Immediate tissue expander or implant-based breast reconstruction does not compromise the oncologic delivery of post-mastectomy radiotherapy (PMRT)

Krishan R. Jethwa, Mohamed M. Kahila, Thomas J. Whitaker, William S. Harmsen, Kimberly S. Corbin, Sean S Park, Elizabeth S. Yan, Valerie Lemaine, Judy C Boughey, Robert Mutter

Research output: Contribution to journalArticle

11 Scopus citations

Abstract

Purpose: Increasingly, women are choosing immediate breast reconstruction (IBR) following mastectomy. Reports have indicated IBR may compromise post-mastectomy radiotherapy (PMRT). We investigated the impact of IBR on timing of PMRT, target coverage, and doses to organs at risk in a modern radiotherapy practice using advanced planning techniques. Methods: Between 2013 and 2015, PMRT was delivered to 116 patients (66 mastectomy alone, 50 IBR). PMRT was delivered with a median dose of 50 Gy in 25 fractions. Left-sided patients were treated in breath-hold under image guidance. Differences in dosimetric parameters and time to the initiation of PMRT were assessed between patients with and without reconstruction. Results: Reconstructed patients were younger and had lower clinical stage disease. Reconstruction did not significantly increase the mean time to PMRT initiation (51 days reconstructed vs. 45 days non-reconstructed, p = 0.14) or the number of patients who initiated PMRT within 12 weeks of the last therapeutic intervention (48/50 [96.0] vs. 61/66 [92.4%], p = 0.41). There was no significant difference in the percentage of patients in whom the internal mammary lymph nodes (IMNs) were targeted (72 vs. 80%, p = 0.29) or in IMN target coverage (mean IMN V40.5 Gy 92.6 vs. 94.1%, p = 0.62). Reconstruction did not significantly affect the mean ipsilateral lung V20 (25.4 vs. 26.4%, p = 0.37) or the mean heart dose (2.2 vs. 2.1 Gy, p = 0.63). Conclusions: In a specialized breast multidisciplinary practice, immediate breast reconstruction did not significantly delay PMRT, compromise target coverage, or increase dose to organs at risk.

Original languageEnglish (US)
Pages (from-to)237-244
Number of pages8
JournalBreast Cancer Research and Treatment
Volume164
Issue number1
DOIs
StatePublished - Jul 1 2017

    Fingerprint

Keywords

  • Breast
  • Cancer
  • Dosimetry
  • PMRT
  • Radiotherapy
  • Reconstruction

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this