Neoadjuvant chemoradiation and breast reconstruction: the potential for improved outcomes in the treatment of breast cancer
- 3 Downloads
Immediate breast reconstruction (IBR) improves psychosocial and quality of life outcomes. Post-mastectomy radiation therapy is indicated for patients with a high risk of locoregional recurrence including locally advanced tumours (≥ 5 cm) or greater than or equal to four axillary nodes positive for breast cancer and can be a relative contraindication to IBR. Administration of radiation therapy pre-operatively, analogous to neoadjuvant chemotherapy, may reduce time to completion of treatment and facilitate better access to IBR.
This is a prospective pilot study in a tertiary referral breast cancer unit, comparing surgical, pathological response and oncological outcomes and time to completion of therapy for a prospective group of patients who received neoadjuvant radiotherapy with a cohort of age- and stage-matched patients requiring post-mastectomy (± reconstruction) radiation between 2010 and 2016.
Sixteen patients with locally advanced breast cancer underwent neoadjuvant radiation and were age- and stage-matched to 32 patients who received post-mastectomy radiation therapy (PMRT) between 2010 and 2016. Neoadjuvant radiotherapy resulted in shorter time between diagnosis and treatment completion (245.6 ± 44.2 days in the neoadjuvant group, 291.2 ± 36.7 days in the adjuvant group, p = 0.001). A higher proportion of patients undergoing neoadjuvant chemoradiation therapy underwent breast reconstruction (14/16 patients in the neoadjuvant group, 15/32 patients in the adjuvant group, p = 0.007) without an increase in complication rate (p = 0.117). There was a trend towards improved pathological complete response and survival in the neoadjuvant group.
This pilot study confirms that neoadjuvant chemoradiation is a feasible way of delivering breast cancer treatment and may facilitate improved access to IBR.
KeywordsBreast cancer Breast reconstruction Mastectomy Neoadjuvant chemoradiation Neoadjuvant radiotherapy
The authors would like to acknowledge Mr. Alan Hussey for his contribution of clinical images to this manuscript.
This research was funded by the Breast Cancer Research (CHY9997). This organisation had no role in the study design; in the collection, analysis and interpretation of the data; in the writing of the report; and in the decision to submit the article for publication.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
- 2.Cortazar P, Zhang L, Untch M, Mehta K, Costantino JP, Wolmark N, Bonnefoi H, Cameron D, Gianni L, Valagussa P, Swain SM, Prowell T, Loibl S, Wickerham DL, Bogaerts J, Baselga J, Perou C, Blumenthal G, Blohmer J, Mamounas EP, Bergh J, Semiglazov V, Justice R, Eidtmann H, Paik S, Piccart M, Sridhara R, Fasching PA, Slaets L, Tang S, Gerber B, Geyer CE Jr, Pazdur R, Ditsch N, Rastogi P, Eiermann W, von Minckwitz G (2014) Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet 384(9938):164–172CrossRefPubMedGoogle Scholar
- 3.von Minckwitz G, Blohmer JU, Costa SD, Denkert C, Eidtmann H, Eiermann W, Gerber B, Hanusch C, Hilfrich J, Huober J, Jackisch C, Kaufmann M, Kümmel S, Paepke S, Schneeweiss A, Untch M, Zahm DM, Mehta K, Loibl S (2013) Response-guided neoadjuvant chemotherapy for breast cancer. J Clin Oncol 31(29):3623–3630CrossRefGoogle Scholar
- 8.Monrigal E, Dauplat J, Gimbergues P, le Bouedec G, Peyronie M, Achard JL, Chollet P, Mouret-Reynier MA, Nabholtz JM, Pomel C (2011) Mastectomy with immediate breast reconstruction after neoadjuvant chemotherapy and radiation therapy. A new option for patients with operable invasive breast cancer. Results of a 20 years single institution study. Eur J Surg Oncol 37(10):864–870CrossRefPubMedGoogle Scholar
