Hypofractionated vs Conventional Fractionated Post-Mastectomy Radiotherapy After Immediate-Autologous Reconstruction: Acute Toxicity and Patient Satisfaction

Abstract

Immediate autologous reconstruction (IAR) is associated with less morbidity than implants in the setting of post-mastectomy radiotherapy (PMRT) in breast cancer patients (BCP). When PMRT is needed, conventional fractionated RT (CFRT) has been the standard schedule. However, the use of hypofractionated RT (HFRT) is increasing and is considered the standard of care nowadays. Our aim was to evaluate acute side-effects and patient’s satisfaction receiving PMRT after IAR, comparing CFRT vs HFRT. Between June 2015 and February 2020, 43 patients received either CF or HF PMRT after IAR in a tertiary hospital. IAR was performed with latissimus dorsi (LD) or deep inferior epigastric perforator (DIEP) flaps at the time of mastectomy. Prescribed radiotherapy dose was 50Gy over 25 fractions In the CF schedule and 40,05Gy over 15 fractions in the HF schedule. Target volume was the reconstructed chest-wall and axillary-supraclavicular nodes if indicated, and treatment technique was intensity-modulated radiotherapy. Acute toxicity was evaluated using CTCAE v.5.0 criteria, and patient’s global satisfaction was assessed using a self-evaluation questionnaire from 1-5 points. Chi square test was used for the statistical comparison. Median age was 48 years (28-77) and median follow-up was 19 months (6-56). 19 patients received HFRT and 24 CFRT. DIEP and LD flaps were performed in 20 (46%) and 23 (54%) patients respectively. Acute side effects after PMRT and tolerance until 6 months with HFRT schedule are shown in Table 1. No relationship was found between incidence of acute side effects and RT fractionation. Mean patient’s satisfaction was 3.8 in the CFRT schedule and 3.9 in the HFRT schedule. According to our findings, HFRT after IAR is comparable to CFRT in terms of acute toxicity and patient’s satisfaction.Abstract 2153; TableSix months side effects of Hypofractionated radiotherapy after mastectomy and immediate autologous reconstruction in 19 patientsAt the end of RTOne month after RTSix months after RTEventn (%)Eventn (%)Eventn (%)Dermatitis (grade 1-2)9 (47)Dermatitis (any grade)0 (0)Dermatitis (any grade)0 (0)Dermatitis (grade 3)0 (0)Flap induration (grade 1)0 (0)Hyperpigmentation (any grade)0 (0)Fatigue (grade 1-2)2 (10)Fatigue (any grade)3 (15)Lymphedema (grade 2)1 (5)Esophagitis (grade 1)2 (10)Dysphagia (any grade)0 (0)Breast induration (grade 1-2)9 (39)Dysphagia (grade 1-2)2 (9)Hyperpigmentation (grade 1-2)9 (47)Flap induration (grade 1)0 (0)Dysphagia (grade 3)0 (0)Fat necrosis (grade 1)2 (10)Fat necrosis (grade 3)2 (10)RT = Radiotherapy; All events are graded following Common Terminology Criteria for Adverse Events (CTCAE) v5.0 Open table in a new tab