Cargando…

Postmastectomy Radiation Therapy (PMRT) before and after 2-Stage Expander-Implant Breast Reconstruction: A Systematic Review

Background: In those undergoing treatment for breast cancer, evidence has demonstrated a significant improvement in survival, and a reduction in the risk of local recurrence in patients who undergo postmastectomy radiation therapy (PMRT). There is uncertainty about the optimal timing of PMRT, whethe...

Descripción completa

Detalles Bibliográficos
Autores principales: Oliver, Jeremie D., Boczar, Daniel, Huayllani, Maria T., Restrepo, David J., Sisti, Andrea, Manrique, Oscar J., Broer, Peter Niclas, McLaughlin, Sarah, Rinker, Brian D., Forte, Antonio Jorge
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6630203/
https://www.ncbi.nlm.nih.gov/pubmed/31146506
http://dx.doi.org/10.3390/medicina55060226
_version_ 1783435246425866240
author Oliver, Jeremie D.
Boczar, Daniel
Huayllani, Maria T.
Restrepo, David J.
Sisti, Andrea
Manrique, Oscar J.
Broer, Peter Niclas
McLaughlin, Sarah
Rinker, Brian D.
Forte, Antonio Jorge
author_facet Oliver, Jeremie D.
Boczar, Daniel
Huayllani, Maria T.
Restrepo, David J.
Sisti, Andrea
Manrique, Oscar J.
Broer, Peter Niclas
McLaughlin, Sarah
Rinker, Brian D.
Forte, Antonio Jorge
author_sort Oliver, Jeremie D.
collection PubMed
description Background: In those undergoing treatment for breast cancer, evidence has demonstrated a significant improvement in survival, and a reduction in the risk of local recurrence in patients who undergo postmastectomy radiation therapy (PMRT). There is uncertainty about the optimal timing of PMRT, whether it should be before or after tissue expander or permanent implant placement. This study aimed to summarize the data reported in the literature on the effect of the timing of PMRT, both preceding and following 2-stage expander-implant breast reconstruction (IBR), and to statistically analyze the impact of timing on infection rates and the need for explantation. Methods: A comprehensive systematic review of the literature was conducted using the PubMed/Medline, Ovid, and Cochrane databases without timeframe limitations. Articles included in the analysis were those reporting outcomes data of PMRT in IBR published from 2009 to 2017. Chi-square statistical analysis was performed to compare infection and explantation rates between the two subgroups at p < 0.05. Results: A total of 11 studies met the inclusion criteria for this study. These studies reported outcomes data for 1565 total 2-stage expander-IBR procedures, where PMRT was used (1145 before, and 420 after, implant placement). There was a statistically significant higher likelihood of infection following pre-implant placement PMRT (21.03%, p = 0.000079), compared to PMRT after implant placement (9.69%). There was no difference in the rate of explantation between pre-implant placement PMRT (12.93%) and postimplant placement PMRT (11.43%). Conclusion: This study suggests that patients receiving PMRT before implant placement in 2-stage expander–implant based reconstruction may have a higher risk of developing an infection.
format Online
Article
Text
id pubmed-6630203
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-66302032019-08-19 Postmastectomy Radiation Therapy (PMRT) before and after 2-Stage Expander-Implant Breast Reconstruction: A Systematic Review Oliver, Jeremie D. Boczar, Daniel Huayllani, Maria T. Restrepo, David J. Sisti, Andrea Manrique, Oscar J. Broer, Peter Niclas McLaughlin, Sarah Rinker, Brian D. Forte, Antonio Jorge Medicina (Kaunas) Review Background: In those undergoing treatment for breast cancer, evidence has demonstrated a significant improvement in survival, and a reduction in the risk of local recurrence in patients who undergo postmastectomy radiation therapy (PMRT). There is uncertainty about the optimal timing of PMRT, whether it should be before or after tissue expander or permanent implant placement. This study aimed to summarize the data reported in the literature on the effect of