The impact of immediate breast reconstruction on the technical delivery of postmastectomy radiotherapy

• DOI: 10.1016/j.ijrobp.2006.03.040
• Publication Date: 2006-06-11T09:58:40Z
• Authors: Sabin B. Motwani; Eric A. Strom; Naomi R. Schechter; Charles E. Butler; Gordon K. Lee; Howard N. Langstein; Steven J. Kronowitz; Funda Meric-Bernstam; Nuhad K. Ibrahim; Thomas A. Buchholz
• Keywords: Radiotherapy; Mammaplasty; Radiotherapy Planning, Computer-Assisted; Rectus Abdominis; Breast Neoplasms; Combined Modality Therapy; Surgical Flaps; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Case-Control Studies; Humans; Female; Mastectomy

To quantify the impact of immediate breast reconstruction on postmastectomy radiation therapy (PMRT) planning.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.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).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.