Radiotherapy and breast reconstruction: A meta-analysis

Department of Breast Surgery, BreastCheck, Mater Misericordiae University Hospital, Dublin, Ireland.
Breast Cancer Research and Treatment (Impact Factor: 3.94). 02/2011; 127(1):15-22. DOI: 10.1007/s10549-011-1401-x
Source: PubMed


The optimum sequencing of breast reconstruction (BR) in patients receiving postmastectomy radiation therapy (PMRT) is controversial. A comprehensive search of published studies that examined postoperative morbidity following immediate or delayed BR with combined radiotherapy was performed. Medical (MEDLINE & EMBASE) databases were searched and cross-referenced for appropriate studies where morbidity following BR was the primary outcome measured. A total of 1,105 patients were identified from 11 appropriately selected studies. Patients undergoing PMRT and BR are more likely to suffer morbidity compared with patients not receiving PMRT (OR = 4.2; 95% CI, 2.4-7.2 [no PMRT vs. PMRT]). Reconstruction technique was also examined with outcome when PMRT was delivered after BR, and this demonstrated that autologous reconstruction is associated with less morbidity in this setting (OR = 0.21; 95% CI, 0.1-0.4 [autologous vs. implant-based]). Delaying BR until after PMRT had no significant effect on outcome (OR = 0.87; 95% CI, 0.47-1.62 [delayed vs. immediate]). PMRT has a detrimental effect on BR outcome. These results suggest that where immediate reconstruction is undertaken with the necessity of PMRT, an autologous flap results in less morbidity when compared with implant-based reconstruction.

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Available from: Mitchel Barry, Oct 10, 2015
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    • "In our study, in patients with invasive cancer, radiotherapy significantly reduced the odds of having reconstruction, however confounding factors may be present, including cancer stage and type of reconstruction. In most patients with a history of radiotherapy, autologous reconstruction is required because the complication rate with implant-based reconstruction is greater than 40% (Barry & Kell 2011; Kronowitz & Robb 2009). The advantages and disadvantages of the different techniques enter into the patient's final decision as concerns delayed reconstruction (Alderman et al. 2002; Cordeiro & McCarty 2006; Rouzier et al. 2000). "
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    ABSTRACT: Background The aims of the study were to investigate the factors associated with not having breast reconstruction following mastectomy and to assess patient satisfaction with information on reconstruction. Patients and methods We analysed a historical cohort of 1937 consecutive patients who underwent mastectomy at Institut Curie between January 2004 and February 2007. Their sociodemographic and clinicobiological characteristics were recorded in a prospective database. A questionnaire was sent to 10% of nonreconstructed patients. Results The proportion of patients with invasive cancer was 82.7%. The rate of nonreconstruction in patients with in situ and invasive cancer was 34.6% and 74.9%, respectively. On multivariate analysis, only employment outside the home was associated with reconstruction in patients with in situ cancer (p < 0.001). In patients with invasive cancer, employment status (p < 0.001) and smoking (p = 0.045) were associated with reconstruction, while age > 50, ASA score >1, radiotherapy (p < 0.0001) and metastatic status (p = 0.018) were associated with nonreconstruction. For 80% of questionnaire responders, nonreconstruction was a personal choice, mainly for the following reasons: refusal of further surgery, acceptance of body asymmetry, risk of complications and advanced age. Information on reconstruction was entirely unsatisfactory or inadequate for 62% of patients. Conclusion Better understanding the factors that influence decision of nonreconstruction can help us adapt the information to serve the patient’s personal needs.
    SpringerPlus 07/2013; 2(1). DOI:10.1186/2193-1801-2-325
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    ABSTRACT: Background and purpose Radiotherapy (RT) of reconstructed breasts was associated with major complications and poor cosmetic outcome. The present study assessed complication rates, the link between risk factors and prosthesis removal, as well as cosmetic outcomes. Patients and methods From 1997 to 2009, 101 consecutive patients received RT after breast reconstruction because of risk factors for relapse (92) or because relapse had occurred (9). At RT, 90 patients had temporary tissue expanders and 11 had permanent implants. Twelve patients underwent neo-adjuvant chemotherapy; all patients received adjuvant chemo- and/or hormone therapy. Results At a median follow-up of 50 months, late toxicities occurred in 28 patients: pain in 7, lymphedema in 6, G1 cutaneous toxicity in 5, and subcutaneous toxicity in 19 (2G1, 9G2, 7G3, 1G4), with more than one side effect in 12. In 8 patients the prosthesis ruptured (3), was displaced (3), was displaced and ruptured (1), or lost shape (1). Capsular contracture was classified in 89 patients as IA in 14, IB in 47, II in 10, III in 11, and IV in 7. Twelve prostheses (11.9%) were removed. The only significant factor for prosthesis removal was age (p = 0.007). Judgments of cosmetic results were available from 81 physicians and 84 patients. Outcome was excellent/good in 58/81 physician judgments and in 57/84 patient evaluations. Overall inter-rater agreement on outcome was good (κ-value 0.64; 95% CI: 0.48–0.79). Conclusion RT to reconstructed breasts was associated with low rates of late toxicity and prosthesis removal. Cosmetic outcomes were, on the whole, good to excellent.
    Strahlentherapie und Onkologie 12/2012; 188(12). DOI:10.1007/s00066-012-0231-z · 2.91 Impact Factor
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    ABSTRACT: The practical implementation of a bit serial lossless discrete integrator (LDI)[1] recursive ladder filter suitable for implementation as a single integrated circuit is described. The low coefficient sensitivity and simplicity of the LDI signal flowgraph make the filter structure suitable for implementing high quality digital filters. A bit serial integrated circuit filter has been designed and simulated using the silicon compiler system FIRST[2,3]. The LDI filter coefficients which yield a Chebyscheff transfer function characteristic are found using an exact synthesis method[4]. The finite precision time domain response of the filter is simulated using the FIRST simulator and the magnitude response is verified by calculating the fourier transform of the filter unit sample response. The LDI filter implementation makes use of an alternate clocking scheme which simplifies the signal flow graph. This is a form of multiplexing which is easily implemented using bit serial arithmetic.
    Acoustics, Speech, and Signal Processing, IEEE International Conference on ICASSP '84.; 04/1984
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