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The impact of immediate breast reconstruction on the technical delivery of postmastectomy radiotherapy.
- Source :
-
International journal of radiation oncology, biology, physics [Int J Radiat Oncol Biol Phys] 2006 Sep 01; Vol. 66 (1), pp. 76-82. Date of Electronic Publication: 2006 Jun 09. - Publication Year :
- 2006
-
Abstract
- Purpose: To quantify the impact of immediate breast reconstruction on postmastectomy radiation therapy (PMRT) planning.<br />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 > or =2.0 point deductions.<br />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).<br />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.
- Subjects :
- Breast Neoplasms pathology
Case-Control Studies
Combined Modality Therapy
Female
Humans
Radiotherapy adverse effects
Rectus Abdominis radiation effects
Rectus Abdominis transplantation
Breast Neoplasms radiotherapy
Breast Neoplasms surgery
Mammaplasty adverse effects
Mastectomy rehabilitation
Radiotherapy Planning, Computer-Assisted
Surgical Flaps
Subjects
Details
- Language :
- English
- ISSN :
- 0360-3016
- Volume :
- 66
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- International journal of radiation oncology, biology, physics
- Publication Type :
- Academic Journal
- Accession number :
- 16765534
- Full Text :
- https://doi.org/10.1016/j.ijrobp.2006.03.040