Article

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: 4.47). 02/2011; 127(1):15-22. DOI: 10.1007/s10549-011-1401-x
Source: PubMed

ABSTRACT 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.

0 Bookmarks
 · 
120 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Radiation dermatitis is a frequent sequela of adjuvant radiation therapy for breast cancer. Clinical manifestations include prominent telangiectasias that may be physically disfiguring and psychologically distressing for the patient. The objective of this study was to review cases of breast cancer patients with radiation-induced breast telangiectasias treated with the pulsed dye laser and assess clinical efficacy. The patient's perception of treatment was also reviewed. A retrospective chart review of patients treated for radiation-induced telangiectasias was conducted at the Dermatology Division of Memorial Sloan-Kettering Cancer Center. Pre- and post-clinical photos were used to assess clearance by two independent raters. Patient's comments were assessed from visit notes and the treating physicians for the impact of treatment on the patient's overall well-being. All patients (n=11) experienced clinical improvement in the radiation-induced telangiectasias. The mean number of treatments was 4.3 (2-9) with an average fluence of 4.2J/cm(2) (585nm platform) and 7.8J/cm(2) (595nm) (4-8 J/cm(2)) used. The mean percent clearance was 72.7 percent (50-90%). Adverse effects were not encountered including those with breast implants or flap reconstruction. Patients reported an improvement in their well-being, including an improved sense of confidence. LIMITATIONS include the small sample size, nonstandardized digital images, and nonsystematic collection of patient-reported outcomes. The pulsed dye laser is an efficacious treatment for radiation-induced breast telangiectasias. Multiple treatments are required for greater than 50-percent clearance and conservative treatment parameters are advised. Patients also reported an improved quality of life.
    Journal of Clinical and Aesthetic Dermatology 12/2014; 7(12):34-7.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Since complications of postmastectomy breast reconstruction may reduce patient satisfaction, we investigated complications of reconstruction with tissue expanders (TEs), particularly surgical site infections requiring TE/permanent implant (PI) removal. A retrospective review was performed of 234 primary breast cancer patients undergoing 239 postmastectomy breast reconstructions with TEs/PIs from 1997 to 2009. Clinicopathological findings and postoperative complications, particularly infections, were analyzed. Data were analyzed by the Chi-square test and a multivariate logistic regression model. TE infection risk factors considered for model inclusion were excisional biopsy, (neo) adjuvant chemotherapy, lymph node resection, body mass index (BMI), simultaneous bilateral reconstructions, and seroma aspiration. Removal of TEs/PIs was observed in 15.5 % (37/239) of reconstructions, and 18/37 underwent re-reconstructions. Of the 19/37 reconstructions that were not achieved completely, the most frequent reason was TE infection (11 reconstructions). The completion rate was 92 % (220/239 reconstructions) and it was significantly higher in reconstructions without TE infection than with infection (96 vs. 54 %, p < 0.0001). Patients with BMI ≥ 25 kg/m(2) and seroma aspiration were more likely to develop TE infections (p = 0.0019, p < 0.001, respectively). By multivariate logistic regression analysis, seroma aspiration was a significant independent risk factor for TE infection (odds ratio 28.75, 95 % confidence interval 5.71-40.03, p < 0.0001). To improve completion rates of breast reconstruction, prevention of TE infection plays a key role. We should reduce unnecessary seroma aspirations and delay elevation/exercise of the ipsilateral arm.
    Breast Cancer 12/2014; · 1.51 Impact Factor
  • EMC - Tecniche Chirurgiche - Chirurgia Generale. 11/2014;

Full-text (2 Sources)

Download
63 Downloads
Available from
May 27, 2014