<< Back to the abstract archive
Adjuvant Radiation Therapy Techniques Following Mastectomy and Breast Reconstruction
Zoe MacIsaac, MD
James Cray, PhD
Sameer Shakir, BS
Mark Greyson, BS
Sushil Beriwal, MD
Vu T Nguyen, MD
University of Pittsburgh
2012-01-31
Presenter: Zoe MacIsaac
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. Please make a statement as to how much of the above work represents the original work of the resident.
Director Name: Joseph Losee, MD
Author Category: Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
How does this presentation meet the established conference educational objectives?
Despite the prevalence of breast reconstruction and increasing number of women receiving radiation therapy after mastectomy, there remains a lack of consensus regarding the implications of radiotherapeutic approach on reconstructive outcome. Outcomes, especially cosmetic, are difficult to measure, rendering comparison of radiation and surgical technique difficult. Here, we will introduce an alternative method in measuring potential associations of radiation technique with breast reconstructive outcome. Moreover, we will update on the current reconstructive preferences of Plastic and Reconstructive Surgeons, such as preferred action when radiation therapy is required after tissue expander placement.
How will your presentation be used by practicing physicians in the audience?
The audience will review current practices and preferred surgical and radiotherapeutic technique in breast reconstruction after mastectomy, and understand radiotherapeutic techniques found to be associated with negative outcome in our survey, as well as the need for further studies to optimize practices in breast reconstructive surgery.
Background:
Radiation therapy has a known deleterious influence on breast reconstruction. It is widely accepted that the results of irradiated breast reconstructions are, overall, cosmetically inferior, with more frequent complications. Whether specific aspects of radiation therapy result in less favorable results, however, remains controversial. The aim of this study was to survey Plastic and Reconstructive Surgeons and Radiation Oncologists for association of radiation technique with breast reconstructive outcome.
Methods:
A web-based survey was developed by breast specialists practicing in Plastic and Reconstructive Surgery and Radiation Oncology. Electronic solicitations were sent to invite physicians to participate in the survey over three weeks, and responses were accepted for 10 weeks. Statistical analysis included Mann-Whitney and Kendall Tau tests (p<0.05.)
Results:
Of 170 Radiation Oncologists and 196 Plastic Surgeons, responses were obtained for 29/51 mutual institutions (56.9%). Correlation of radiotherapy practices with reported outcomes revealed several associations with negative outcome: irradiated autologous reconstruction and internal mammary lymph node treatment (p=0.038), irradiated autologous reconstruction and higher boost dose (p=0.036), irradiated prosthetic reconstruction and higher chest wall dose (p=0.012).
Conclusions:
Treatment of breast cancer with mastectomy and subsequent reconstruction of the breast involves a delicate balance between tissue preservation and tumor eradication, demanding the coordinated efforts of multiple care teams. Here, we found several treatment variables associated with negative outcomes. Our results highlight the importance of a multicenter study to better develop a consensus on breast reconstructive practices.
