Postmastectomy Radiotherapy of the Chest Wall

Hehr, Thomas; Claßen, Johannes; Huth, Marco; Durst, Ilona; Christ, Günter; Bamberg, M.; Budach, Wilfried

doi:10.1007/s00066-004-1264-8

Cited by 21 publications

(5 citation statements)

References 28 publications

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“…Radiation therapy delivered to the chest wall and regional lymph nodes, including the supra- and infraclavicular regions and the internal mammary nodes, has proven to be of benefit in preventing relapse in the chest wall and supraclavicular fossa for high-risk patients. [23-25] The American Society of Clinical Oncology guidelines state that adjuvant radiotherapy is suggested following mastectomy in patients with four or more involved axillary lymph nodes and in patients with T3 tumors. [26] Additional professional guidelines support the use of post-mastectomy radiation therapy in cases where there is skin, pectoral or chest wall invasion, but no clear guidelines with respect to margin status are defined.…”

Section: Discussionmentioning

confidence: 99%

Compromised margins following mastectomy for stage I–III invasive breast cancer

Mushawah

Taylor

et al. 2012

Journal of Surgical Research

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Background We investigated factors associated with positive margins following mastectomy and the impact on outcomes. Methods We identified 240 patients with stage I-III invasive breast cancer who underwent mastectomy from 1999-2009. Data included patient and tumor characteristics, pathologic margin assessment, and outcomes. Margin positivity was defined as the presence of in situ or invasive malignancy present at any margin. Descriptive statistics were utilized for data summary and were compared using Chi-square. Results Of the 240 patients, 132 (55%) had a simple mastectomy with sentinel lymph node biopsy and 108 (45%) had a modified radical mastectomy. Overall, 21 (9%) patients had positive margins, including 12 (57%) with one positive margin, 3 (14%) with two positive margins, and 6 (29%) with three or more positive margins. The most commonly affected margin was the deep margin (48% of patients). Eight (38%) of the 21 patients received adjuvant chest wall irradiation. There were no differences between patients who had a positive margin versus those who did not with respect to patient age, race, percentage of in situ component, tumor size, tumor grade, lymphovascular invasion, or immunostain profile (p>0.05 for all). None of the patients with positive margins experienced a local recurrence. Conclusions Positive margins following mastectomy occurred in nearly 10% of our patients. No specific patient or tumor characteristics predicted a risk for having a positive margin. Despite the finding that only approximately 40% of patients received adjuvant radiation in the setting of a positive margin, no local recurrences have been observed.

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Section: Discussionmentioning

confidence: 99%

Compromised margins following mastectomy for stage I–III invasive breast cancer

Mushawah

Taylor

et al. 2012

Journal of Surgical Research

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“…Parasternal nodes were irradiated in seven patients (17%) using the mixed-beam-technique. Re-irradiation was performed using 6 MV photons (n = 24) with tangential fields or 4-12 MeV electrons with an electron beam rotation technique (n = 18) as described elsewhere [11]. Chestwall was defined as thoracic wall extending from the second to the sixth/seventh intercostal space including a small portion of the underlying lung.…”

Section: Methodsmentioning

confidence: 99%

Re-surgery and chest wall re-irradiation for recurrent breast cancer - a second curative approach

et al. 2011

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BackgroundRepeat radiation is a rarely used treatment strategy that must be performed with caution. The efficacy and toxicity of a second curative radiotherapy series was investigated in cases of recurrent breast cancer.MethodsForty-two patients treated from 1993 to 2003 with resection (n = 30) and postoperative re-irradiation or definitive re-irradiation (n = 12) for recurrent breast cancer were enrolled in the study. Concurrent hyperthermia was performed in 29 patients. The median age was 57 years. The median pre-radiation exposure was 54Gy. Re-irradiation was conventionally fractionated to a median total dose of 60Gy.ResultsAfter a median follow-up of 41 months (range 3-92 months) higher graded late toxicity > G3 according to CTC 3.0 and LENT-SOMA was not observed. The estimated 5-year local control rate reached 62%. The estimated 5-year overall survival rate was 59%. Significantly inferior survival was associated with recurrence within two years (40 vs. 71%, p < ([0-9]).01) and presence of macroscopic tumour load (24 vs. 75%, p = 0.03).ConclusionsRepeat radiotherapy for recurrent breast cancer with total radiation doses of 60 Gy and the addition of hyperthermia in the majority of patients was feasible, with acceptable late morbidity and improved prognosis, particularly in patients with previous resection of recurrent tumours.

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“…The cumulative doses typically used in postmastectomy radiation therapy are 50–60 Gy and are administered in fractions of 1.8-2.5 Gy/day over several weeks to minimize damage to tissue [7,8]. Modern clinical radiotherapy utilizes megavoltage X-rays produced by a linear accelerator with energies typically ranging from 4–20 MV [9-11].…”

Section: Methodsmentioning

confidence: 99%

Radiation testing of the AeroForm co2-based breast tissue expander implant

Rembert

Heitz²,

Hoffman³

2013

Radiat Oncol

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BackgroundTissue expanders are used in breast reconstruction after mastectomy to stretch the remaining tissue to create space for placement of permanent breast implants. The AeroForm™ Tissue Expander, developed by AirXpanders™ Inc., contains electronic components designed to activate the release of carbon dioxide from an internal reservoir to inflate the expander. Breast cancer patients who undergo mastectomy and tissue expander/implant-based breast reconstruction may require radiation therapy at doses up to 50–60 Gy while the expander is in place. The ionizing radiation used in postmastectomy radiation therapy interacts with electronic components in medical implants, which may cause degradation in performance above certain levels. Most commercial electronic components used in medical devices, such as complementary metal-oxide semiconductor or bipolar integrated circuits can withstand radiation levels in the 50 Gy range without any performance degradation. Beyond this level, the performance may still be sufficient to guarantee functionality, but this needs to be confirmed at the system and electronic circuit level. We assessed the impact of radiation levels up to 75 Gy on 32 AeroForm™ Tissue Expanders (AirXpanders, Inc., Palo Alto, CA USA) and on the associated internal printed circuit assemblies.FindingsThe electronics inside the AeroForm™ Tissue Expander implant continued to function properly after exposure to radiation levels up to 75 Gy, which is well above the maximum total dose level typically used in postmastectomy radiation therapy.ConclusionsStandard postmastectomy radiation therapy doses do not damage or affect the functionality of the AeroForm™ Tissue Expander.

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Postmastectomy Radiotherapy of the Chest Wall

Cited by 21 publications

References 28 publications

Compromised margins following mastectomy for stage I–III invasive breast cancer

Compromised margins following mastectomy for stage I–III invasive breast cancer

Re-surgery and chest wall re-irradiation for recurrent breast cancer - a second curative approach

Radiation testing of the AeroForm co2-based breast tissue expander implant

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