Safety of Radiation Therapy Following Mastectomy with Immediate Reconstruction for Breast Cancer
*Lauren A. Gamble, *Julia Kelly, *Lesley Jarvis, Kari Rosenkranz, Christina Angeles
Dartmouth-Hitchcock Medical Center, Lebanon, NH
Objective: Assess safety of post mastectomy radiation therapy (PMRT) following mastectomy with breast reconstruction.
Design: Chart review of patients treated with mastectomy and immediate breast reconstruction (IBR) between 2000-2006.
Setting: Individual academic center in New England.
Patients: 603 patients underwent mastectomy, 273 underwent IBR, mean age at diagnosis was 47 years (range 25-75), 100% women.
Interventions: 273 of 603 patients (45.3%) underwent IBR. 62 of the 273 who underwent IBR (22.7%) received PMRT.
Main Outcome Measures: Complications following IBR and PMRT including seroma, infection, fat necrosis, and contracture were documented. Median follow-up was 6.3 years.
Results: Two thirds (59.7%) of the IBR patients received transverse rectus abdominis (TRAM) flaps, 20.9% latissmus dorsi (LD), 16.5% expander/implant prosthesis alone, and 2.9% other flaps. The majority of those undergoing IBR did not receive PMRT (211, 77.3%); 98 (46.5%) suffered a surgical complication and 54 (25.6%) classified as Clavien-Dindo grade IIIb (CD IIIb). Comparatively, less than a quarter of patients undergoing IBR (n=62, 22.7%) underwent PMRT; 36 (58.1%) complications occurred, 14 (22.6%) classified as CD IIIb, and half of these (n=7) followed radiation therapy. Using chi-square analysis, there was no statistically significant difference in overall complication rate or CD IIIb complications between those who received PMRT and those who did not (p=0.1076 and p=0.6298 respectively). In both groups, the complication rate was highest in those who received TRAM flaps - 56 (57.1%) in the non-PMRT group and 23 (63.9%) in the PMRT group.
Conclusions: Conflicting evidence exists regarding the safety of PMRT following breast reconstruction. Our data shows no statistically significant difference in complication rate in IBR patients with or without PMRT.
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