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Title: Immediate breast reconstruction with anatomical implants following mastectomy: The radiation perspective

Abstract

Immediate implant-based breast reconstruction followed by postmastectomy radiation therapy (PMRT) is controversial because of the risk of compromised treatment plans and concerns regarding cosmetic outcomes. We evaluated the effects of immediate direct-to-implant breast reconstruction with anatomical implants on the quality of PMRT delivered by 3-dimensional conformal radiotherapy (3D-CRT). In this retrospective, single-institution study, patients who had undergone reconstruction with direct anatomic implant, performed by a single surgeon, received 3D-CRT between 2008 and 2013. For each patient, 2 plans (including or excluding internal mammary nodes [IMN]) were created and calculated. The primary end point was the dose distribution among reconstructed breasts, heart, lungs, and IMNs, and between right and left breasts. Of 29 consecutive patients, 11 received right-sided and 18 received left-sided PMRT to a total dose of 50 Gy. For plans excluding IMN coverage, mean D{sub mean} for right and left reconstructed breasts was 49.09 Gy (98.2% of the prescribed dose) and 48.51 Gy (97.0%), respectively. For plans including IMNs, mean D{sub mean} was 49.15 Gy (98.3%) for right and 48.46 Gy (96.9%) for left reconstructed breasts; the mean IMN D{sub mean} was 47.27 Gy (right) and 47.89 Gy (left). Heart D{sub mean} was below 1.56 Gy for all plans.more » Mean total lung volume receiving a dose of ≥ 20 Gy was 13.80% to 19.47%. PMRT can be delivered effectively and safely by 3D-CRT after direct-to-implant breast reconstruction with anatomical implants, even if patients require IMN treatment.« less

Authors:
 [1];  [2];  [1];  [3];  [4]
  1. Radiation Oncology Unit, Chaim Sheba Medical Center, Ramat Gan (Israel)
  2. (Israel)
  3. Statistical Laboratory, School of Mathematics, Tel Aviv University, Tel Aviv (Israel)
  4. Department of Surgery, Assuta and Herzliya Medical Centers, Ramat Gan (Israel)
Publication Date:
OSTI Identifier:
22577875
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Dosimetry; Journal Volume: 41; Journal Issue: 2; Other Information: Copyright (c) 2016 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
61 RADIATION PROTECTION AND DOSIMETRY; 62 RADIOLOGY AND NUCLEAR MEDICINE; HEALTH HAZARDS; HEART; IMPLANTS; LUNGS; MAMMARY GLANDS; PATIENTS; RADIATION DOSE DISTRIBUTIONS; RADIATION DOSES; RADIOTHERAPY

Citation Formats

Ben-David, Merav, E-mail: Merav.ben-david@sheba.health.gov.il, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Granot, Hila, Gelernter, Ilana, and Scheflan, Michael. Immediate breast reconstruction with anatomical implants following mastectomy: The radiation perspective. United States: N. p., 2016. Web. doi:10.1016/J.MEDDOS.2015.11.002.
Ben-David, Merav, E-mail: Merav.ben-david@sheba.health.gov.il, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Granot, Hila, Gelernter, Ilana, & Scheflan, Michael. Immediate breast reconstruction with anatomical implants following mastectomy: The radiation perspective. United States. doi:10.1016/J.MEDDOS.2015.11.002.
Ben-David, Merav, E-mail: Merav.ben-david@sheba.health.gov.il, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Granot, Hila, Gelernter, Ilana, and Scheflan, Michael. Fri . "Immediate breast reconstruction with anatomical implants following mastectomy: The radiation perspective". United States. doi:10.1016/J.MEDDOS.2015.11.002.
@article{osti_22577875,
title = {Immediate breast reconstruction with anatomical implants following mastectomy: The radiation perspective},
author = {Ben-David, Merav, E-mail: Merav.ben-david@sheba.health.gov.il and Sackler School of Medicine, Tel Aviv University, Tel Aviv and Granot, Hila and Gelernter, Ilana and Scheflan, Michael},
abstractNote = {Immediate implant-based breast reconstruction followed by postmastectomy radiation therapy (PMRT) is controversial because of the risk of compromised treatment plans and concerns regarding cosmetic outcomes. We evaluated the effects of immediate direct-to-implant breast reconstruction with anatomical implants on the quality of PMRT delivered by 3-dimensional conformal radiotherapy (3D-CRT). In this retrospective, single-institution study, patients who had undergone reconstruction with direct anatomic implant, performed by a single surgeon, received 3D-CRT between 2008 and 2013. For each patient, 2 plans (including or excluding internal mammary nodes [IMN]) were created and calculated. The primary end point was the dose distribution among reconstructed breasts, heart, lungs, and IMNs, and between right and left breasts. Of 29 consecutive patients, 11 received right-sided and 18 received left-sided PMRT to a total dose of 50 Gy. For plans excluding IMN coverage, mean D{sub mean} for right and left reconstructed breasts was 49.09 Gy (98.2% of the prescribed dose) and 48.51 Gy (97.0%), respectively. For plans including IMNs, mean D{sub mean} was 49.15 Gy (98.3%) for right and 48.46 Gy (96.9%) for left reconstructed breasts; the mean IMN D{sub mean} was 47.27 Gy (right) and 47.89 Gy (left). Heart D{sub mean} was below 1.56 Gy for all plans. Mean total lung volume receiving a dose of ≥ 20 Gy was 13.80% to 19.47%. PMRT can be delivered effectively and safely by 3D-CRT after direct-to-implant breast reconstruction with anatomical implants, even if patients require IMN treatment.},
doi = {10.1016/J.MEDDOS.2015.11.002},
journal = {Medical Dosimetry},
number = 2,
volume = 41,
place = {United States},
year = {Fri Jul 01 00:00:00 EDT 2016},
month = {Fri Jul 01 00:00:00 EDT 2016}
}