Postmastectomy radiotherapy: Indications and implications

Walsh, Siún; Lowery, Aoife; Prichard, Ruth; McDermott, Enda; Evoy, Denis; Geraghty, James

doi:10.1016/j.surge.2014.04.004

Cited by 12 publications

(12 citation statements)

References 44 publications

(41 reference statements)

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“…To our knowledge, there have not been any cohort studies demonstrating a survival advantage of mastectomy over BCS plus radiotherapy. Radiotherapy has been deemed an important component of treatment of many breast cancer patients who receive mastectomy [16,17]. One-third of the mastectomy patients in the current study received adjuvant radiotherapy treatment and, therefore, a potential explanation for the observed survival disparity is the inappropriate lack of post-mastectomy radiotherapy treatment in some patients.…”

Section: Discussionmentioning

confidence: 87%

Survival in stage I–III breast cancer patients by surgical treatment in a publicly funded health care system

Fisher¹,

Gao²,

Yasui³

et al. 2015

Annals of Oncology

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Background: Recent investigations of breast cancer survival in the United States suggest that patients who receive mastectomy have poorer survival than those who receive breast-conserving surgery (BCS) plus radiotherapy, despite clinically established equivalence. This study investigates breast cancer survival in the publicly funded health care system present in Alberta, Canada.Patients and methods: Surgically treated stage I-III breast cancer cases diagnosed in Alberta from 2002 to 2010 were included. Demographic, treatment and mortality information were collected from the Alberta Cancer Registry. Unadjusted overall and breast cancer-specific mortality was assessed using Kaplan-Meier and cumulative incidence curves, respectively. Cox proportional hazards models were used to calculate stage-specific mortality hazard estimates associated with surgical treatment received.Results: A total of 14 939 cases of breast cancer (14 633 patients) were included in this study. The unadjusted 5-year all-cause survival probabilities for patients treated with BCS plus radiotherapy, mastectomy, and BCS alone were 94% (95% CI 93% to 95%), 83% (95% CI 82% to 84%) and 74% (95% CI 70% to 78%), respectively. Stage II and III patients who received mastectomy had a higher all-cause (stage II HR = 1.36, 95% CI 1.13-1.48; stage III HR = 1.74, 95% CI 1.24-2.45) and breast cancer-specific (stage II HR = 1.39, 95% CI 1.09-1.76; stage III HR = 1.79, 95% CI 1.21-2.65) mortality hazard compared with those who received BCS plus radiotherapy, adjusting for patient and clinical characteristics. BCS alone was consistently associated with poor survival.Conclusions: Stage II and III breast cancer patients diagnosed in Alberta, Canada, who received mastectomy had a significantly higher all-cause and breast cancer-specific mortality hazard compared with those who received BCS plus radiotherapy. We suggest greater efforts toward educating and encouraging patients to receive BCS plus radiotherapy rather than mastectomy when it is medically feasible and appropriate.

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Section: Discussionmentioning

confidence: 87%

Survival in stage I–III breast cancer patients by surgical treatment in a publicly funded health care system

Fisher¹,

Gao²,

Yasui³

et al. 2015

Annals of Oncology

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“…Since PMRT was first described in 1997 by Overgaard and colleagues, and demonstrated a survival benefit, use of this treatment intervention has become more widespread. 1–7 As a consequence, more patients presenting for breast reconstruction after mastectomy will receive PMRT. 1, 8 As reflected in the overall population of women who undergo breast reconstruction, an increasing proportion of those women who face PMRT will elect to undergo immediate implant-based reconstruction with a two-staged approach.…”

Section: Introductionmentioning

confidence: 99%

Postmastectomy Radiation Therapy and Two-Stage Implant-Based Breast Reconstruction: Is There a Better Time to Irradiate?

Santosa

Chen

et al. 2016

Plastic &Amp; Reconstructive Surgery

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Background The ideal timing of post-mastectomy radiation therapy (PMRT) in the setting of two-staged implant-based breast reconstruction remains unclear. In this cohort study, we sought to determine whether complication rates differed between patients who received PMRT following tissue expander placement (TE-XRT) and those who received PMRT after exchange for permanent implant (Implant-XRT) utilizing prospective, multicenter data. Methods Eligible patients in the Mastectomy Reconstruction Outcomes Consortium (MROC) study from 11 institutions across North America were included in the analysis. All patients had at least six-month follow-up after their last intervention (i.e. implant exchange for TE-XRT patients and radiation for Implant-XRT patients). Complications including seroma, hematoma, infection, wound dehiscence, capsular contracture, and implant loss were recorded. Results We identified a total of 150 patients who underwent immediate, two-staged implant-based breast reconstruction and received PMRT. Of these, there were 104 (69.3%) TE-XRT and 46 (30.7%) Implant-XRT patients. There were no differences in the incidence of any complications or complications leading to reconstructive failure between the two cohorts. After adjusting for patient characteristics and site effect, the timing of PMRT (i.e. TE-XRT versus Implant-XRT) was not a significant predictor in the development of any complication, a major complication, or reconstructive failure. Conclusions In the setting of PMRT and two-staged implant-based reconstruction, patients who received PMRT after expander placement (TE-XRT) did not have a higher incidence or increased odds of developing complications than those who received PMRT after exchange for a permanent implant (Implant-XRT).

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“…Radiotherapy is a key component in the treatment of BC and is typically indicated after mastectomy and for the treatment of metastasis, including bone, brain, and soft-tissue metastasis 9 . From our survey, we were able to determine that, similar to what is observed in a number of high-income countries, radio-oncologists in Mexico primarily treat BC, which is the most frequent tumor location that requires radiation therapy 13 .…”

Section: Improvement Of Symptoms With Radiation Therapy For Palliativmentioning

confidence: 99%

“…For patients with advanced disease, radiotherapy is also a key component in the treatment and it is typically indicated after mastectomy. Radiotherapy is also used for the treatment of breast cancer metastasis, including bone, brain, and soft-tissue metastasis [1][2][3]9 . Radiation therapy also has favorable results in palliative care, relieving symptoms earlier and demonstrating functional recovery in a more efficient manner compared to other therapies.…”

Section: Introductionmentioning

confidence: 99%

Radiotherapy for Metastatic Breast Cancer in Mexico: Results from the 2015 National Survey

Álvarez-Águila¹,

Cook²,

Prada

et al. 2017

RIC

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Postmastectomy radiotherapy: Indications and implications

Cited by 12 publications

References 44 publications

Survival in stage I–III breast cancer patients by surgical treatment in a publicly funded health care system

Survival in stage I–III breast cancer patients by surgical treatment in a publicly funded health care system

Postmastectomy Radiation Therapy and Two-Stage Implant-Based Breast Reconstruction: Is There a Better Time to Irradiate?

Radiotherapy for Metastatic Breast Cancer in Mexico: Results from the 2015 National Survey

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