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Neoadjuvant Radiotherapy to Facilitate Immediate Breast Reconstruction: A Systematic Review and Current Clinical Trials

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Postmastectomy radiotherapy currently is used for locally advanced breast cancers that carry a high risk of locoregional failure. However, radiotherapy can have deleterious effects on immediate breast reconstruction (IBR). Neoadjuvant radiotherapy (NART) to facilitate postmastectomy IBR is an emerging new therapeutic sequence. A systematic review was undertaken to evaluate the current evidence on the feasibility and safety of this sequence.

Methods

A comprehensive search of MEDLINE, EMBASE, Cochrane Library, Web of Science, and ClinicalTrials.gov from inception to 2018 was conducted, resulting in 592 records. The review included 18 retrospective and prospective studies of NART and IBR.

Results

The majority of the studies used whole-breast radiotherapy with 50 Gy, conventionally fractionated, and waited 6–8 weeks before surgery. The IBR methods were varied, with both implant and autologous reconstructions. No intraoperative complications occurred, and the postoperative complication rates ranged from 3 to 36%. The partial and total flap loss rates were very low. Studies reporting cosmetic outcomes rated the majority of cases as good or excellent. The pathologic complete response rates ranged from 17 to 55%, and the locoregional recurrence rates were low (≤ 10%), with a short follow-up period. The current MD Anderson Cancer Center prospective clinical trial is described.

Conclusions

The initial results of NART and IBR demonstrate the safety of this treatment both technically and oncologically. Longer follow-up evaluation of these studies and larger prospective controlled clinical trials are needed to establish this new therapeutic sequence as a standard of care.

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Acknowledgment

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

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Authors and Affiliations

  1. Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Puneet Singh MD & Henry M. Kuerer MD, PhD, FACS

  2. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Karen Hoffman MD & Benjamin D. Smith MD

  3. Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Mark V. Schaverien MD & Charles Butler MD

  4. Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Kate J. Krause MS

Authors
  1. Puneet Singh MD
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  2. Karen Hoffman MD
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  3. Mark V. Schaverien MD
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  4. Kate J. Krause MS
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  5. Charles Butler MD
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  6. Benjamin D. Smith MD
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  7. Henry M. Kuerer MD, PhD, FACS
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Corresponding author

Correspondence to Henry M. Kuerer MD, PhD, FACS.

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Disclosure

Dr. Benjamin D. Smith has received previous grant funding from Varian Medical Systems and has current licensing/royalties from Oncora Medical. The remainder of the authors have no conflicts of interest to disclose.

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Singh, P., Hoffman, K., Schaverien, M.V. et al. Neoadjuvant Radiotherapy to Facilitate Immediate Breast Reconstruction: A Systematic Review and Current Clinical Trials. Ann Surg Oncol 26, 3312–3320 (2019). https://doi.org/10.1245/s10434-019-07538-x

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  • DOI: https://doi.org/10.1245/s10434-019-07538-x

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