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Radiation Therapy Safe Before or After Breast Reconstruction: Presented at ASTRO

By Charlene Laino

SALT LAKE CITY, UT -- October 31, 2003 -- Contrary to what is commonly believed, radiation therapy can be performed safely before or after breast reconstruction surgery, a new study suggests.

Following mastectomy, "a lot of institutions want to do radiation therapy first, and some may recommend against reconstruction altogether," said Penny R. Anderson, MD, a radiation oncologist at Fox Chase Cancer Center in Philadelphia, Pennsylvania, United States.

Prior studies have shown a high rate of complications among breast cancer patients who undergo post-reconstruction radiation therapy, she said. "Anecdotally, we weren't seeing that at our institution, and that observation became the impetus for this study."

"We found a very, very low complication rate in women who received radiation treatment before breast reconstruction," she reported here on October 22^nd at the 45^th Annual Meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO). "And the cosmetic results were great."

The study enrolled 85 breast cancer patients who underwent mastectomy, breast reconstruction and post-operative radiation therapy between 1987 and 2002. Fifty of the women had tissue expander placement with or without a subsequent implant, and 35 patients had an autologous transverse rectus abdominis myocutaneous (TRAM) flap.

Seventy of the patients received radiation therapy a median of 7 months after reconstruction, while 15 patients received radiation therapy a median of 13 months before their reconstruction.

The dose of radiation to the reconstructed breast/chest wall was 50 to 50.4 Gy, and four patients received a scar boost. All patients also received a bolus; 44 patients received a custom wax bolus fashioned to the shape of the reconstruction to eliminate air gaps, and 41 patients received a standard bolus.

Kaplan-Meier methodology and the log-rank test showed that by 5 years later, none of the women who had the TRAM procedure had major complications, defined as requiring corrective surgery or loss of reconstruction, compared with 5% of the women in the tissue expander placement-implant arm (p=0.21).

"We had to remove the implants in two of the women for reasons such as infection, but they could undergo the procedure again if they wanted," Dr. Anderson said.

Minor complications, such as infection or scarring, occurred in 39% of TRAM patients and 14% of those in the tissue expander placement group (p=0.04).

The timing of reconstruction and radiation therapy had no significant impact on complication rates, she said.

On a scale of excellent/good or fair/poor, 100% of the TRAM patients with complications had statistically significant superior cosmetic scores of excellent/good, compared with only 17% of the tissue expander placement patients (p=0.003).

Nine percent of patients who received the custom fashioned bolus suffered complications, compared with 24% of patients who received the standard bolus (p=0.05).


[Study title: Low Complication Rates Are Achievable After Post-Mastectomy Breast Reconstruction and Radiation Therapy. Abstract 189]

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