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Postmastectomy Radiotherapy with and Without Reconstruction

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Radiation Therapy Techniques and Treatment Planning for Breast Cancer

Abstract

The role of radiotherapy after mastectomy, postmastectomy radiotherapy (PMRT), in women with node-positive or high-risk node-negative breast cancer has evolved over the last several decades since the publication of the randomized trials from the British Columbia Cancer Agency and the Danish Breast Cancer Cooperative Group [1–3]. These trials were the first trials using modern radiation techniques and systemic therapy to demonstrate that PMRT not only reduced locoregional recurrences (LRRs) but also improved survival. The impact of PMRT on local control and overall survival has been further supported by the results of the Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) meta-analysis [4, 5].

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References

  1. Ragaz J, Jackson SM, Le N et al (1997) Adjuvant radiotherapy and chemotherapy in node-positive premenopausal women with breast cancer. N Engl J Med 337:956–962

    Article  CAS  PubMed  Google Scholar 

  2. Overgaard M, Hansen PS, Overgaard J et al (1997) Postoperative radiotherapy in high-risk menopausal women with breast cancer who receive adjuvant chemotherapy. Danish Breast Cancer Cooperative Group 82b Trial. N Engl J Med 337:949–955

    Article  CAS  PubMed  Google Scholar 

  3. Overgaard M, Jensen MB, Overgaard J et al (1999) Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomized trial. Lancet 353:1641–1648

    Article  CAS  PubMed  Google Scholar 

  4. Clarke M, Collins R, Darby S et al (2005) Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomized trials. Lancet 366:2087–2106

    Article  CAS  PubMed  Google Scholar 

  5. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (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 383:2127–2135

    Article  Google Scholar 

  6. Harris JR, Halpin-Murphy P, McNeese M et al (1999) Consensus statement of postmastectomy radiation therapy. Int J Radiat Oncol Biol Phys 44:989–990

    Article  CAS  PubMed  Google Scholar 

  7. Recht A, Edge SB, Solin LJ et al (2001) Postmastectomy radiotherapy: guidelines of the American Society of Clinical Oncology. J Clin Oncol 19:1539–1569

    CAS  PubMed  Google Scholar 

  8. Whelan TJ, Olivott IA, Parulekar WR et al (2015) Regional nodal irradiation in early-stage breast cancer. N Engl J Med 373(4):307–316

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Poortmans PM, Collette S, Kirkove C et al (2015) Internal mammary and medial supraclavicular irradiation in breast cancer. N Engl J Med 373(4):317–327

    Article  CAS  PubMed  Google Scholar 

  10. SUPREMO. Selective use of postoperative radiotherapy after mastectomy (http://supremo-trial.com)

  11. Kyndi M, Sorensen FB, Kndusen H et al (2008) Estrogen receptor, progesterone receptor, HER-2, and response to postmastectomy radiotherapy in high-risk breast cancer: the Danish Breast Cancer Cooperative Group. J Clin Oncol 26:1419–1426

    Article  CAS  PubMed  Google Scholar 

  12. Tseng YD, Uno H, Hughes ME et al (2015) Biological subtype predicts risk of locoregional recurrence after mastectomy and impact of postmastectomy radiation in a large national database. Int J Radiat Oncol Biol Phys 93(3):622–630

    Article  PubMed  Google Scholar 

  13. Buchholz TA, Katz A, Strom EA et al (2002) Pathologic tumor size and lymph node status predict for different rates of locoregional recurrence after mastectomy for breast cancer patients treated with neoadjuvant versus adjuvant chemotherapy. Int J Radiat Oncol Biol Phys 53:880–888

    Article  PubMed  Google Scholar 

  14. Buchholz TA, Tucker SL, Masullo L et al (2002) Predictors of local-regional recurrence after neoadjuvant chemotherapy and mastectomy without radiation. J Clin Oncol 20:17–23

