Primary radiotherapy and deep inferior epigastric perforator flap reconstruction for patients with breast cancer (PRADA): a multicentre, prospective, non-randomised, feasibility study

Thiruchelvam, Paul; Leff, Daniel; Godden, Amy; Cleator, Susan; Wood, Simon; Kirby, Anna M.; Jallali, Navid; Somaiah, Navita; Hunter, JO; Henry, Frances; Micha, Aikaterini; O’Connell, Rachel; Mohammed, Kabir; Patani, Neill; Tan, Melissa; Gujral, Dorothy M.; Ross, Gillian; James, Simon; Khan, Aadil; Rusby, Jennifer; Hadjiminas, Dimitri; MacNeill, Fiona

doi:10.1016/s1470-2045(22)00145-0

Cited by 30 publications

(27 citation statements)

References 30 publications

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“…The most recently published study in this field is the small prospective PRADA trial. This study investigated preoperative chemotherapy followed by radiotherapy with an interval of 2–6 weeks, followed by skin-sparing mastectomy and DIEP flap reconstruction [ 40 ]. This approach was found to be feasible with wound complications similar to postoperative approaches.…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors of Long-Term Survival after Neoadjuvant Radiotherapy and Chemotherapy in High-Risk Breast Cancer

Haussmann

Budach

Nestle-Krämling

et al. 2022

Cancers

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Background: Neoadjuvant radiotherapy (naRT) in addition to neoadjuvant chemotherapy (naCT) has been used for locally advanced, inoperable breast cancer or to allow breast conserving surgery (BCS). Retrospective analyses suggest that naRT + naCT might result in an improvement in pathological complete response (pCR rate and disease-free survival). pCR is a surrogate parameter for improved event-free and overall survival (OS) and allows for the adaption of the post-neoadjuvant therapy regimens. However, it is not clear whether pCR achieved with the addition of naRT has the same prognostic value. Patients and methods: We performed a retrospective re-analysis of 356 patients (cT1-cT4/cN0-N+) treated with naRT and naCT with a long-term follow-up. Patients underwent naRT on the breast and regional lymph nodes combined with a boost to the primary tumor. Chemotherapy with different agents was given either sequentially or concomitantly to naRT. We used the Cox proportional hazard regression model to estimate the effect of pCR in our cohort in different subgroups as well as chemotherapy protocols. Clinical response markers correlating with OS were also analyzed. Results: For patients with median follow-ups of 20 years, 10 years, 15 years, 20 years, and 25 years, OS rates were 69.7%, 60.6%, 53.1%, and 45.1%, respectively. pCR was achieved in 31.1% of patients and associated with a significant improvement in OS (HR = 0.58; CI-95%: 0.41–0.80; p = 0.001). The prognostic impact of pCR was evident across breast cancer subtypes and chemotherapy regimens. Multivariate analysis showed that age, clinical tumor and nodal stage, chemotherapy, and pCR were prognostic for OS. Conclusion: NaCT and naRT prior to surgical resection achieve good long-term survival in high-risk breast cancer. pCR after naRT maintains its prognostic value in breast cancer subtypes and across different subgroups. pCR driven by naRT and naCT independently influences long-term survival.

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Section: Discussionmentioning

confidence: 99%

Predictive Factors of Long-Term Survival after Neoadjuvant Radiotherapy and Chemotherapy in High-Risk Breast Cancer

Haussmann

Budach

Nestle-Krämling

et al. 2022

Cancers

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“…Centro 4 In the setting of skin-sparing mastectomy and immediate autologous free flap breast reconstruction, it is unclear whether preoperative radiotherapy is feasible and safe, or whether it can help prevent radiation-induced damage to healthy donor tissues and reduce overall treatment time. In this prospective, nonrandomized feasibility study, the investigators enrolled 33 patients who underwent skin-sparing mastectomy and deep inferior epigastric perforator flap reconstruction.…”

Section: Claudio D Rojas Gutiérrez Mdmentioning

confidence: 99%

Spotlight in Plastic Surgery: July 2023

Phillips,

Chaya,

Eddine

et al. 2023

Plastic &Amp; Reconstructive Surgery

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“…The initial latent period before RT endothelial injuries may explain the relevance of early reconstruction following RT. In 2022, the PRADA trial demonstrated that neoadjuvant chemoradiotherapy (40–42.72 Gy in 15–16 fractions), followed by mastectomy and immediate flap reconstruction, seems safe and possible ( 56 ). At 4 weeks following surgery, 4 out of 33 (12.1%, 95% CI: 3.4–28.2) patients developed open breast wounds (>1 cm), which is comparable to post-mastectomy RT.…”

Section: Radiotherapy and Surgerymentioning

confidence: 99%

The State of the Art of Radiotherapy for Non-melanoma Skin Cancer: A Review of the Literature

et al. 2022

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Due to the general aging population and the fashion trend of sun exposure, non-melanoma skin cancer (NMSC) is rising. The management of NMSC is difficult and necessitates a multidisciplinary team (i.e., pathologists, dermatologists, medical oncologists, surgeons, and radiation oncologists). When surgery is not an option or will cause unacceptably functional morbidity, radiation therapy (RT) may be a preferable tissue-preserving option. Whether used alone or in conjunction with other treatments, RT has been shown to be quite effective in terms of cosmetic results and local control. Contact hypofractionated RT, brachytherapy, and electronic brachytherapy are all promising new treatments. However, rigorous, randomized trials are missing, explaining the disparity in dose, fractionation, and technique recommendations. Therefore, it is essential that interdisciplinary teams better understand RT modalities, benefits, and drawbacks. Our review will provide the role and indications for RT in patients with NMSC.

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Primary radiotherapy and deep inferior epigastric perforator flap reconstruction for patients with breast cancer (PRADA): a multicentre, prospective, non-randomised, feasibility study

Cited by 30 publications

References 30 publications

Predictive Factors of Long-Term Survival after Neoadjuvant Radiotherapy and Chemotherapy in High-Risk Breast Cancer

Predictive Factors of Long-Term Survival after Neoadjuvant Radiotherapy and Chemotherapy in High-Risk Breast Cancer

Spotlight in Plastic Surgery: July 2023

The State of the Art of Radiotherapy for Non-melanoma Skin Cancer: A Review of the Literature

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