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Redefining postmastectomy radiation contouring in the era of immediate breast reconstruction: An accurate assessment of local recurrence risk

INTRODUCTION: Most studies report post-mastectomy local recurrences as chest wall recurrences without clarifying whether the recurrence is in the subcutaneous tissue, muscle or underlying rib. Post-mastectomy chest wall radiation is recommended in patients at increased risk of locoregional recurrenc...

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Autores principales: Lao, Nicholas, Brackstone, Muriel, Formenti, Silvia C., Doherty, Christopher, Perera, Francisco, Chow, Ronald, DeLyzer, Tanya, Grant, Aaron, Boldt, Gabriel, Lock, Michael
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8170417/
https://www.ncbi.nlm.nih.gov/pubmed/34113723
http://dx.doi.org/10.1016/j.ctro.2021.05.002
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author Lao, Nicholas
Brackstone, Muriel
Formenti, Silvia C.
Doherty, Christopher
Perera, Francisco
Chow, Ronald
DeLyzer, Tanya
Grant, Aaron
Boldt, Gabriel
Lock, Michael
author_facet Lao, Nicholas
Brackstone, Muriel
Formenti, Silvia C.
Doherty, Christopher
Perera, Francisco
Chow, Ronald
DeLyzer, Tanya
Grant, Aaron
Boldt, Gabriel
Lock, Michael
author_sort Lao, Nicholas
collection PubMed
description INTRODUCTION: Most studies report post-mastectomy local recurrences as chest wall recurrences without clarifying whether the recurrence is in the subcutaneous tissue, muscle or underlying rib. Post-mastectomy chest wall radiation is recommended in patients at increased risk of locoregional recurrence. Chest wall radiation-related fibrosis has become an important clinical consideration in the era of immediate implant-based breast reconstruction. In patients with commonly performed subpectoral implant-based reconstruction, the pectoralis major becomes relocated anterior to the implant and just deep to skin, therefore raising the question of value in radiating deep chest wall structures. This study assessed the rate of recurrence in each anatomical region of chest wall in post-mastectomy patients. METHODS: A comprehensive breast cancer database of 4287 patients at a single regional cancer center from 2006 to 2018 was retrospectively analyzed to identify 1571 mastectomy patients. Recurrences were classified as local skin/subcutaneous, pectoralis muscle (pectoralis major), deep chest wall (pectoralis minor, intercostal muscle or rib) or regional axillary recurrence. RESULTS: A total of 26 patients with locoregional recurrence were identified. Most recurrences were in the skin/subcutaneous level. Of 1571 mastectomy patients, only one patient developed a local recurrence posterior to pectoralis major. Our literature search and meta-analysis revealed that local recurrences post-mastectomy are much more likely to be in subcutaneous tissues/pectoralis major versus deeper chest wall. CONCLUSION: A reduced clinical target volume which encompasses skin/subcutaneous and pectoralis muscle layers without treating deep chest wall may be more appropriate to reduce radiation-associated toxicity since avoiding circumferential radiation of an implant may prevent capsular contracture without compromising treatment benefit.
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spelling pubmed-81704172021-06-09 Redefining postmastectomy radiation contouring in the era of immediate breast reconstruction: An accurate assessment of local recurrence risk Lao, Nicholas Brackstone, Muriel Formenti, Silvia C. Doherty, Christopher Perera, Francisco Chow, Ronald DeLyzer, Tanya Grant, Aaron Boldt, Gabriel Lock, Michael Clin Transl Radiat Oncol Article INTRODUCTION: Most studies report post-mastectomy local recurrences as chest wall recurrences without clarifying whether the recurrence is in the subcutaneous tissue, muscle or underlying rib. Post-mastectomy chest wall radiation is recommended in patients at increased risk of locoregional recurrence. Chest wall radiation-related fibrosis has become an important clinical consideration in the era of immediate implant-based breast reconstruction. In patients with commonly performed subpectoral implant-based reconstruction, the pectoralis major becomes relocated anterior to the implant and just deep to skin, therefore raising the question of value in radiating deep chest wall structures. This study assessed the rate of recurrence in each anatomical region of chest wall in post-mastectomy patients. METHODS: A comprehensive breast cancer database of 4287 patients at a single regional cancer center from 2006 to 2018 was retrospectively analyzed to identify 1571 mastectomy patients. Recurrences were classified as local skin/subcutaneous, pectoralis muscle (pectoralis major), deep chest wall (pectoralis minor, intercostal muscle or rib) or regional axillary recurrence. RESULTS: A total of 26 patients with locoregional recurrence were identified. Most recurrences were in the skin/subcutaneous level. Of 1571 mastectomy patients, only one patient developed a local recurrence posterior to pectoralis major. Our literature search and meta-analysis revealed that local recurrences post-mastectomy are much more likely to be in subcutaneous tissues/pectoralis major versus deeper chest wall. CONCLUSION: A reduced clinical target volume which encompasses skin/subcutaneous and pectoralis muscle layers without treating deep chest wall may be more appropriate to reduce radiation-associated toxicity since avoiding circumferential radiation of an implant may prevent capsular contracture without compromising treatment benefit. Elsevier 2021-05-06 /pmc/articles/PMC8170417/ /pubmed/34113723 http://dx.doi.org/10.1016/j.ctro.2021.05.002 Text en © 2021 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Article
Lao, Nicholas
Brackstone, Muriel
Formenti, Silvia C.
Doherty, Christopher
Perera, Francisco
Chow, Ronald
DeLyzer, Tanya
Grant, Aaron
Boldt, Gabriel
Lock, Michael
Redefining postmastectomy radiation contouring in the era of immediate breast reconstruction: An accurate assessment of local recurrence risk
title Redefining postmastectomy radiation contouring in the era of immediate breast reconstruction: An accurate assessment of local recurrence risk
title_full Redefining postmastectomy radiation contouring in the era of immediate breast reconstruction: An accurate assessment of local recurrence risk
title_fullStr Redefining postmastectomy radiation contouring in the era of immediate breast reconstruction: An accurate assessment of local recurrence risk
title_full_unstemmed Redefining postmastectomy radiation contouring in the era of immediate breast reconstruction: An accurate assessment of local recurrence risk
title_short Redefining postmastectomy radiation contouring in the era of immediate breast reconstruction: An accurate assessment of local recurrence risk
title_sort redefining postmastectomy radiation contouring in the era of immediate breast reconstruction: an accurate assessment of local recurrence risk
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8170417/
https://www.ncbi.nlm.nih.gov/pubmed/34113723
http://dx.doi.org/10.1016/j.ctro.2021.05.002
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