    Article  CAS  PubMed  Google Scholar 

  15. McGuire SE, Gonzalez-Angulo AM, Huang EH et al (2007) Postmastectomy radiation improves the outcomes of patients with locally advanced breast cancer who achieve a pathologic complete response to neoadjuvant chemotherapy. Int J Radiat Oncol Biol Phys 68:1004–1009

    Article  PubMed  PubMed Central  Google Scholar 

  16. Mamounas EP, Anderson SJ, Dignam JJ et al (2012) Predictors of locoregional recurrence after neoadjuvant chemotherapy: results from combined analysis of National Surgical Adjuvant Breast and Bowel Project B-18 and B-27. J Clin Oncol 30:3960–3966

    Article  PubMed  PubMed Central  Google Scholar 

  17. Buchholz TA, Lehman CD, Harris JR et al (2008) Statement of the science concerning locoregional treatments after preoperative chemotherapy for breast cancer: a National Cancer Institute conference. J Clin Oncol 26:791–797

    Article  PubMed  Google Scholar 

  18. National Surgical Adjuvant Breast and Bowel Project (NSABP). NSABP B-51/RTOG 1304 (http://www.nsabp.pitt.edu/B-51.asp)

  19. RTOG. Breast cancer atlas for radiation therapy planning: consensus definitions (https://www.rtog.org/CoreLab/ContouringAtlases/BreastCancerAtlas.aspx)

  20. Offersen BV, Boersma LJ, Kirkove C et al (2015) ESTRO consensus guideline on target volume delineation for elective radiation therapy of early stage breast cancer. Radiother Oncol 114:3–10

    Article  PubMed  Google Scholar 

  21. Moran MS, Haffty BG (2009) Radiation techniques and toxicities for locally advanced breast cancer. Semin Radiat Oncol 19:244–255

    Article  PubMed  Google Scholar 

  22. Daves I, Rumble RB, Bowen J et al (2012) Intensity-modulated radiotherapy in the treatment of breast cancer. Clin Oncol 24(7):488–498

    Article  Google Scholar 

  23. Hall EJ, Wuu C-S (2003) Radiation-induced second cancers: the impact of 3D-CRT and IMRT. Int J Radiat Oncol Biol Phys 56:83–88

    Article  PubMed  Google Scholar 

  24. Haviland JS, Owen JR, Dewar JA et al (2013) The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomized controlled trials. Lancet Oncol 14:1086–1094

    Article  PubMed  Google Scholar 

  25. Cordeiro PG, Albornoz CR, McCormick B et al (2015) What is the optimum timing of postmastectomy radiotherapy in two-stage prosthetic reconstruction: radiation to the tissue expander or permanent implant? Plast Reconstr Surg 135(6):1509–1517

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. El-Sabawi B, Carey JN, Hagopian TM et al (2016) Radiation and breast reconstruction: algorithmic approach and evidence-based outcomes. J Surg Oncol. doi:10.1002/jso.24143 [Epub ahead of print]

    PubMed  Google Scholar 

  27. Thompson R, Morgan AM (2005) Investigation into dosimetric effect of a MAGNA-SITETM tissue expander on post-mastectomy radiotherapy. Med Phys 32:1640–1646

    Article  PubMed  Google Scholar 

  28. Chen SA, Ogunleye T, Dhabbaan A, Huang EH, Losken A, Gabram S, Davis L, Torres MA (2013) Impact of internal metallic ports in temporary tissue expanders on postmastectomy radiation dose distribution. Int J Radiat Oncol Biol Phys 85(3):630–635

    Article  PubMed  Google Scholar 

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Correspondence to Kathleen C. Horst MD .

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Horst, K.C., Kovalchuk, N., Marquez, C. (2016). Postmastectomy Radiotherapy with and Without Reconstruction. In: Bellon, J., Wong, J., MacDonald, S., Ho, A. (eds) Radiation Therapy Techniques and Treatment Planning for Breast Cancer. Practical Guides in Radiation Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-40392-2_2

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  • DOI: https://doi.org/10.1007/978-3-319-40392-2_2

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