The impact of immediate breast reconstruction on the technical delivery of postmastectomy radiotherapy

Journal Article · Fri Sep 01 04:00:00 EDT 2006 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2006.03.040· OSTI ID:20850055

Motwani, Sabin B ^[1]; Strom, Eric A ^[1]; Schechter, Naomi R ^[2]; Butler, Charles E ^[3]; Lee, Gordon K ^[4]; Langstein, Howard N ^[3]; Kronowitz, Steven J ^[3]; Meric-Bernstam, Funda ^[5]; Ibrahim, Nuhad K ^[6]; Buchholz, Thomas A ^[1]

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1. Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States)
2. Department of Radiation Oncology, University of California-San Francisco, San Francisco, CA (United States)
3. Department of Plastic Surgery, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States)
4. Department of Plastic Surgery, Scott and White Memorial Hospital, Temple, TX (United States)
5. Department of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States)
6. Department of Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States)

Purpose: To quantify the impact of immediate breast reconstruction on postmastectomy radiation therapy (PMRT) planning. Methods: A total of 110 patients (112 treatment plans) who had mastectomy with immediate reconstruction followed by radiotherapy were compared with contemporaneous stage-matched patients who had undergone mastectomy without intervening reconstruction. A scoring system was used to assess optimal radiotherapy planning using four parameters: breadth of chest wall coverage, treatment of the ipsilateral internal mammary chain, minimization of lung, and avoidance of heart. An 'optimal' plan achieved all objectives or a minor 0.5 point deduction; 'moderately' compromised treatment plans had 1.0 or 1.5 point deductions; and 'major' compromised plans had {>=}2.0 point deductions. Results: Of the 112 PMRT plans scored after reconstruction, 52% had compromises compared with 7% of matched controls (p < 0.0001). Of the compromised plans after reconstruction, 33% were considered to be moderately compromised plans and 19% were major compromised treatment plans. Optimal chest wall coverage, treatment of the ipsilateral internal mammary chain, lung minimization, and heart avoidance was achieved in 79%, 45%, 84%, and 84% of the plans in the group undergoing immediate reconstruction, compared respectively with 100%, 93%, 97%, and 92% of the plans in the control group (p < 0.0001, p < 0.0001, p = 0.0015, and p = 0.1435). In patients with reconstructions, 67% of the 'major' compromised radiotherapy plans were left-sided (p < 0.16). Conclusions: Radiation treatment planning after immediate breast reconstruction was compromised in more than half of the patients (52%), with the largest compromises observed in those with left-sided cancers. For patients with locally advanced breast cancer, the potential for compromised PMRT planning should be considered when deciding between immediate and delayed reconstruction.

• OSTI ID: 20850055
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 1 Vol. 66; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
CARCINOMAS
CHEST
HEART
LUNGS
MAMMARY GLANDS
MINIMIZATION
PATIENTS
PLANNING
RADIOTHERAPY