Use of Postmastectomy Radiation in Patients Treated for Invasive Breast Cancer with Mastectomy and Immediate Reconstruction.

Use of Postmastectomy Radiation in Patients Treated for Invasive Breast Cancer with Mastectomy and Immediate Reconstruction. Am Surg. 2019 Nov 01;85(11):1299-1303 Authors: Hayek G, Winslow M, Maier M, Corsetti R, Rivere A, Mackey A, Tanaka S, Fuhrman G Abstract Immediate reconstruction after mastectomy helps women manage the psychological impact of deforming surgery. Postmastectomy radiation therapy (PMRT) can negatively impact the aesthetic result after breast reconstruction. We performed this study to achieve a better understanding of how PMRT is used after reconstruction in our institution. We conducted a retrospective review of a prospectively maintained database of all women who underwent mastectomy for invasive breast cancer followed by immediate reconstruction from 2006 to 2017. Patients were divided into two groups depending on whether PMRT was included in their treatment, and we compared clinical and pathologic characteristics to determine which factors were likely to lead to PMRT. A total of 315 women treated with mastectomy and immediate reconstruction were identified. A total of 96 were treated with PMRT; 219 had mastectomy and immediate reconstruction without radiotherapy. Tumor characteristics, tumor stage, demographics, and comorbidities did not predict the use of PMRT. Neoadjuvant chemotherapy (NAC) was the most powerful predictor for using PMRT. In 47 of 81 (58%) patients treated with NAC, PMRT was used. Whereas 49 of 234 (21%) patients ...
Source: The American Surgeon - Category: Surgery Authors: Tags: Am Surg Source Type: research

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Among breast-cancer patients presenting with cN1 disease, nodal pathologic complete response (ypN0) after neoadjuvant chemotherapy (NACT) was associated with decreased likelihood of post-mastectomy and post-lumpectomy nodal radiation (NRT). There was no survival benefit associated with nodal (vs no) radiation in ypN0 patients post-mastectomy, but benefit approached significance among ypN1 patients. NRT was associated with improved survival for ypN0 and ypN1 patients post-lumpectomy but this benefit was not significantly greater than that conferred by breast-only radiation.
Source: International Journal of Radiation Oncology * Biology * Physics - Category: Radiology Authors: Source Type: research
Conclusions: Postoperative complications delay the commencement of radiation therapy in patients who received neoadjuvant chemotherapy and undergo mastectomy with immediate breast reconstruction. The period from the last dose of neoadjuvant chemotherapy was equivalent between those that experienced postoperative complications and those that did not. Patients with a higher body mass index are more likely to experience postoperative complications, and this should be considered when offering tissue expanders to obese patients who have received neoadjuvant chemotherapy and require adjuvant radiation treatment. CLINICAL QUES...
Source: Plastic and Reconstructive Surgery - Category: Cosmetic Surgery Tags: Breast: Original Articles Source Type: research
Background: Complications from breast reconstruction may delay postmastectomy radiation therapy and impact breast cancer outcomes. The authors hypothesized that immediate breast reconstruction may be associated with delays in the initiation of radiation, but that this delay would not significantly impact overall patient survival. Methods: Using the National Cancer Database, the authors identified women with breast cancer who underwent mastectomy and received postmastectomy radiation therapy. Delayed radiation was defined as treatment initiated 6 months or more after surgery in patients who received adjuvant chemothera...
Source: Plastic and Reconstructive Surgery - Category: Cosmetic Surgery Tags: Breast: Original Articles Source Type: research
Conclusion: In patients who achieve ypN0 following NAC and mastectomy, PMRT shows no additional survival benefits for any molecular subtype. PMID: 31281730 [PubMed]
Source: Journal of Breast Cancer - Category: Cancer & Oncology Tags: J Breast Cancer Source Type: research
ConclusionThe preferred treatment is always aggressive surgical removal and, as our atypical clinical case suggests, neoadjuvant chemotherapy in very high doses is also needed. A biopsy of any suspicious breast skin lesion after radiotherapy is recommended. Despite the treatment challenges, our case provides enlightening details on the management of such a rare cancer even when faced with unplanned events which do not always allow for a textbook approach.
Source: International Journal of Surgery Case Reports - Category: Surgery Source Type: research
Conclusions: This study is the first to demonstrate a dose-response relationship between risk of complications and near Dmax, where hypofractionated regimen or boost RT can play an important role. Rigorous RT-quality assurance program and modification of dose constraints could be considered as a critically important component for ongoing trials of hypofractionation. Based on our findings, we initiated a multi-center retrospective study (KROG 18-04) and a prospective study (NCT03523078) to validate our findings. Introduction Breast reconstruction provides important psychosocial, cosmetic, and quality of life benefits ...
Source: Frontiers in Oncology - Category: Cancer & Oncology Source Type: research
ConclusionLipofilling is a very useful tool that could help in cases of an uninfected exposed implant. It could also be used primarily as an adjunct procedure to implant based reconstruction to optimize the outcome.
Source: International Journal of Surgery Case Reports - Category: Surgery Source Type: research
ConclusionsAfter NAC, most patients received irradiation of the breast/chest wall and axillary and supraclavicular nodes. In this setting, PORT to breast/chest wall with or without regional nodal irradiation was safe and effective, with acceptable disease-free and overall survival rates reported in this high-risk population.
Source: Reports of Practical Oncology and Radiotherapy - Category: Cancer & Oncology Source Type: research
In conclusion, sufficient evidence is now available to suggest that breast conservation after neoadjuvant chemotherapy is safe and effective for selected patients. Though neoadjuvant chemotherapy may increase the complexity of breast conservative treatment, a close collaboration between a multidisciplinary team and use of oncoplastic surgical techiques permit to optimize oncological and cosmetis outcomes. PMID: 30352955 [PubMed - in process]
Source: Annali Italiani di Chirurgia - Category: Surgery Tags: Ann Ital Chir Source Type: research
This patient presents with stage IV, cT4dN3cM1 oligometastatic inflammatory breast cancer (IBC) (1). The initial treatment would be neoadjuvant chemotherapy (NAC). In the absence of progression with NAC, we would recommend mastectomy with axillary lymph node dissection and postmastectomy radiation therapy (PMRT). Given IBC's penchant for locoregional recurrence and progression to carcinoma en cuirasse, an aggressive approach to PMRT is warranted, despite the presence of initial limited metastatic disease.
Source: International Journal of Radiation Oncology * Biology * Physics - Category: Radiology Authors: Tags: Gray Zone Source Type: research
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