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Annals of Surgical Oncology

, Volume 26, Issue 10, pp 3312–3320 | Cite as

Neoadjuvant Radiotherapy to Facilitate Immediate Breast Reconstruction: A Systematic Review and Current Clinical Trials

  • Puneet Singh
  • Karen Hoffman
  • Mark V. Schaverien
  • Kate J. Krause
  • Charles Butler
  • Benjamin D. Smith
  • Henry M. KuererEmail author
Breast Oncology

Abstract

Background

Postmastectomy radiotherapy currently is used for locally advanced breast cancers that carry a high risk of locoregional failure. However, radiotherapy can have deleterious effects on immediate breast reconstruction (IBR). Neoadjuvant radiotherapy (NART) to facilitate postmastectomy IBR is an emerging new therapeutic sequence. A systematic review was undertaken to evaluate the current evidence on the feasibility and safety of this sequence.

Methods

A comprehensive search of MEDLINE, EMBASE, Cochrane Library, Web of Science, and ClinicalTrials.gov from inception to 2018 was conducted, resulting in 592 records. The review included 18 retrospective and prospective studies of NART and IBR.

Results

The majority of the studies used whole-breast radiotherapy with 50 Gy, conventionally fractionated, and waited 6–8 weeks before surgery. The IBR methods were varied, with both implant and autologous reconstructions. No intraoperative complications occurred, and the postoperative complication rates ranged from 3 to 36%. The partial and total flap loss rates were very low. Studies reporting cosmetic outcomes rated the majority of cases as good or excellent. The pathologic complete response rates ranged from 17 to 55%, and the locoregional recurrence rates were low (≤ 10%), with a short follow-up period. The current MD Anderson Cancer Center prospective clinical trial is described.

Conclusions

The initial results of NART and IBR demonstrate the safety of this treatment both technically and oncologically. Longer follow-up evaluation of these studies and larger prospective controlled clinical trials are needed to establish this new therapeutic sequence as a standard of care.

Notes

Acknowledgment

This work was supported by the PH and Fay Etta Robinson Distinguished Professorship in Cancer Research (H.M.K.) and a Cancer Center Support grant from the National Institutes of Health (NIH) (CA16672).

Disclosure

Dr. Benjamin D. Smith has received previous grant funding from Varian Medical Systems and has current licensing/royalties from Oncora Medical. The remainder of the authors have no conflicts of interest to disclose.

Supplementary material

10434_2019_7538_MOESM1_ESM.docx (12 kb)
Supplementary material 1 (DOCX 11 kb)
10434_2019_7538_MOESM2_ESM.doc (64 kb)
Supplementary material 2 (DOC 64 kb)

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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Puneet Singh
    • 1
  • Karen Hoffman
    • 2
  • Mark V. Schaverien
    • 3
  • Kate J. Krause
    • 4
  • Charles Butler
    • 3
  • Benjamin D. Smith
    • 2
  • Henry M. Kuerer
    • 1
    Email author
  1. 1.Department of Breast Surgical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  3. 3.Department of Plastic SurgeryThe University of Texas MD Anderson Cancer CenterHoustonUSA
  4. 4.Research Medical LibraryThe University of Texas MD Anderson Cancer CenterHoustonUSA

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