Radiotherapy and breast reconstruction: a meta-analysis

Abstract

To cite this version:M Barry, M. R. Kell. Radiotherapy and breast reconstruction: a meta-analysis. Breast Cancer Research and Treatment, Springer Verlag, 2011, 127 (1) databases were searched and cross-referenced for appropriate studies where morbidity following BR was the primary outcome measured.. Results:1,105 patients were identified from 11 appropriately selected studies.Patients undergoing PMRT and BR are more likely to suffer morbidity compared to patients not receiving PMRT ((OR) = 4.2; 95% CI, 2.4-7.2(no PMRT vs. PMRT)). Reconstruction technique was also examined with outcome whenPMRT was delivered after BR and this demonstrated that autologous reconstruction is associated with less morbidity in this setting ((OR) = 0.21; (95% CI, 0.1-0.4 (autologous vs. implant based)). Delaying BR until after PMRT had no significant effect on outcome ((OR) =0.87; 95% CI, 0.47-1.62 (delayed vs. immediate)).Conclusions: PMRT has a detrimental effect on BR outcome. These results suggest that where immediate reconstruction is undertaken with the necessity of PMRT, an autologous flap results in less morbidity when compared to implant based reconstruction. 3 INTRODUCTION:Breast Eligibility CriteriaAll trials whether randomized or non-randomized, prospective or retrospective were eligible that examined the effects of radiotherapy on immediate or delayed breast reconstruction using either a prosthesis or autologous tissue (Latissimus Dorsi (LD) or Trasversus Rectus Abdominis Muscle (TRAM). Case series orreports were not included. Studies where the data could not be accurately extracted were also excluded. Data Extraction and OutcomesThe following information regarding each eligible trial was recorded: authors' names, journal, patient numbers, timing and method of reconstruction, addition of radiotherapy and the post-operative complication rate. The primary end point of 7 this meta-analysis was postoperative morbidity including capsular contracture, fibrosis, fat necrosis, surgical site infections requiring removal of prosthesis/reoperation (see tables 2, 4 and 6). Statistical AnalysisFor post-operative complications in each study, the odds ratio (O.R.) of the simple proportions of events was estimated with its variance and 95% CI.Heterogeneity between the O.R.s for the same outcome between studies was assessed by use of the X 2 -based Q statistic [24]. Data were then combined across studies by the use of general variance methods with fixed and random effects models [14]. Analyses were conducted using StatsDirect version 2.5.6(StatsDirect Ltd, Chesire, United Kingdom) and SPSS version 12.0 (SPSS, Inc, Chicago, IL). All statistical tests were two tailed. 8 RESULTS:Eligible Studies 20 potentially eligible studies were identified that examined the effects of radiotherapy on immediate or delayed breast reconstructions. 9 studies were excluded from the meta-analysis due to low numbers (e.g. n < 15) or incomplete data set regarding postoperative morbidity. Of the 11 studies selected, 4 were studies that examined the effects of RT...

Patient determinants as independent risk factors for postoperative complications of breast reconstruction

“…However, autologous breast reconstruction provides reduced morbidity than implantbased reconstruction in the setting of postoperative radiotherapy (2,26). In the present study, no patients received radiotherapy after the breast reconstruction, only before.…”

“…Radiotherapy after mastectomy but before reconstruction has not been shown to increase complications of the flaps after autologous reconstruction (25), although not all studies agree on this (26,27). However, autologous breast reconstruction provides reduced morbidity than implantbased reconstruction in the setting of postoperative radiotherapy (2,26).…”

“…Radiotherapy after mastectomy but before reconstruction has not been shown to increase complications after autologous reconstruction (25); however, not all studies are in agreement (26,27). Certain studies show that postoperative radiotherapy to the breast reconstructed with a deep inferior epigastric perforator flap (DIEP) or transverse rectus abdominis myocutaneous (TRAM) flap has no effect on the reconstruction (28,29), while several others show a considerable negative effect on the final results of autologous reconstruction (24,26,(30)(31)(32)(33)(34).…”

General Overview and Treatment Recommendations for Young Women with Breast Cancer

“…Some authors suggest that patients with postoperative complications, such as those with large breasts for whom a maximum dose of < 107% is not achievable, or patients with breast implants who have an increased risk for late fibrosis or cosmetic deterioration following radiotherapy, should receive a biologically less-intense dose 94 . Adjuvant radiotherapy after breast reconstruction (especially implant-based) is a risk factor for higher tissue toxicity 95 .…”

Should We Be Doing Implant-Based Breast Reconstruction in the Setting of Radiotherapy?

“…Barry and Kell in a meta-analysis of 11 studies found that patients receiving postmastectomy radiotherapy (PMRT) after implant reconstruction had significantly increased risk of complications (odds ratio [OR] 4.2; 95 % CI 2.4-7.2) compared with those who did not receive radiation. 3 Autologous reconstruction was associated with less morbidity (OR 0.21; 95 % CI 0.1-0.4) in the setting of PMRT. The impact of radiation therapy on implant breast reconstruction from the patients' perspective is less well documented.…”