Does Locoregional Radiation Therapy Improve Survival in Breast Cancer? A Meta-Analysis

PurposeTo evaluate the feasability of immediate breast reconstruction (IBR) following mastectomy after neoadjuvant chemotherapy (NACT) and radiation therapy (RT) for operable invasive breast cancer (OIBC), in terms of incidence of local complications, locoregional control and survival. Patients and methodsFrom 1990 to 2008, 210 patients were treated by NACT, RT and mastectomy with IBR for OIBC. One hundred and seven patients underwent a latissimus dorsi flap with implant (LDI), 56 patients a transverse rectus abdominis musculocutaneous (TRAM) flap, 25 an autologous latissimus dorsi flap (ALD) and 22, a retropectoral implant (RI) reconstruction. ResultsForty-six (21,9%) early events were recorded: 20 necrosis, 9 surgical site infections and 6 haematomas, requiring further surgery in 23 patients. More necrosis were observed with TRAM flap reconstructions (p=0,000004), requiring more surgical revision than LD reconstructions. Seromas represented 42% of early complications in LD reconstructions. Fifty-five patients presented with late complications (26,2%) with mainly implant complications (capsular contracture, infection, dislocation, deflation) (23,6%), requiring reintervention in 14 cases. There were more delayed surgical revisions in RI reconstructions (p=0,0005). The 5 years overall and disease-free survival rates were respectively 86,7% and 75,6%. Sixty-four patients presented at least one recurrence (30,5%) with 5 local , 9 locoregional and 54 distant relapses. ConclusionThis therapeutic sequence does not seem to increase the IBR morbidity nor alter disease-free and overall survival.

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“…The mean follow-up was 8 years (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Five patients were lost to follow-up.…”

Section: Resultsmentioning

confidence: 99%

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

Monrigal

Dauplat

Gimbergues

et al. 2011

European Journal of Surgical Oncology (EJSO)

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“…Postmastecomy chest wall radiotherapy (PMRT) is a common treatment modality for high‐risk breast cancer patients following mastectomy because it has been shown to improve local control and survival 1 , 2 , 3 . The RTOG breast atlas (4) defines the chest‐wall target volume as extending cranially to the caudal border of the clavicle head, caudally to the loss of computed‐tomography (CT) apparent contralateral breast, laterally to the mid‐axillary line, medially to the sternal‐rib junction, posteriorly to the rib‐pleural interface, and anteriorly to the skin.…”

Section: Introductionmentioning

confidence: 99%

Dosimetric assessment of brass mesh bolus for postmastectomy photon radiotherapy

Manger

Paxton

Cerviño

2016

J Applied Clin Med Phys

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Brass mesh bolus has been shown to be an acceptable substitute for tissue‐equivalent bolus to increase superficial dose for chest wall tangent photon radiotherapy. This work investigated the increase in surface dose, the change in the dose at depth, and the safety implications of higher energy photon beams when using brass mesh bolus for postmastectomy chest wall radiotherapy. A photon tangent plan was delivered to a thorax phantom, and the superficial dose ranged from 40%–72% of prescription dose with no bolus. The surface dose increased to 75%–110% of prescription dose with brass mesh bolus and 85%–109% of prescription dose with tissue‐equivalent bolus. It was also found that the dose at depth when using brass mesh bolus is comparable to that measured with no bolus for en face and oblique incidence. Monte Carlo calculations were used to assess the photoneutron production from brass mesh bolus used with 15 MV and 24 MV photon beams. The effective dose from photoneutrons was approximated and found to be relatively small, yet not negligible. Activation products generated by these photoneutrons, the surface dose rate due to the activation products, and the half‐life of the activation products were also considered in this work. The authors conclude that brass mesh bolus is a reasonable alternative to tissue‐equivalent bolus, and it may be used with high‐energy beam; but one should be aware of the potential increased effective dose to staff and patients due to the activation products produced by photoneutrons.PACS number(s): 87.53.Kn, 87.55.K

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“…It should, however, be noted that in this series, patients treated with exclusive or preoperative radiotherapy fared worse in terms of locoregional control than others, perhaps also because of a selection of patients with poor prognosis. This opens the debate as to whether radiotherapy could not play a role in increasing the rate of breast-conserving treatments for some invasive carcinomas, as it is an important part of the treatment of large breast cancers (Whelan et al, 2000;Clarke et al, 2005) and has been shown to achieve complete clinical response (6 -41%) with doses compatible with planned secondary surgeries (Calitchi et al, 1991;Scholl et al, 1994;Broet et al, 1999;Bollet et al, 2006). At the Institut Curie, the S6 trial randomised premenopausal women between chemotherapy and radiotherapy as an initial treatment for large breast cancers (Scholl et al, 1994).…”

Section: Discussionmentioning

confidence: 99%

High rates of breast conservation for large ductal and lobular invasive carcinomas combining multimodality strategies

et al. 2008

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The literature reports low rates of breast conservation after neoadjuvant chemotherapy for operable breast cancers not amenable to initial breast-conserving surgery. This study aims to compare the outcome of lobular vs ductal carcinomas after neoadjuvant chemotherapy. Between 1989 and 1999, 750 patients with clinical stage II/IIIA ductal (672) or lobular (78) invasive breast carcinomas were treated at the Institut Curie with primary anthracycline-based polychemotherapy followed by either breast conservation (surgery and/or radiotherapy) or mastectomy. Median follow-up was 10 years. Clinical response to primary chemotherapy was significantly worse for lobular than for ductal carcinomas (47 vs 60%; P ¼ 0.04), but only histological grade remained predictive in multivariate analysis. Breast conservation was high for both ductal and lobular carcinomas (65 and 54%; P ¼ 0.07), due, in part, to the use of radiotherapy, either exclusive or preoperative, for respectively 26 and 40% of patients. The lobular type had no adverse effect, neither on locoregional control nor on overall survival, even in the group of patients treated with breast conservation.

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Does Locoregional Radiation Therapy Improve Survival in Breast Cancer? A Meta-Analysis

Abstract: Locoregional radiation after surgery in patients treated with systemic therapy reduced mortality. Several questions remain on how these results should be translated into current-day clinical practice.

Cited by 465 publications

References 46 publications

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

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

Dosimetric assessment of brass mesh bolus for postmastectomy photon radiotherapy

High rates of breast conservation for large ductal and lobular invasive carcinomas combining multimodality strategies

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