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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    • "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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