Irish Journal of Medical Science (1971 -)

, Volume 188, Issue 1, pp 75–83 | Cite as

Neoadjuvant chemoradiation and breast reconstruction: the potential for improved outcomes in the treatment of breast cancer

  • Niamh O’ HalloranEmail author
  • Terri McVeigh
  • Joseph Martin
  • Maccon Keane
  • Aoife Lowery
  • Michael Kerin
Original Article



Immediate breast reconstruction (IBR) improves psychosocial and quality of life outcomes. Post-mastectomy radiation therapy is indicated for patients with a high risk of locoregional recurrence including locally advanced tumours (≥ 5 cm) or greater than or equal to four axillary nodes positive for breast cancer and can be a relative contraindication to IBR. Administration of radiation therapy pre-operatively, analogous to neoadjuvant chemotherapy, may reduce time to completion of treatment and facilitate better access to IBR.


This is a prospective pilot study in a tertiary referral breast cancer unit, comparing surgical, pathological response and oncological outcomes and time to completion of therapy for a prospective group of patients who received neoadjuvant radiotherapy with a cohort of age- and stage-matched patients requiring post-mastectomy (± reconstruction) radiation between 2010 and 2016.


Sixteen patients with locally advanced breast cancer underwent neoadjuvant radiation and were age- and stage-matched to 32 patients who received post-mastectomy radiation therapy (PMRT) between 2010 and 2016. Neoadjuvant radiotherapy resulted in shorter time between diagnosis and treatment completion (245.6 ± 44.2 days in the neoadjuvant group, 291.2 ± 36.7 days in the adjuvant group, p = 0.001). A higher proportion of patients undergoing neoadjuvant chemoradiation therapy underwent breast reconstruction (14/16 patients in the neoadjuvant group, 15/32 patients in the adjuvant group, p = 0.007) without an increase in complication rate (p = 0.117). There was a trend towards improved pathological complete response and survival in the neoadjuvant group.


This pilot study confirms that neoadjuvant chemoradiation is a feasible way of delivering breast cancer treatment and may facilitate improved access to IBR.


Breast cancer Breast reconstruction Mastectomy Neoadjuvant chemoradiation Neoadjuvant radiotherapy 



The authors would like to acknowledge Mr. Alan Hussey for his contribution of clinical images to this manuscript.


This research was funded by the Breast Cancer Research (CHY9997). This organisation had no role in the study design; in the collection, analysis and interpretation of the data; in the writing of the report; and in the decision to submit the article for publication.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical 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.


