The Effects of Radiotherapy on the Sequence and Eligibility of Breast Reconstruction: Current Evidence and Controversy
Abstract
:Simple Summary
Abstract
1. Introduction
2. Breast Reconstruction Techniques
2.1. Overview of Immediate Reconstruction Options
2.2. Overview of Delayed Reconstruction Options
3. Influence of Post-Mastectomy Radiotherapy on Choice of Reconstruction
4. Complications
Author | Study Design | Patients (n) | Reconstruction Modality | Complication Rates |
---|---|---|---|---|
Tran et al. [18]. | Retrospective | 41 | Immediate autologous | Fat necrosis (34%) and asymmetry (78%) |
Billig et al. [19]. | Prospective | 108 | Immediate autologous | Fat necrosis (16.9%) and hematoma (5.6%) |
Billig et al. [19]. | Prospective | 67 | Delayed autologous | Fat necrosis (19.5%) and wound dehiscence (9%) |
Albino et al. [20]. | Retrospective | 76 | Immediate autologous | Fat necrosis (19%) and contracture or scarring (30%) |
Dewael et al. [21]. | Retrospective | 20 | Immediate autologous | Fat necrosis (60%), contracture (60%), and infection (20%) |
Dewael et al. [21]. | Retrospective | 40 | Delayed autologous | Fat necrosis (12%) and wound dehiscence (10%) |
Jhaveri et al. [22]. | Retrospective | 69 | Immediate autologous | Grade 2–4 complications (55%) |
Jhaveri et al. [22]. | Retrospective | 23 | Delayed implant | Grade 2–4 complications (8%) |
Maalouf et al. [23]. | Retrospective | 30 | Immediate autologous | Reoperation (40%) |
Maalouf et al. [23]. | Retrospective | 32 | Delayed autologous | Reoperation (12%) |
McCarthy et al. [24]. | Prospective | 10 | Delayed implant | Capsular contracture (60%) |
Cordeiro et al. [25]. | Retrospective | 68 | Delayed implant | Capsular contracture (68%) |
Rella et al. [26]. | Retrospective | 80 | Delayed implant | Capsular contracture (15%) and seroma (10%) |
Benediktsson et al. [27]. | Prospective | 24 | Immediate implant | Capsular contracture (41%) |
5. Influence of Post-Mastectomy Radiotherapy on Survival Outcomes
Impact of Nodal and Molecular Subtypes on Locoregional Recurrence (LRR) and Survival
6. Influence of Post-Mastectomy Radiotherapy on Cosmetic Outcomes and Patient Satisfaction
7. Future Directions and PreMRT
8. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Advantages | Disadvantages | |
---|---|---|
Immediate Autologous | Lower chance of capsular contracture Lower morbidity compared with implant One surgery Better QOL vs. delayed options | Often contraindicated due to patient comorbidities or anatomy More invasive than implant Longer recovery time More expensive in the short term |
Immediate Implant | One surgery Less complex Shorter recovery time More cost-effective in the short term Better QOL vs. delayed options | Increased risk of complications, including capsular contracture, infection, and skin breakdown |
Delayed Autologous | Lower complication and failure rates compared with immediate autologous technique More invasive More cost-effective in the long term | Lower overall QOL Multiple surgeries Less cost-effective in the short term Longer time to achieve cosmetic results Increased risk of capsular contracture |
Delayed Expander/Implant | Lower complication and failure rates compared with immediate implant Option to revise implants after TE removal Faster recovery time than delayed autologous options | Lower QOL Multiple surgeries Increased risk of capsular contracture compared with immediate implant |
NCT | Phase | Number of Patients Enrolled (Estimated *) | Primary Endpoint | Currently Enrolling |
---|---|---|---|---|
NCT05993559 | 3 | 1314 | Evaluates 5-year survival rate in breast cancer patients receiving a mastectomy and neoadjuvant chemotherapy without PMRT compared to with PMRT | No |
