Elsevier

Radiotherapy and Oncology

Volume 163, October 2021, Pages 105-113
Radiotherapy and Oncology

Original Article
Implant risk failure in patients undergoing postmastectomy 3-week hypofractionated radiotherapy after immediate reconstruction

https://doi.org/10.1016/j.radonc.2021.08.006Get rights and content

Highlights

  • •

    A growing number of patients is being treated with postmastectomy radiotherapy.

  • •

    The number of patients with implant-based breast reconstruction is increasing.

  • •

    The optimal timing and sequence of reconstruction and radiotherapy is unanswered.

  • •

    Hypofractionation has been gaining ground in implant-based breast reconstruction radiotherapy.

Abstract

Aim

To evaluate reconstruction failure (RF) rate in patients receiving implant-based immediate breast reconstruction (IBR) and hypofractionated (HF) postmastectomy radiation therapy (PMRT).

Materials and methods

Stage II–III breast cancer patients, treated with HF-PMRT using intensity modulated radiotherapy were stratified in two groups according to IBR: single-stage direct-to-implant (DTI-group) and two-stage expander and implant (TE/I-group). Irradiated patients were matched with non-irradiated ones who underwent the same IBR during the same period. Prescription dose was 40.05 Gy/15 fractions to chest wall and infra/supraclavicular nodal region.

Primary endpoint was RF defined as the need of major revisional surgery (MaRS) for implant removal or conversion to autologous reconstruction. Secondary endpoint was the rate of minor revisional surgeries (MiRS) including implant repositioning or substitution with another implant.

Results

One hundred and seven irradiated patients (62 in TE/I-group, 45 in DTI-group) were matched with 107 non-irradiated subjects. Median follow-up was 4.2 years (0.1–6.1)

In the TE/I setting, MaRS was performed in 8/62 irradiated patients (12.9%) of the irradiated TE/I group compared to 1/62 (1.6%) non-irradiated subjects (p = 0.015). In the DTI setting, MaRs occurred in 3/45 irradiated patients (6.7%) compared to 1/45 non-irradiated ones (2.2%) (p = 0.35). Overall MaRS rate was 10.3% in the irradiated group.

MiRS was performed in 35.6% and 31.1% of the irradiated and non-irradiated DTI-groups (p = 0.65), respectively, and in 12.9% and 8.1% of the irradiated and non-irradiated TE/I groups (p = 0.38), respectively.

Conclusions

Compared to the non-irradiated counterparts, the TE/I group showed higher rate of RF, while no statistically significant difference was observed for the DTI group. The use of hypofractionation and IMRT to implant-based IBR did not seem to increase the risk of RF which appeared to be in line with the literature

Section snippets

Materials and methods

This investigation is a part of the research project on IMRT and hypofractionation on breast cancer notified to the Ethical Committee of the European Institute of Oncology (IEO) (26 May 2016, Milan, Italy) and approved by the review board. This is a retrospective study, whose data are collected in a dedicated RT databank (RTP R039-000-Tomotherapy-breast) and continually updated. All the patients gave written informed consent for treatment and for use of their anonymized data for educational and

Results

Over the study period, 124 consecutive patients received hypofractionated PMRT after implant-based IBR. Among them, 10 were excluded (prior thoracic RT, local relapse), leaving 114 available for the analysis: 69 patients in the irradiated TE/I-group and 45 patients in the irradiated DTI-group. All patients completed PMRT (baseline characteristics are summarized in Table 1S). The two groups of irradiated patients (both DTI and TE/I) were well balanced with no significant differences, except the

Discussion

The study focused on the reconstructive outcome of patients with implant-based IBR who received PMRT compared to non-irradiated matched controls.

Although it is well known that autologous reconstruction is associated with better outcomes than implants in the RT setting [24], [25], [26], the rapid expansion of the use of skin and nipple-sparing mastectomies has resulted in a growing number of breast cancer patients with implant-based IBR, fueling the debate over the timing and sequence of PMRT

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgements

This work was partially supported by the Italian Ministry of Health with Ricerca Corrente and 5x1000 funds.

The author Damaris Patricia Rojas, M.D., was supported in part by research grants from the Fondazione IEO-CCM and Fondazione Veronesi.

Mattia Zaffaroni had research grant from Accuray Inc. (Data collection and analysis of Tomotherapy and CyberKnife breast clinical studies, breast physics studies and prostate study).The funders had no role in study design, data collection and analysis,

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Availability of data and material

The authors confirm that the data supporting the findings of this study are available within the article.

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