  1. 1.
    Tansley P, Ramsey K, Wong S, Guerrieri M, Pitcher M, Grinsell D (2013) New treatment sequence protocol to reconstruct locally advanced breast cancer. ANZ J Surg 83(9):630–635Google Scholar
  2. 2.
    Cortazar P, Zhang L, Untch M, Mehta K, Costantino JP, Wolmark N, Bonnefoi H, Cameron D, Gianni L, Valagussa P, Swain SM, Prowell T, Loibl S, Wickerham DL, Bogaerts J, Baselga J, Perou C, Blumenthal G, Blohmer J, Mamounas EP, Bergh J, Semiglazov V, Justice R, Eidtmann H, Paik S, Piccart M, Sridhara R, Fasching PA, Slaets L, Tang S, Gerber B, Geyer CE Jr, Pazdur R, Ditsch N, Rastogi P, Eiermann W, von Minckwitz G (2014) Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet 384(9938):164–172Google Scholar
  3. 3.
    von Minckwitz G, Blohmer JU, Costa SD, Denkert C, Eidtmann H, Eiermann W, Gerber B, Hanusch C, Hilfrich J, Huober J, Jackisch C, Kaufmann M, Kümmel S, Paepke S, Schneeweiss A, Untch M, Zahm DM, Mehta K, Loibl S (2013) Response-guided neoadjuvant chemotherapy for breast cancer. J Clin Oncol 31(29):3623–3630Google Scholar
  4. 4.
    E.B.C.T.C. Group (2005) Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 366(9503):2087–2106Google Scholar
  5. 5.
    E.B.C.T.C. Group (2011) Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10 801 women in 17 randomised trials. Lancet 378(9804):1707–1716Google Scholar
  6. 6.
    Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, Aguilar M, Marubini E (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 347(16):1227–1232Google Scholar
  7. 7.
    Wolmark N, Wang J, Mamounas E, Bryant J, Fisher B (2001) Preoperative chemotherapy in patients with operable breast cancer: nine-year results from National Surgical Adjuvant Breast and Bowel Project B-18. Monogr Natl Cancer Inst 2001(30):96–102Google Scholar
  8. 8.
    Monrigal E, Dauplat J, Gimbergues P, le Bouedec G, Peyronie M, Achard JL, Chollet P, Mouret-Reynier MA, Nabholtz JM, Pomel C (2011) Mastectomy with immediate breast reconstruction after neoadjuvant chemotherapy and radiation therapy. A new option for patients with operable invasive breast cancer. Results of a 20 years single institution study. Eur J Surg Oncol 37(10):864–870Google Scholar
  9. 9.
    Heneghan H et al (2011) Quality of life after immediate breast reconstruction and skin-sparing mastectomy—a comparison with patients undergoing breast conserving surgery. Eur J Surg Oncol 37(11):937–943Google Scholar
  10. 10.
    Harnett A et al (2009) Diagnosis and treatment of early breast cancer, including locally advanced disease—summary of NICE guidance. BMJ 338(7694):598–600Google Scholar
  11. 11.
    Walsh S et al (2014) Postmastectomy radiotherapy: indications and implications. Surgeon 12(6):310–315Google Scholar
  12. 12.
    McGale P et al (2014) Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. ElsevierGoogle Scholar
  13. 13.
    Coates AS, Winer EP, Goldhirsch A, Gelber RD, Gnant M, Piccart-Gebhart M, Thürlimann B, Senn HJ, Panel Members (2015) Tailoring therapies—improving the management of early breast cancer: St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2015. Ann Oncol 26(8):1533–1546Google Scholar
  14. 14.
    Huang Y et al A systematic review and network meta-analysis of neoadjuvant therapy combined with surgery for patients with resectable esophageal squamous cell carcinoma. Int J Surg 2016Google Scholar
  15. 15.
    Vandeweyer E, Deraemaecker R (2000) Radiation therapy after immediate breast reconstruction with implants. Plast Reconstr Surg 106(1):56–58 discussion 59-60Google Scholar
  16. 16.
    Whitfield GA, Horan G, Irwin MS, Malata CM, Wishart GC, Wilson CB (2009) Incidence of severe capsular contracture following implant-based immediate breast reconstruction with or without postoperative chest wall radiotherapy using 40 gray in 15 fractions. Radiother Oncol 90(1):141–147Google Scholar
  17. 17.
    Benediktsson K, Perbeck L (2006) Capsular contracture around saline-filled and textured subcutaneously-placed implants in irradiated and non-irradiated breast cancer patients: five years of monitoring of a prospective trial. J Plast Reconstr Aesthet Surg 59(1):27–34Google Scholar
  18. 18.
    Nahabedian MY, Tsangaris T, Momen B, Manson PN (2003) Infectious complications following breast reconstruction with expanders and implants. Plast Reconstr Surg 112(2):467–476Google Scholar
  19. 19.
    Cordeiro PG, McCarthy CM (2006) A single surgeon’s 12-year experience with tissue expander/implant breast reconstruction: part I. A prospective analysis of early complications. Plast Reconstr Surg 118(4):825–831Google Scholar
  20. 20.
    El-Sabawi B et al (2015) Breast reconstruction and adjuvant therapy: a systematic review of surgical outcomes. J Surg Oncol 112(5):458–464Google Scholar
  21. 21.
    Kronowitz SJ, Robb GL (2009) Radiation therapy and breast reconstruction: a critical review of the literature. Plast Reconstr Surg 124(2):395–408Google Scholar
  22. 22.
    Barry M, Kell M (2011) Radiotherapy and breast reconstruction: a meta-analysis. Breast Cancer Res Treat 127(1):15–22Google Scholar
  23. 23.
    Berbers J, van Baardwijk A, Houben R, Heuts E, Smidt M, Keymeulen K, Bessems M, Tuinder S, Boersma LJ (2014) ‘Reconstruction: before or after postmastectomy radiotherapy?’ A systematic review of the literature. Eur J Cancer 50(16):2752–2762Google Scholar
  24. 24.
