Complications May Outweigh the Benefits

Abstract

Postmastectomy radiation therapy (PMRT) improves local control, disease-free survival, and overall survival, but it also increases the risk of reconstruction complications. PMRT recommendations for this patient 1 Francis D.M. Brower J.V. Post-mastectomy radiation after immediate reconstruction for multifocal early-stage breast cancer; to irradiate or not?. Int J Radiat Oncol Biol Phys. 2020; 108: 1129-1130 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar should assess the balance between the benefit and risk of complications, and here the risk of implant complication might outweigh the benefits from PMRT for the following reasons: 1.Lymphovascular invasion is a significant risk factor for local recurrence. This case is lymphovascular invasion negative. 2.Close/positive margins postmastectomy are not independent risk factors for local recurrence. 3.Her oncotype score of 24 places her as intermediate risk for recurrence and distant metastasis; this risk has been addressed by Taxotere Cyclophosphamide chemotherapy. 4.Several series have demonstrated that multifocality/multicentricity itself as a feature is not an independent risk factor for locoregional failure. Although the largest tumor focus was 1.9 cm (T1c), the different foci span across 7.5 cm. Assume this was a single focus of invasive cancer of 7.5 cm; data regarding T3N0 suggested that LRF rates are around 7%, 2 Taghian A.G. Jeong J.-H. Mamounas E.P. et al. Low locoregional recurrence rate among node-negative breast cancer patients with tumors 5 cm or larger treated by mastectomy, with or without adjuvant systemic therapy and without radiotherapy: Results from five national surgical adjuvant breast and bowel project randomized clinical trials. J Clin Oncol. 2006; 24: 3927-3932 Crossref PubMed Scopus (82) Google Scholar and therefore PMRT could be omitted. 5.Although N1 is a debatable indication for PMRT, patients with N0(i+) have shown no increase in locoregional failure compared with N0 (no isolated tumor cells). 3 Keruakous A.R. Sadek B.T. Shenouda M.N. et al. The impact of isolated tumor cells on loco-regional recurrence in breast cancer patients treated with breast-conserving treatment or mastectomy without post-mastectomy radiation therapy. Breast Cancer Res Treat. 2014; 146: 365-370 Crossref PubMed Scopus (7) Google Scholar 6.Recent data suggested that 5-year cumulative incidence of any reconstruction complications was 18.2% for single stage. For expander/implant, it is 36.8%. 4 Naoum G.E. Salama L. Niemierko A. et al. Single stage direct-to-implant breast reconstruction has lower complication rates than tissue expander and implant and comparable rates to autologous reconstruction in patients receiving postmastectomy radiation. Int J Radiat Oncol Biol Phys. 2020; 106: 514-524 Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar 7.Although young age could be considered a risk factor for LRF, it is not clear whether that alone should be a reason for PMRT. Post-Mastectomy Radiation After Immediate Reconstruction for Multifocal Early-Stage Breast Cancer; to Irradiate or Not?International Journal of Radiation Oncology, Biology, PhysicsVol. 108Issue 5PreviewA 36-year-old woman presented to her primary care physician after noting a palpable irregularity in her left breast. A diagnostic mammogram and ultrasound were performed, revealing an 8 × 4 cm area of segmental pleomorphic calcifications and scattered oval density masses in the 7 to 8 o’clock position, posterior depth of the left breast (Fig. 1). A magnetic resonance imaging scan of the breast characterized multiple heterogeneously enhancing irregular masses in the left breast, spanning 6.7 × 3.2 × 3.1 cm (Fig. 2). Full-Text PDF