the timing of PMRT, both preceding and following 2-stage expander-implant breast reconstruction (IBR), and to statistically analyze the impact of timing on infection rates and the need for explantation. Methods: A comprehensive systematic review of the literature was conducted using the PubMed/Medline, Ovid, and Cochrane databases without timeframe limitations. Articles included in the analysis were those reporting outcomes data of PMRT in IBR published from 2009 to 2017. Chi-square statistical analysis was performed to compare infection and explantation rates between the two subgroups at p < 0.05. Results: A total of 11 studies met the inclusion criteria for this study. These studies reported outcomes data for 1565 total 2-stage expander-IBR procedures, where PMRT was used (1145 before, and 420 after, implant placement). There was a statistically significant higher likelihood of infection following pre-implant placement PMRT (21.03%, p = 0.000079), compared to PMRT after implant placement (9.69%). There was no difference in the rate of explantation between pre-implant placement PMRT (12.93%) and postimplant placement PMRT (11.43%). Conclusion: This study suggests that patients receiving PMRT before implant placement in 2-stage expander–implant based reconstruction may have a higher risk of developing an infection. MDPI 2019-05-29 /pmc/articles/PMC6630203/ /pubmed/31146506 http://dx.doi.org/10.3390/medicina55060226 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Oliver, Jeremie D.
Boczar, Daniel
Huayllani, Maria T.
Restrepo, David J.
Sisti, Andrea
Manrique, Oscar J.
Broer, Peter Niclas
McLaughlin, Sarah
Rinker, Brian D.
Forte, Antonio Jorge
Postmastectomy Radiation Therapy (PMRT) before and after 2-Stage Expander-Implant Breast Reconstruction: A Systematic Review
title Postmastectomy Radiation Therapy (PMRT) before and after 2-Stage Expander-Implant Breast Reconstruction: A Systematic Review
title_full Postmastectomy Radiation Therapy (PMRT) before and after 2-Stage Expander-Implant Breast Reconstruction: A Systematic Review
title_fullStr Postmastectomy Radiation Therapy (PMRT) before and after 2-Stage Expander-Implant Breast Reconstruction: A Systematic Review
title_full_unstemmed Postmastectomy Radiation Therapy (PMRT) before and after 2-Stage Expander-Implant Breast Reconstruction: A Systematic Review
title_short Postmastectomy Radiation Therapy (PMRT) before and after 2-Stage Expander-Implant Breast Reconstruction: A Systematic Review
title_sort postmastectomy radiation therapy (pmrt) before and after 2-stage expander-implant breast reconstruction: a systematic review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6630203/
https://www.ncbi.nlm.nih.gov/pubmed/31146506
http://dx.doi.org/10.3390/medicina55060226
work_keys_str_mv AT oliverjeremied postmastectomyradiationtherapypmrtbeforeandafter2stageexpanderimplantbreastreconstructionasystematicreview
AT boczardaniel postmastectomyradiationtherapypmrtbeforeandafter2stageexpanderimplantbreastreconstructionasystematicreview
AT huayllanimariat postmastectomyradiationtherapypmrtbeforeandafter2stageexpanderimplantbreastreconstructionasystematicreview
AT restrepodavidj postmastectomyradiationtherapypmrtbeforeandafter2stageexpanderimplantbreastreconstructionasystematicreview
AT sistiandrea postmastectomyradiationtherapypmrtbeforeandafter2stageexpanderimplantbreastreconstructionasystematicreview
AT manriqueoscarj postmastectomyradiationtherapypmrtbeforeandafter2stageexpanderimplantbreastreconstructionasystematicreview
AT broerpeterniclas postmastectomyradiationtherapypmrtbeforeandafter2stageexpanderimplantbreastreconstructionasystematicreview
AT mclaughlinsarah postmastectomyradiationtherapypmrtbeforeandafter2stageexpanderimplantbreastreconstructionasystematicreview
AT rinkerbriand postmastectomyradiationtherapypmrtbeforeandafter2stageexpanderimplantbreastreconstructionasystematicreview
AT forteantoniojorge postmastectomyradiationtherapypmrtbeforeandafter2stageexpanderimplantbreastreconstructionasystematicreview