    Recht A, Comen EA, Fine RE, Fleming GF, Hardenbergh PH, Ho AY, Hudis CA, Hwang ES, Kirshner JJ, Morrow M, Salerno KE, Sledge GW Jr, Solin LJ, Spears PA, Whelan TJ, Somerfield MR, Edge SB (2016) Postmastectomy radiotherapy: an American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology focused guideline update. Pract Radiat Oncol 6(6):e219–e234Google Scholar
  25. 25.
    Gebski V, Burmeister B, Smithers BM, Foo K, Zalcberg J, Simes J, Australasian Gastro-Intestinal Trials Group (2007) Survival benefits from neoadjuvant chemoradiotherapy or chemotherapy in oesophageal carcinoma: a meta-analysis. Lancet Oncol 8(3):226–234Google Scholar
  26. 26.
    Bosset J-F, Calais G, Mineur L, Maingon P, Stojanovic-Rundic S, Bensadoun RJ, Bardet E, Beny A, Ollier JC, Bolla M, Marchal D, van Laethem J, Klein V, Giralt J, Clavère P, Glanzmann C, Cellier P, Collette L, EORTC Radiation Oncology Group (2014) Fluorouracil-based adjuvant chemotherapy after preoperative chemoradiotherapy in rectal cancer: long-term results of the EORTC 22921 randomised study. Lancet Oncol 15(2):184–190Google Scholar
  27. 27.
    Wasserberg N (2014) Interval to surgery after neoadjuvant treatment for colorectal cancer. World J Gastroenterol: WJG 20(15):4256–4262Google Scholar
  28. 28.
    Foster JD, Jones EL, Falk S, Cooper EJ, Francis NK (2013) Timing of surgery after long-course neoadjuvant chemoradiotherapy for rectal cancer: a systematic review of the literature. Dis Colon Rectum 56(7):921–930Google Scholar
  29. 29.
    Zinzindohoué C, Bertrand P, Michel A, Monrigal E, Miramand B, Sterckers N, Faure C, Charitansky H, Gutowski M, Cohen M, Houvenaeghel G, Trentini F, Raro P, Daures JP, Lacombe S (2016) A prospective study on skin-sparing mastectomy for immediate breast reconstruction with latissimus dorsi flap after neoadjuvant chemotherapy and radiotherapy in invasive breast carcinoma. Ann Surg Oncol 23(7):2350–2356Google Scholar
  30. 30.
    Grinsell D et al (2017) Immediate autologous breast reconstruction after neoadjuvant chemoradiotherapy for breast cancer: initial results of the first 29 patients. ANZ J SurgGoogle Scholar
  31. 31.
    Pazos M, Corradini S, Dian D, von Bodungen V, Ditsch N, Wuerstlein R, Schönecker S, Harbeck N, Scheithauer H, Belka C (2017) Neoadjuvant radiotherapy followed by mastectomy and immediate breast reconstruction. Strahlenther Onkol 193(4):324–331Google Scholar
  32. 32.
    Whelan TJ, Julian J, Wright J, Jadad AR, Levine ML (2000) Does locoregional radiation therapy improve survival in breast cancer? A meta-analysis. J Clin Oncol 18(6):1220–1229Google Scholar
  33. 33.
    Giacalone PL, Rathat G, Daures JP, Benos P, Azria D, Rouleau C (2010) New concept for immediate breast reconstruction for invasive cancers: feasibility, oncological safety and esthetic outcome of post-neoadjuvant therapy immediate breast reconstruction versus delayed breast reconstruction: a prospective pilot study. Breast Cancer Res Treat 122(2):439–451Google Scholar
  34. 34.
    Aryus B, Audretsch W, Gogolin F, Gripp S, Königshausen T, Lammering G, Rohn R, Hartmann KA (2000) Remission rates following preoperative chemotherapy and radiation therapy in patients with breast cancer. Strahlenther Onkol 176(9):411–415Google Scholar
  35. 35.
    Van de Wiel M et al Neoadjuvant systemic therapy in breast cancer: challenges and uncertainties. Eur J Obstet Gynecol Reprod Biol 2016Google Scholar
  36. 36.
    Mauri D, Pavlidis N, Ioannidis JP (2005) Neoadjuvant versus adjuvant systemic treatment in breast cancer: a meta-analysis. J Natl Cancer Inst 97(3):188–194Google Scholar
  37. 37.
    Nahabedian MY, Momen B (2008) The impact of breast reconstruction on the oncologic efficacy of radiation therapy: a retrospective analysis. Ann Plast Surg 60(3):244–250Google Scholar
  38. 38.
    Boughey JC, McCall LM, Ballman KV, Mittendorf EA, Ahrendt GM, Wilke LG, Taback B, Leitch AM, Flippo-Morton T, Hunt KK (2014) Tumor biology correlates with rates of breast-conserving surgery and pathologic complete response after neoadjuvant chemotherapy for breast cancer: findings from the ACOSOG Z1071 (Alliance) Prospective Multicenter Clinical Trial. Ann Surg 260(4):608–616Google Scholar
  39. 39.
    von Minckwitz G, Untch M, Blohmer JU, Costa SD, Eidtmann H, Fasching PA, Gerber B, Eiermann W, Hilfrich J, Huober J, Jackisch C, Kaufmann M, Konecny GE, Denkert C, Nekljudova V, Mehta K, Loibl S (2012) Definition and impact of pathologic complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes. J Clin Oncol 30(15):1796–1804Google Scholar
  40. 40.
    Carey LA, Dees EC, Sawyer L, Gatti L, Moore DT, Collichio F, Ollila DW, Sartor CI, Graham ML, Perou CM (2007) The triple negative paradox: primary tumor chemosensitivity of breast cancer subtypes. Clin Cancer Res 13(8):2329–2334Google Scholar
  41. 41.
    Houssami N, Macaskill P, von Minckwitz G, Marinovich ML, Mamounas E (2012) Meta-analysis of the association of breast cancer subtype and pathologic complete response to neoadjuvant chemotherapy. Eur J Cancer 48(18):3342–3354Google Scholar
  42. 42.
    Roth SL, Audretsch W, Bojar H, Lang I, Willers R, Budach W (2010) Retrospective study of neoadjuvant versus adjuvant radiochemotherapy in locally advanced noninflammatory breast cancer. Strahlenther Onkol 186(6):299–306Google Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2018

Authors and Affiliations

  1. 1.Discipline of Surgery, Lambe InstituteNUI GalwayGalwayIreland
  2. 2.Department of Radiation OncologyGalway University HospitalGalwayIreland
  3. 3.Department of Medical OncologyGalway University HospitalGalwayIreland

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