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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 10/2019

01-10-2019 | Radiotherapy | Breast Oncology

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

Authors: Puneet Singh, MD, Karen Hoffman, MD, Mark V. Schaverien, MD, Kate J. Krause, MS, Charles Butler, MD, Benjamin D. Smith, MD, Henry M. Kuerer, MD, PhD, FACS

Published in: Annals of Surgical Oncology | Issue 10/2019

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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.
Appendix
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Metadata
Title
Neoadjuvant Radiotherapy to Facilitate Immediate Breast Reconstruction: A Systematic Review and Current Clinical Trials
Authors
Puneet Singh, MD
Karen Hoffman, MD
Mark V. Schaverien, MD
Kate J. Krause, MS
Charles Butler, MD
Benjamin D. Smith, MD
Henry M. Kuerer, MD, PhD, FACS
Publication date
01-10-2019
Publisher
Springer International Publishing
Keyword
Radiotherapy
Published in
Annals of Surgical Oncology / Issue 10/2019
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-07538-x

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