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

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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.

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Fig. 1

Abbreviations

IBR:

Immediate breast reconstruction

PMRT:

Post-mastectomy radiotherapy

IMNs:

Internal mammary lymph nodes

CTV:

Clinical target volume

RTOG:

Radiation Therapy Oncology Group

DVH:

Dose-volume histogram

PTV:

Planning target volume

ER:

Estrogen receptor

NCIC:

National Cancer Institute of Canada

EORTC:

European Organization for Research and Treatment of Cancer

DBCG:

Danish Breast Cancer Cooperative Group

NSABP:

National Surgical Adjuvant Breast and Bowel Project

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Author notes

    Authors and Affiliations

    1. Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA

      Krishan R. Jethwa, Mohamed M. Kahila, Thomas J. Whitaker, Kimberly S. Corbin, Sean S. Park, Elizabeth S. Yan & Robert W. Mutter

    2. Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA

      William S. Harmsen

    3. Department of Surgery, Mayo Clinic, Rochester, MN, USA

      Judy C. Boughey

    4. Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA

      Valerie Lemaine

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    1. Krishan R. Jethwa
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    Correspondence to Robert W. Mutter.

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    Krishan R. Jethwa and Mohamed M. Kahila have contributed equally to this work.

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    Jethwa, K.R., Kahila, M.M., Whitaker, T.J. et al. Immediate tissue expander or implant-based breast reconstruction does not compromise the oncologic delivery of post-mastectomy radiotherapy (PMRT). Breast Cancer Res Treat 164, 237–244 (2017). https://doi.org/10.1007/s10549-017-4241-5

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    • DOI: https://doi.org/10.1007/s10549-017-4241-5

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