Abstract
Introduction
The aim of this paper is to investigate the outcome of patients treated with mastectomy, immediate breast reconstruction (IBR) and post-mastectomy radiotherapy (PMRT) and the risk of late complications.
Material and method
All patients had post-mastectomy, immediate reconstructive surgical procedure by using autologous abdominal implant; tissue expander (TE)/permanent prosthesis (PP); or even combined procedures. Adjuvant external beam radiotherapy treatment (EBRT) was delivered to the reconstructed chest wall and supraclavicular nodes, for a total dose of 50 Gy in 25 fractions. The Kaplan-Meyer analysis evaluates patients’ rate of late side effects, Overall Survival (OS), Progression Free survival (PFS), Local–regional free survival (LRFS) and Metastasis Free Survival (MFS). The univariate analysis investigates the correlation between late toxicity and related factors.
Results
Between November 2003 and October 2016, 91 breast cancer patients were treated with IBR and PMRT. Twenty-three (25.3%) patients experimented late toxicity. Overall, 16 (17.6%) patients experienced late complications which required a surgical approach. The 1- 2- 5- years late toxicity rates were 96.6%, 87.1% and 77.9%, respectively. The type of reconstruction was not statistically related with late toxicity rate (P = 0.35). The median follow-up period was 59 months (range 6–142 months). Median OS was not reached, the 1- 2- 5-years OS rates were 100%, 95.4% and 81% respectively.
Conclusion
This study underlines that the type of reconstruction does not influence late toxicity rate. Moreover, IBR followed by adjuvant radiotherapy, has showed acceptable late toxicity profile and no influence on OS.
Similar content being viewed by others
Reference
Ho AY, Hu ZI, Mehrara BJ, Wilkins EG (2017) Radiotherapy in the setting of breast reconstruction: types, techniques, and timing. Lancet Oncol 18:e742–753
EBCTCG, (Early Breast Cancer Trialists' Collaborative group) (2014) Effect of Radiotherapy After Mastectomy and Axillary Surgery on 10-year Recurrence and 20-year Breast Cancer Mortality: Meta-Analysis of Individual Patient Data for 8135 Women in 22 Randomised Trials. Lancet 383(9935):2127–2135
Cabanuz MA, del Arribas AMD, Navarro BA, Guemes SAT (2019) Influence of radiotherapy on immediate breast reconstruction after skin-sparing mastectomy. Before or after: Does it matter? c i r e s p 97(3):156–161
Colwell AS (2017) Discussion: Should Immediate Autologous Breast Reconstruction Be Considered in Women Who Require Postmastectomy Radiation Therapy? A Prospective Analysis of Outcomes. Plast Reconstr Surg 139(6):1289–1290
Pont LP, Marcelli S, Robustillo M, Song D, Grandes D, Martin M, Iglesias I, Aso J, Laloumet I, Díaz AJ (2017) Immediate breast reconstruction with abdominal free flap and adjuvant radiotherapy: evaluation of quality of life and outcomes. Plast Reconstr Surg 140(4):681–690
Barry M, Kell MR (2011) Radiotherapy and breast reconstruction: a meta-analysis. Breast Cancer Res Treat 127:15–22
El-Sabawi B, Ho AH, Sosin M, Patel KM (2017) Patient-centered outcomes of breast reconstruction in the setting of post-mastectomy radiotherapy: a Comprehensive review of the literature. J Plast Reconstr Aesthet Surg 70(6):768–780
Jagsi R, Momoh AO, Qi J, Hamill JB, Billig J, Kim HM, Pusic AL, Wilkins EG (2017) Impact of radiotherapy on complications and patient-reported outcomes after breast reconstruction. J Natl Cancer Inst 110(2):157–165
Lee KT, Mun GH (2017) Optimal sequencing of postmastectomy radiotherapy and two stages of prosthetic reconstruction: a meta-analysis. Ann Surg Oncol 24:1262–1268
Santosa KB, Chen X, Qi J, Ballard TNS, Kim HM, Hamill JB, Bensenhaver JM, Pusic AL, Wilkinset EG (2016) Postmastectomy radiation therapy and two-stage implantbased breast reconstruction: is there a better time to irradiate? Plast Reconstr Surg 1(38):761–769
Ogita M, Nagura N, Kawamori J et al (2018) Risk factors for complications among breast cancer patients treated with post-mastectomy radiotherapy and immediate tissue-expander/permanent implant reconstruction: a retrospective cohort study. Breast Cancer 25(2):167–175
De Rose F, Fogliata A, Franceschini D et al (2019) Postmastectomy radiation therapy using VMAT technique for breast cancer patients with expander reconstruction. Med. Oncol. 36:48
O'Connell RL, Di Micco R, Khabra K, Harris PA, James SE, Power K, Ramsey KWD, Rusby JE (2018) Comparison of immediate versus delayed DIEP flap reconstruction in women who require postmastectomy radiotherapy. Plast Reconstr Surg 142(3):594–605
Maalouf C, Bou-Merhi J, Karam E, Patocskai E, Danino AM (2017) The impact of autologous breast reconstruction using diep flap on the oncologic efficacy of radiation therapy. Ann Chir Plast Esthet 62(6):630–636
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest.
Ethical standards
This study is a retrospective analysis of data. It does not involve Animals. All procedures performed involving human participants were in accordance with the ethical standards of the institution and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants involved in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Reverberi, C., Marinelli, L., Campanella, B. et al. Post-mastectomy immediate breast reconstruction and adjuvant radiotherapy: long term results of a mono institutional experience. Radiol med 125, 887–893 (2020). https://doi.org/10.1007/s11547-020-01161-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11547-020-01161-7