Radiation Therapy Versus No Radiation Therapy to the Neo-breast Following Skin-Sparing Mastectomy and Immediate Autologous Free Flap Reconstruction for Breast Cancer: Patient-Reported and Surgical Outcomes at 1 Year—A Mastectomy Reconstruction Outcomes Consortium (MROC) Substudy

Cooke, Andrew; Diaz-Abele, Julian; Hayakawa, Tom; Buchel, Ed; Dalke, Kimberly R; Lambert, Pascal

doi:10.1016/j.ijrobp.2017.05.001

Cited by 22 publications

(23 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A total of 697 studies were identified. Of these, 12 studies (including 1756 patients) evaluated adjuvant radiotherapy (350 patients), neoadjuvant radiotherapy (723) and no radiotherapy (683) ( Fig . ).…”

Section: Resultsmentioning

confidence: 99%

“…There were three prospective study designs and nine that were retrospective, but no RCTs. There were two multicentre (1 prospective and 1 retrospective) and ten single‐centre studies (2 prospective and 8 retrospective) ( Table ). Study quality (GRADE) was low in eight studies and moderate in the other four, with an overall high risk of bias.…”

Section: Resultsmentioning

confidence: 99%

“…There were two multicentre (1 prospective and 1 retrospective) and ten single‐centre studies (2 prospective and 8 retrospective) ( Table ). Study quality (GRADE) was low in eight studies and moderate in the other four, with an overall high risk of bias. A summary of baseline characteristics, including numbers of centres, country of origin, dates, patient numbers, breast cancer pathology and adjuvant medical treatments in comparative adjuvant and neoadjuvant radiotherapy groups, including non‐comparative studies, is provided in Table S1 (supporting information).…”

Section: Resultsmentioning

confidence: 99%

“…The retrospective grading of surgical complications in the two moderate‐quality studies reported showed a rate of major complications (CDC grade IIIb) of 9 per cent (6 of 64) at 1 year, and 4·6 per cent (5 of 108) at 2 years. These rates are also likely to reflect under‐reporting compared with the MROC rates of 14·8 per cent (35 of 236) at 1 year and 17·6 per cent (35 of 199) at 2 years.…”

Section: Discussionmentioning

confidence: 98%

“…There was limited reporting of patient-reported QOL; outcomes were detailed in only two prospective studies 60,62 and one retrospective study 58 , with small patient numbers and short follow-ups for the PMRT groups 58,60,62 . A priori hypothesis-driven selection of QOL domains was absent from methods 58,60,62 , with no reporting of missing data or how this problem was tackled 34 . Three studies 58,60,62 used the BREAST-Q and one 60 used the breast cancer-specific questionnaire (EORTC QLQ-BR23) 42 .…”

Section: Quality Of Lifementioning

confidence: 99%

See 4 more Smart Citations

Immediate and delayed autologous abdominal microvascular flap breast reconstruction in patients receiving adjuvant, neoadjuvant or no radiotherapy: a meta-analysis of clinical and quality-of-life outcomes

et al. 2019

View full text Add to dashboard Cite

Background Effects of postmastectomy radiotherapy (PMRT) on autologous breast reconstruction (BRR) are controversial regarding surgical complications, cosmetic appearance and quality of life (QOL). This systematic review evaluated these outcomes after abdominal free flap reconstruction in patients undergoing postoperative adjuvant radiotherapy (PMRT), preoperative radiotherapy (neoadjuvant radiotherapy) and no radiotherapy, aiming to establish evidence‐based optimal timings for radiotherapy and BRR to guide contemporary management. Methods The study was registered on PROSPERO (CRD42017077945). Embase, MEDLINE, Google Scholar, CENTRAL, Science Citation Index and ClinicalTrials.gov were searched (January 2000 to August 2018). Study quality and risk of bias were assessed using GRADE and Cochrane's ROBINS‐I respectively. Results Some 12 studies were identified, involving 1756 patients (350 PMRT, 683 no radiotherapy and 723 neoadjuvant radiotherapy), with a mean follow‐up of 27·1 (range 12·0–54·0) months for those having PMRT, 16·8 (1·0–50·3) months for neoadjuvant radiotherapy, and 18·3 (1·0–48·7) months for no radiotherapy. Three prospective and nine retrospective cohorts were included. There were no randomized studies. Five comparative radiotherapy studies evaluated PMRT and four assessed neoadjuvant radiotherapy. Studies were of low quality, with moderate to serious risk of bias. Severe complications were similar between the groups: PMRT versus no radiotherapy (92 versus 141 patients respectively; odds ratio (OR) 2·35, 95 per cent c.i. 0·63 to 8·81, P = 0·200); neoadjuvant radiotherapy versus no radiotherapy (180 versus 392 patients; OR 1·24, 0·76 to 2·04, P = 0·390); and combined PMRT plus neoadjuvant radiotherapy versus no radiotherapy (272 versus 453 patients; OR 1·38, 0·83 to 2·32, P = 0·220). QOL and cosmetic studies used inconsistent methodologies. Conclusion Evidence is conflicting and study quality was poor, limiting recommendations for the timing of autologous BRR and radiotherapy. The impact of PMRT and neoadjuvant radiotherapy appeared to be similar.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 98%

