Neoadjuvant Radiotherapy: Changing the Treatment Sequence to Allow Immediate Free Autologous Breast Reconstruction

Hughes, Kimberley; Neoh, Derek

doi:10.1055/s-0038-1660871

Cited by 19 publications

(15 citation statements)

References 34 publications

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“…A significantly lower number of patients in the IBR group received neoadjuvant radiation therapy, as compared to the DBR group. Currently, the role of neoadjuvant radiation therapy and IBR is discussed as a feasible alternative as opposed to more traditional treatment concepts with a multimodal approach of chemotherapy, surgery, and postmastectomy radiotherapy [50,51]. Ideal timing of breast reconstruction after radiation therapy is, however, controversially debated and further studies are needed in this regard [52][53][54].…”

Section: Discussionmentioning

confidence: 99%

Immediate versus secondary DIEP flap breast reconstruction: a multicenter outcome study

Prantl

Moellhoff

Fritschen

et al. 2020

Arch Gynecol Obstet

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Purpose Immediate breast reconstruction (IBR) at the time of mastectomy is gaining popularity, as studies show no negative impact on recurrence or patient survival, but better aesthetic outcome, less psychological distress and lower treatment costs. Using the largest database available in Europe, the presented study compared outcomes and complications of IBR vs. delayed breast reconstruction (DBR). Methods 3926 female patients underwent 4577 free DIEP-flap breast reconstructions after malignancies in 22 different German breast cancer centers. The cases were divided into two groups according to the time of reconstruction: an IBR and a DBR group. Surgical complications were accounted for and the groups were then compared. Results Overall, the rate of partial-(1.0 versus 1.2 percent of cases; p = 0.706) and total flap loss (2.3 versus 1.9 percent of cases; p = 0.516) showed no significant difference between the groups. The rate of revision surgery was slightly, but significantly lower in the IBR group (7.7 versus 9.8 percent; p = 0.039). Postoperative mobilization was commenced significantly earlier in the IBR group (mobilization on postoperative day 1: 82.1 versus 68.7 percent; p < 0.001), and concordantly the mean length of hospital stay was significantly shorter (7.3 (SD3.7) versus 8.9 (SD13.0) days; p < 0.001). Conclusion IBR is feasible and cannot be considered a risk factor for complications or flap outcome. Our results support the current trend towards an increasing number of IBR. Especially in times of economic pressure in health care, the importance of a decrease of hospitalization cannot be overemphasized.

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Section: Discussionmentioning

confidence: 99%

Immediate versus secondary DIEP flap breast reconstruction: a multicenter outcome study

Prantl

Moellhoff

Fritschen

et al. 2020

Arch Gynecol Obstet

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“…Hughes et al underscored the propensity of NART to induce deleterious tissue damage, which could potentially jeopardize subsequent reconstructive efforts, thereby suggesting a more cautious application of this modality. 13 From a mechanistic perspective, Singh et al discerningly elucidated that NART precipitated DNA damage and incited a robust immune response within the body, thereby playing a substantial role in effectuating tumor shrinkage. 14 Meanwhile, Pazos et al pioneered an avant-garde methodology of administering NART with dual objectives of minimizing collateral tissue damage and maximizing the destruction of cancerous cells, thus marking a paradigm shift in disease management.…”

Section: Preoperative Radiotherapy and Surgical Optionsmentioning

confidence: 99%

“…Hughes et al reported that the average time between NART and surgery was 6.4 weeks. 20 The institutional experience of Teoh et al advocates surgery within a median time of 2-4 weeks following NART, which may heighten the inherent surgical challenges preceding peak inflammation in wound healing. 21 Surgeons and clinical oncologists from Imperial College and Royal Marsden's Hospital developed a protocol for mastectomy and DIEP reconstruction 2-6 weeks post-radiotherapy completion (33 cases, no significant postoperative complications).…”

Section: Risks and Complications Of Preoperative Nartmentioning

confidence: 99%

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Revolutionizing the battle against locally advanced breast cancer: A comprehensive insight into neoadjuvant radiotherapy

Kong,

Song,

Gao

et al. 2023

Medicinal Research Reviews

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Breast cancer (BC) constitutes one of the most pervasive malignancies affecting the female population. Despite progressive improvements in diagnostic and therapeutic technologies, leading to an increased detection of early stage BCs, locally advanced breast cancer (LABC) persists as a significant clinical challenge. Owing to its poor overall survival (OS) rate, elevated recurrence rate, and high potential for distant metastasis, LABC prominently impacts the comprehensive efficacy of BC treatments. Radiotherapy, encompassing preoperative, intraoperative, and postoperative modalities, is acknowledged as an effective strategy for mitigating BC metastasis and enhancing survival rates among patients. Nevertheless, the domain of preoperative neoadjuvant radiotherapy (NART) remains conspicuously underexplored in clinical studies. Available research suggests that NART can induce tumor volume reduction, provoke fibrotic changes in tumor and adjacent normal tissues, thereby mitigating intraoperative cancer propagation and enhancing the quality of life for LABC patients. This manuscript seeks to provide a review of contemporary research pertaining to LABC and its preoperative radiotherapy.

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“…Some groups have been exploring the option of pre-operative radiotherapy or commonly called “reverse-sequencing radiotherapy” where radiation is delivered prior to a reconstructive procedure [ 111 ]. This pathway is attractive as it means adjuvant therapies are not delayed and also avoids expander complications and the traditional two-stage reconstruction pathway.…”

Section: The Role Of Radiotherapymentioning

confidence: 99%

Breast Radiotherapy after Oncoplastic Surgery—A Multidisciplinary Approach

Metz

Snook

Sood

et al. 2022

Cancers

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Oncoplastic breast surgery encompasses a range of techniques used to provide equitable oncological outcomes compared with standard breast surgery while, simultaneously, prioritizing aesthetic outcomes. While the outcomes of oncoplastic breast surgery are promising, it can add an extra complexity to the treatment paradigm of breast cancer and impact on decision-making surrounding adjuvant therapies, like chemotherapy and radiotherapy. As such, early discussions at the multidisciplinary team meeting with surgeons, medical oncologists, and radiation oncologists present, should be encouraged to facilitate best patient care.

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Neoadjuvant Radiotherapy: Changing the Treatment Sequence to Allow Immediate Free Autologous Breast Reconstruction

Abstract: From our experience, this treatment sequence allows patients to have an immediate gold standard reconstruction without an increase in surgical morbidity. It affords the benefits of IBR without concern in delaying adjuvant therapy and appears to be safe from an oncological perspective.

Cited by 19 publications

References 34 publications

Immediate versus secondary DIEP flap breast reconstruction: a multicenter outcome study

Immediate versus secondary DIEP flap breast reconstruction: a multicenter outcome study

Revolutionizing the battle against locally advanced breast cancer: A comprehensive insight into neoadjuvant radiotherapy

Breast Radiotherapy after Oncoplastic Surgery—A Multidisciplinary Approach

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