Mastectomy With Immediate Expander-Implant Reconstruction, Adjuvant Chemotherapy, and Radiation for Stage II-III Breast Cancer: Treatment Intervals and Clinical Outcomes

Journal Article · Tue Jan 01 04:00:00 EST 2008 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2007.05.032· OSTI ID:21039698

Wright, Jean L ^[1]; Cordeiro, Peter G ^[2]; Ben-Porat, Leah ^[3]; Van Zee, Kimberly J ^[4]; Hudis, Clifford ^[5]; Beal, Kathryn ^[1]; McCormick, Beryl ^[1]

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1. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)
2. Department of Surgery, Plastic and Reconstructive Service, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)
3. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)
4. Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)
5. Department of Medicine, Solid Tumor Division, Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)

Purpose: To determine intervals between surgery and adjuvant chemotherapy and radiation in patients treated with mastectomy with immediate expander-implant reconstruction, and to evaluate locoregional and distant control and overall survival in these patients. Methods and Materials: Between May 1996 and March 2004, 104 patients with Stage II-III breast cancer were routinely treated at our institution under the following algorithm: (1) definitive mastectomy with axillary lymph node dissection and immediate tissue expander placement, (2) tissue expansion during chemotherapy, (3) exchange of tissue expander for permanent implant, (4) radiation. Patient, disease, and treatment characteristics and clinical outcomes were retrospectively evaluated. Results: Median age was 45 years. Twenty-six percent of patients were Stage II and 74% Stage III. All received adjuvant chemotherapy. Estrogen receptor staining was positive in 77%, and 78% received hormone therapy. Radiation was delivered to the chest wall with daily 0.5-cm bolus and to the supraclavicular fossa. Median dose was 5040 cGy. Median interval from surgery to chemotherapy was 5 weeks, from completion of chemotherapy to exchange 4 weeks, and from exchange to radiation 4 weeks. Median interval from completion of chemotherapy to start of radiation was 8 weeks. Median follow-up was 64 months from date of mastectomy. The 5-year rate for locoregional disease control was 100%, for distant metastasis-free survival 90%, and for overall survival 96%. Conclusions: Mastectomy with immediate expander-implant reconstruction, adjuvant chemotherapy, and radiation results in a median interval of 8 weeks from completion of chemotherapy to initiation of radiation and seems to be associated with acceptable 5-year locoregional control, distant metastasis-free survival, and overall survival.

• OSTI ID: 21039698
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 1 Vol. 70; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
ALGORITHMS
CARCINOMAS
CHEMOTHERAPY
CHEST
ESTROGENS
IMPLANTS
LYMPH NODES
MAMMARY GLANDS
METASTASES
PATIENTS
RADIATION DOSES
RECEPTORS
SURGERY