Patterns of Post-Mastectomy Radiotherapy in Immediate Breast Reconstruction – Results from the iBRA-2 Cohort Study

Abstract

PurposeLong-term data indicates that post-mastectomy radiotherapy (PMRT) is associated with improved overall survival in all node-positive breast cancer patients. Immediate breast reconstruction (IBR) remains controversial in the context of planned PMRT, but rates of IBR are increasing. The aim of this study was to examine current practice of PMRT in patients undergoing mastectomy +/- IBR.MethodsData were collected from 2,526 patients enrolled in the iBRA-2 prospective cohort study undergoing mastectomy +/- IBR between 1st July and 31st December 2016, recruited consecutively at 71 centres across the United Kingdom, Ireland, and five international centres.ResultsOf a total of 2,590 breast procedures included in the analysis, 696 were implant-based, 105 pedicled flap and 230 free-flap reconstruction. 31.4% of implant-based, 34.3% of pedicled, and 32.5% of free-flap reconstructions were recommended for PMRT. PMRT recommendation by cancer stage was 21% for T1-2 N0, 65% for T1-2 N1, and 89% for Tany N2 and T3 Nany disease. On multivariate analysis, patients undergoing IBR were no less likely to be recommended for PMRT than patients having mastectomy only. However, patients in Northern Ireland/Ireland, the North of England, and Scotland were less likely to be recommended for PMRT.ConclusionAlthough IBR was more likely to be performed for lower stage cancers and younger patients with fewer co-morbidities, patients undergoing IBR were no less likely to be recommended for PMRT, irrespective of reconstruction technique. This study also highlighted regional variation in PMRT practice within the UK which merits further investigation.