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Preoperative Radiotherapy Trials to Facilitate Immediate Breast Reconstruction after Mastectomy

  • Puneet Singh
  • Henry M. KuererEmail author
Clinical Trials (JE Lang, Section Editor)
  • 9 Downloads
Part of the following topical collections:
  1. Topical Collection on Clinical Trials

Abstract

Purpose of Review

Postmastectomy radiotherapy (PMRT) is often a component of treatment algorithms for locally advanced or node-positive breast cancer. Breast reconstruction may be delayed or not performed due to negative effects of PMRT on the reconstruction. Administering radiotherapy in the preoperative setting allows for immediate breast reconstruction (IBR) to be performed in patients who have indications for PMRT and desire IBR. This review summarizes the current literature on this new concept.

Recent Findings

Most prospective treatment protocols included neoadjuvant systemic therapy followed by radiotherapy (RT) dose of 50–50.4 Gy conventionally fractionated and mastectomy with immediate autologous reconstruction after 6–8 weeks. There were no cases of IBR being aborted due to technical complications and overall postoperative complications ranged from 3 to 36%. These were typically non-operatively managed, and cosmetic results when evaluated were favorable. Initial oncologic outcomes indicate low locoregional recurrence rates (≤ 10%) and high 5-year overall survival rates of 87–98%.

Summary

Although published studies are heterogeneous in nature, they suggest that preoperative RT followed by mastectomy with IBR is technically feasible and safe. Larger prospective studies with longer follow-up times may establish this as a new standard in the multidisciplinary treatment of high-risk breast cancer.

Keywords

Post-mastectomy radiotherapy Mastectomy Immediate breast reconstruction Preoperative radiotherapy Breast cancer 

Notes

Funding Information

This work was supported by the PH and Fay Etta Robinson Distinguished Professorship in Cancer Research (HMK) and a Cancer Center Support Grant from the National Institutes of Health (NIH) (CA16672).

Compliance with Ethical Standards

Conflict of Interest

Henry Kuerer reports personal fees and other from Genomic Health, Inc.; other from Physicians’ Education Resource, LLC; personal fees from TME, Inc.; personal fees from McGraw-Hill Professional, UpToDate, Inc.; grants from National Cancer Institute; other from Annals of Surgical Oncology; other from NRG Oncology (Institutional PI and Breast Committee); other from American Society of Breast Surgeons (Chair, Publications Committee); and personal fees from NEJM Group, Inc. outside the submitted work. Puneet Singh declares no conflicts of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Breast Surgical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA

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