- 10.Harnett A et al (2009) Diagnosis and treatment of early breast cancer, including locally advanced disease—summary of NICE guidance. BMJ 338(7694):598–600Google Scholar
- 12.McGale P et al (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. ElsevierGoogle Scholar
- 13.Coates AS, Winer EP, Goldhirsch A, Gelber RD, Gnant M, Piccart-Gebhart M, Thürlimann B, Senn HJ, Panel Members (2015) Tailoring therapies—improving the management of early breast cancer: St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2015. Ann Oncol 26(8):1533–1546CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Huang Y et al A systematic review and network meta-analysis of neoadjuvant therapy combined with surgery for patients with resectable esophageal squamous cell carcinoma. Int J Surg 2016Google Scholar
- 16.Whitfield GA, Horan G, Irwin MS, Malata CM, Wishart GC, Wilson CB (2009) Incidence of severe capsular contracture following implant-based immediate breast reconstruction with or without postoperative chest wall radiotherapy using 40 gray in 15 fractions. Radiother Oncol 90(1):141–147CrossRefPubMedGoogle Scholar
- 24.Recht A, Comen EA, Fine RE, Fleming GF, Hardenbergh PH, Ho AY, Hudis CA, Hwang ES, Kirshner JJ, Morrow M, Salerno KE, Sledge GW Jr, Solin LJ, Spears PA, Whelan TJ, Somerfield MR, Edge SB (2016) Postmastectomy radiotherapy: an American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology focused guideline update. Pract Radiat Oncol 6(6):e219–e234CrossRefPubMedGoogle Scholar
- 26.Bosset J-F, Calais G, Mineur L, Maingon P, Stojanovic-Rundic S, Bensadoun RJ, Bardet E, Beny A, Ollier JC, Bolla M, Marchal D, van Laethem J, Klein V, Giralt J, Clavère P, Glanzmann C, Cellier P, Collette L, EORTC Radiation Oncology Group (2014) Fluorouracil-based adjuvant chemotherapy after preoperative chemoradiotherapy in rectal cancer: long-term results of the EORTC 22921 randomised study. Lancet Oncol 15(2):184–190CrossRefPubMedGoogle Scholar
- 29.Zinzindohoué C, Bertrand P, Michel A, Monrigal E, Miramand B, Sterckers N, Faure C, Charitansky H, Gutowski M, Cohen M, Houvenaeghel G, Trentini F, Raro P, Daures JP, Lacombe S (2016) A prospective study on skin-sparing mastectomy for immediate breast reconstruction with latissimus dorsi flap after neoadjuvant chemotherapy and radiotherapy in invasive breast carcinoma. Ann Surg Oncol 23(7):2350–2356CrossRefPubMedGoogle Scholar
- 30.Grinsell D et al (2017) Immediate autologous breast reconstruction after neoadjuvant chemoradiotherapy for breast cancer: initial results of the first 29 patients. ANZ J SurgGoogle Scholar
- 33.Giacalone PL, Rathat G, Daures JP, Benos P, Azria D, Rouleau C (2010) New concept for immediate breast reconstruction for invasive cancers: feasibility, oncological safety and esthetic outcome of post-neoadjuvant therapy immediate breast reconstruction versus delayed breast reconstruction: a prospective pilot study. Breast Cancer Res Treat 122(2):439–451CrossRefPubMedGoogle Scholar
- 35.Van de Wiel M et al Neoadjuvant systemic therapy in breast cancer: challenges and uncertainties. Eur J Obstet Gynecol Reprod Biol 2016Google Scholar
- 38.Boughey JC, McCall LM, Ballman KV, Mittendorf EA, Ahrendt GM, Wilke LG, Taback B, Leitch AM, Flippo-Morton T, Hunt KK (2014) Tumor biology correlates with rates of breast-conserving surgery and pathologic complete response after neoadjuvant chemotherapy for breast cancer: findings from the ACOSOG Z1071 (Alliance) Prospective Multicenter Clinical Trial. Ann Surg 260(4):608–616CrossRefPubMedPubMedCentralGoogle Scholar
- 39.von Minckwitz G, Untch M, Blohmer JU, Costa SD, Eidtmann H, Fasching PA, Gerber B, Eiermann W, Hilfrich J, Huober J, Jackisch C, Kaufmann M, Konecny GE, Denkert C, Nekljudova V, Mehta K, Loibl S (2012) Definition and impact of pathologic complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes. J Clin Oncol 30(15):1796–1804CrossRefGoogle Scholar