postsurgical breast cancer treatment, including radiation therapy (RT), antiestrogen therapy, and chemotherapy. [26][27][28][29][30][31][32][33][34][35][36][37] Recently, these long-held tenets have been questioned within certain subsets of patients. 38,39 Delays in adjuvant treatments after mastectomy appear less adverse than similar delays after OBS.…”

Section: Discussionmentioning

confidence: 99%

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Oncoplastic Breast Reduction: A Systematic Review of Postoperative Complications

Benedict,

Brown,

Berry

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: Breast-conserving therapy with oncoplastic reduction is a useful strategy for partial mastectomy defect reconstruction. The most recently published systematic review of oncoplastic breast reduction outcomes from 2015 showed wound dehiscence in 4.3%, hematoma in 0.9%, infection in 2.8%, and nipple necrosis in 0.9% of patients. We performed a systematic review of oncoplastic breast reduction literature, comparing outcomes and complication rates reported over the past 8 years. Methods: Studies describing the use of oncoplastic breast reduction and discussion of postoperative complications were included. The primary outcome assessed was the postoperative complication rate; secondary outcomes analyzed were rates of margin expansion, completion mastectomy, and delays in adjuvant therapy due to complications. Results: Nine articles met inclusion criteria, resulting in 1715 oncoplastic breast reduction patients. The mean rate of hematoma was 3%, nipple necrosis was 2%, dehiscence was 4%, infection was 3%, and seroma was 2%. The need for re-excision of margins occurred in 8% of patients, and completion mastectomy in 2%. Finally, delay in adjuvant treatment due to a postoperative complication occurred in 4% of patients. Conclusions: Oncoplastic breast reduction is an excellent option for many patients undergoing breast-conserving therapy; however, postoperative complications can delay adjuvant radiation therapy. Results of this systematic literature review over the past 8 years showed a slight increase in complication rate compared to the most recent systematic review from 2015. With increased popularity and surgeon familiarity, oncoplastic breast reduction remains a viable option for reconstruction of partial mastectomy defects despite a slight increase in complication rate.

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“…Post‐mastectomy radiation therapy (PMRT) decreases locoregional recurrence and improves overall survival for breast cancer patients after mastectomy (Chen et al, 2022; McGale et al, 2014; Overgaard et al, 1997, 2022; Ragaz et al, 1997, 2005; Sittenfeld et al, 2022). However, radiation therapy can have harmful effects on tissue healing and reconstructive outcomes (Jagsi et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

The impact of post‐mastectomy radiation timing on overall outcomes of autologous free‐flap breast reconstruction

et al. 2023

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BackgroundThe optimal timing of post‐mastectomy radiation therapy (PMRT) in autologous breast reconstruction is controversial. Our study compares overall reconstructive outcomes in patients who received post‐mastectomy radiation therapy either before or after the autologous flap.MethodsA single‐center retrospective review was performed for patients who underwent free flap breast reconstruction and post‐mastectomy radiation from January 2004 through January 2021. Demographic, intraoperative, and post‐operative variables were recorded.ResultsA total of 452 free flaps were identified, and 82 underwent PMRT. 59.8% were radiated with an expander prior to free flap surgery (PreFlap), and 40.2% flaps underwent PMRT (PostFlap). PostFlap patients were significantly younger (43.0 vs. 47.9 years, p = .016). There were no significant differences in free flap outcomes between the two cohorts including thrombosis, venous congestion, flap loss, takebacks, fat necrosis, seroma, or infection. Mastectomy skin flap necrosis was significantly higher in the PostFlap cohort (9.1% vs. 0%, p = .032), but nipple necrosis rates did not differ. There were no significant differences in number or need for revision surgeries, fat necrosis, or fat grafting between groups. However, there were significantly more total reconstructive complications, including infection and wound breakdown, experienced by the PreFlap cohort (46.9% vs. 24.2%, p = .038).ConclusionsTiming of PMRT did not impact free flap outcomes, but those who had the expander radiated experienced significantly more complications overall. For the 34.7% of patients in the preFlap group who planned for autologous reconstruction form initial consultation, radiation after the flap may have improved their overall outcomes. As added complications cause delays in cancer therapy and final reconstruction, our results suggest that PMRT of the flap when possible may improve the overall experience for breast cancer patients.

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Timing of postmastectomy radiotherapy following adjuvant chemotherapy for high-risk breast cancer: A post hoc analysis of a randomised controlled clinical trial

Cited by 6 publications

References 20 publications

Treatment intervals and survival for women diagnosed with early breast cancer in Queensland: the Breast Cancer Outcomes Study, a population‐based cohort study

Treatment intervals and survival for women diagnosed with early breast cancer in Queensland: the Breast Cancer Outcomes Study, a population‐based cohort study

Oncoplastic Breast Reduction: A Systematic Review of Postoperative Complications

The impact of post‐mastectomy radiation timing on overall outcomes of autologous free‐flap breast reconstruction

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