Post-Mastectomy Radiotherapy Does Not Preclude Successful Breast Reconstruction
More study is needed to determine the impacts of PMRT on autologous breast reconstructions, but as radiation therapy techniques have become more sophisticated, the risk of expander/implant (E/I)-based reconstruction loss appears to be declining, they reported.
“Whereas PMRT and the addition of regional irradiation has been traditionally associated with increased complications and worse outcomes with E/I reconstruction, recent data suggest that no difference in perioperative complications exists in patients receiving PMRT using modern techniques,” reported Chirag Shah, MD, at the Department of Radiation Oncology, Washington University School of Medicine in St. Louis, Missouri, and coauthors.
Approximately 50% of women with breast cancer opt for reconstruction, the authors noted. PMRT is associated with improved local control, disease-free survival and overall survival among women with stage II and III breast cancer who undergo mastectomy, but studies suggest it might result in loss of breast reconstruction in some cases.
Only studies of 20 or more patients, published between 1992 and 2012, were included in the review.
The rate of loss of expander/implant-based breast reconstruction associated with “more advanced radiation techniques is less than 30% in patients undergoing PMRT,” the authors reported. “More recent data have highlighted that with current technology, rates of reconstruction loss approach 20%.”
However, factors “beyond PMRT,” such as older patient age, obesity, smoking and hypertension, could also be partly responsible for such losses, they wrote.
PMRT is “potentially associated” with increased rates of breast reconstruction loss “regardless of reconstruction technique utilized,” they cautioned. But the available clinical study data does not yet allow any definitive conclusions about PMRT impacts on autologous reconstructions.
“Despite the potential complications associated with PMRT, data support that women should continue to be encouraged to pursue reconstruction following mastectomy due to the psychological, social, and sexual benefits on a patient's well-being, regardless of their age or comorbidities,” the authors concluded.