NCT05512286 | N/A | 80 | Evaluates patient-reported outcomes for pre-operative and post-mastectomy radiotherapy regarding patients with DIEP flaps | No |
NCT05440149 | 3 | 1106 | Evaluates 7-year survival receiving PMRT/whole breast irradiation versus those not receiving it | Yes |
NCT05253170 | 3 | 622 | Evaluates non-inferiority of complication rates in patients with breast reconstructions between hypofractionated vs. conventional fraction radiotherapy | No |
NCT05045287 | 2 | 57 | Evaluates failure rate of hypofractionated PMRT in patients with two-stage expander/implant reconstructions | Yes |
NCT04992650 | N/A | 50 | Evaluates breast skin blood supply after fat grafting in patients with PMRT | By invitation |
NCT03523078 | N/A | 500 | Evaluates cosmetic/patient-reported outcomes and complications in patients with and without PMRT | Unknown |
NCT03414970 | 3 | 897 | Evaluates non-inferiority of hypofractionated PMRT complication rates and reoccurrence rates in patients with stage IIa-IIIa breast cancer | No |
NCT03319069 | 3 | 60 | Evaluates efficacy/toxicities of hypofractionated vs. conventional PMRT in high-risk breast cancer patients | Unknown |
NCT03072316 | N/A | 300 | Evaluates effects of PMRT on breast cancer patients who received DIEP reconstructions | Unknown |
NCT02992574 | N/A | 1022 | Evaluates efficacy/reoccurrence in patients with early high-risk, but node-negative, breast cancer treated with PMRT | Yes |
NCT02679040 | 2 | 101 | Evaluates histological response of patients receiving neoadjuvant chemotherapy and radiation after a mastectomy and immediate reconstruction | No |
NCT01925651 | N/A | 58 | Evaluated if bolus usage during PMRT increased the treatment time or decreased efficacy | Complete |
NCT01666899 | N/A | 10 | Evaluates effect of PMRT on skin and blood vessels after treatment | Complete |
NCT01452672 | 3 | 600 | Evaluates the necessity of chest wall irradiation alone vs. chest wall and supraclavicular fossa irradiation in PMRT | Unknown |
NCT01417286 | 2 | 69 | Evaluates efficacy and toxicities of accelerated radiotherapy in post-mastectomy patients | Complete |
NCT01292772 | N/A | 12 | Evaluates effects of PMRT on patients who had immediate breast reconstructions | Complete |
NCT00966888 | 3 | 3500 | Evaluates efficacy of PMRT in patients with stage II breast cancer compared to observations alone after a mastectomy | Unknown |
NCT00005588 | 3 | Not listed | Evaluates different radiation regimens in patients with early-stage breast cancer after a mastectomy | Complete |
NCT05483712 | N/A | 20 | Evaluates efficacy of brass mesh bolus compared to the current standard of care in PMRT patients | Yes |
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Campbell, A.R.; Didier, A.J.; Sheikh, T.M.; Ansari, S.; Watkins, D.E.; Fahoury, A.M.; Nandwani, S.V.; Rashid, M. The Effects of Radiotherapy on the Sequence and Eligibility of Breast Reconstruction: Current Evidence and Controversy. Cancers 2024, 16, 2939. https://doi.org/10.3390/cancers16172939
Campbell AR, Didier AJ, Sheikh TM, Ansari S, Watkins DE, Fahoury AM, Nandwani SV, Rashid M. The Effects of Radiotherapy on the Sequence and Eligibility of Breast Reconstruction: Current Evidence and Controversy. Cancers. 2024; 16(17):2939. https://doi.org/10.3390/cancers16172939
Chicago/Turabian StyleCampbell, Andrew R., Alexander J. Didier, Taha M. Sheikh, Sami Ansari, Dean E. Watkins, Alan M. Fahoury, Swamroop V. Nandwani, and Mohammad Rashid. 2024. "The Effects of Radiotherapy on the Sequence and Eligibility of Breast Reconstruction: Current Evidence and Controversy" Cancers 16, no. 17: 2939. https://doi.org/10.3390/cancers16172939