Section: Quality Of Lifementioning

confidence: 99%

See 3 more Smart Citations

Immediate and delayed autologous abdominal microvascular flap breast reconstruction in patients receiving adjuvant, neoadjuvant or no radiotherapy: a meta-analysis of clinical and quality-of-life outcomes

et al. 2019

View full text Add to dashboard Cite

show abstract

International multidisciplinary expert panel consensus on breast reconstruction and radiotherapy

Nava

Benson

Audretsch

et al. 2019

British Journal of Surgery

View full text Add to dashboard Cite

Background Conflicting evidence challenges clinical decision‐making when breast reconstruction is considered in the context of radiotherapy. Current literature was evaluated and key statements on topical issues were generated and discussed by an expert panel at the International Oncoplastic Breast Surgery Meeting in Milan 2017. Methods Studies on radiotherapy and breast reconstruction (1985 to September 2017) were screened using MEDLINE, Embase and CENTRAL. The literature review yielded 30 controversial key questions. A set of key statements was derived and the highest levels of clinical evidence (LoE) for each of these were summarized. Nineteen panellists convened for dedicated discussions at the International Oncoplastic Breast Surgery Meeting to express agreement, disagreement or abstention for the generated key statements. Results The literature review identified 1522 peer‐reviewed publications. A list of 22 key statements was produced, with the highest LoE recorded for each statement. These ranged from II to IV, with most statements (11 of 22, 50 per cent) supported by LoE III. There was full consensus for nine (41 per cent) of the 22 key statements, and more than 75 per cent agreement was reached for half (11 of 22). Conclusion Poor evidence exists on which to base patient‐informed consent. Low‐quality studies are conflicting with wide‐ranging treatment options, precluding expert consensus regarding optimal type and timing of breast reconstruction in the context of radiotherapy. There is a need for high‐quality evidence from prospective registries and randomized trials in this field.

show abstract

Identifying factors impacting the efficacy of postmastectomy radiotherapy in patients with early‐stage breast cancer and one to two positive lymph nodes

Bhutiani

Egger

Stromberg

et al. 2020

Journal of Surgical Oncology

View full text Add to dashboard Cite

Introduction In women with T1‐2 breast cancer and one to two positive axillary lymph nodes (LN) at low risk for recurrence, postmastectomy radiation therapy (PMRT) may provide insufficient benefit to justify its toxicity. This study evaluated the interaction of factors associated with overall survival (OS) after PMRT in these patients. Methods The National Cancer Database was queried for women with T1‐2 breast cancer undergoing mastectomy with one to two positive LN identified on lymphadenectomy. Patients were grouped according to number of positive LN and then stratified by PMRT use. Differences in OS were evaluated. Results Multivariable modeling demonstrated an interaction effect of age on the efficacy of PMRT. In patients more than or equal to 60 years old, PMRT was associated with improved survival when adjusting for age and tumor grade in patients with 1 to 2 positive LN (risk ratio = 0.62, 95% confidence interval = 0.40‐0.93, P = .018). In patients less than 60 years old, tumor size and grade, but not PMRT, were associated with improved OS. Conclusion For women with T1‐2 breast cancer and one to two positive LN, PMRT's association with OS is influenced by age, tumor grade, and number of positive LN. PMRT appears to be associated with improvements in OS in older patients, but not younger patients, regardless of tumor size or nodal status.

show abstract

Radiation Therapy Versus No Radiation Therapy to the Neo-breast Following Skin-Sparing Mastectomy and Immediate Autologous Free Flap Reconstruction for Breast Cancer: Patient-Reported and Surgical Outcomes at 1 Year—A Mastectomy Reconstruction Outcomes Consortium (MROC) Substudy

Cited by 22 publications

References 41 publications

Immediate and delayed autologous abdominal microvascular flap breast reconstruction in patients receiving adjuvant, neoadjuvant or no radiotherapy: a meta-analysis of clinical and quality-of-life outcomes

Immediate and delayed autologous abdominal microvascular flap breast reconstruction in patients receiving adjuvant, neoadjuvant or no radiotherapy: a meta-analysis of clinical and quality-of-life outcomes

International multidisciplinary expert panel consensus on breast reconstruction and radiotherapy

Identifying factors impacting the efficacy of postmastectomy radiotherapy in patients with early‐stage breast cancer and one to two positive lymph nodes

Contact Info

Product

Resources

About