Impact of radiation dose on complications among women with breast cancer who underwent breast reconstruction and post-mastectomy radiotherapy: A multi-institutional validation study

Abstract

Major complication Radiation therapyEquivalent Dose in 2 Gy fractions (EQD2; a/b ¼ 3.5) varied from 43.4 to 71.0 Gy (median dose: 48.6 Gy).Boost radiation therapy was administered to 49 patients. Major post-radiation therapy complications were observed in 24 (7.6%) patients. In multivariate analysis, an increasing EQD2 per Gy (odds ratio [OR]: 1.58, 95% confidence interval [CI]: 1.26e1.98; p < 0.001), current smoking status (OR: 25.48, 95% CI: 1.56 e415.65; p ¼ 0.023), and prosthetic breast reconstruction (OR: 9.28, 95% CI: 1.84e46.70; p ¼ 0.007) were independently associated with an increased risk of major complications. Conclusion:A dose-response relationship between radiation dose and the risk of complications was validated in this multi-center dataset. In this context, we hypothesize that the use of hypofractionated radiotherapy (40 Gy in 15 fractions) may improve breast reconstruction outcomes. Our multi-center prospective observational study (NCT03523078) is underway to further validate this hypothesis.

A Comparative Analysis of Immediate and Delayed-immediate Breast Reconstruction after Postmastectomy Radiation Therapy

“…As this patient population was sourced retrospectively from a prospectively maintained database focused on breast reconstruction outcomes, and many patients may not receive their cancer care at our institution, information regarding cancer staging and tumor characteristics were not able to be incorporated into our propensity match. Further, we acknowledge that some chemotherapy- and radiation-specific adverse events may be therapy, dose, or duration dependent, 37 and this warrants further research. Finally, patient-reported outcomes would be helpful in this population to determine how these reconstructive timelines, and their risks and benefits, affect the holistic patient experience.…”

Breast reconstruction during the COVID-19 pandemic in resource-limited settings

“…There has been a paradigm shift in the management of breast cancer and the advent of oncoplastic breast surgery has revolutionised the concept of breast preservation, utilising limited tissue resection as opposed to a mastectomy [ 20 ], [ 21 ], [ 22 ], [ 23 ], [ 24 ], [ 25 ], [ 26 ], [ 27 ]. Although breast conservation therapy can be an attractive alternative, it is dependent upon a number of clinical factors including tumour size and location, and importantly approximately 40% of women with primary breast cancer still undergo mastectomy [ 14 ], [ 27 ], [ 28 ], [ 29 ], [ 30 ], [ 31 ], [ 32 ], [ 33 ].…”

“…A third option of immediate-delayed reconstruction may provide an alternative solution for those patients awaiting histological confirmation and possible post-mastectomy radiotherapy [ 36 ]. In this situation, a saline tissue expander implant is placed at the time of mastectomy protecting the breast skin envelope and remains until the patient completes the radiation cycle [ 30 ], [ 32 ], [ 36 ]. They can then undergo the standard delayed reconstruction.…”

“…They can then undergo the standard delayed reconstruction. If radiotherapy is not required, the implant can be exchanged for a reconstructive procedure at an earlier date [ 32 ].…”

“…This can then be replaced with a permanent implant once the desired volume is achieved [ 31 ], [ 36 ]. Although the use of breast implants can be advantageous in breast reconstruction as it provides an aesthetically pleasing result with a short recovery period, it is not recommended for patients undergoing post-mastectomy radiotherapy due to the potential risk of wound breakdown and extrusion [ 31 ], [ 32 ], [ 33 ], [ 47 ].…”