Pre-operative radiotherapy for breast cancer patients receiving mastectomy and immediate autologous tissue reconstruction.

INTRODUCTION

Radiotherapy (RT) is typically administered as adjuvant therapy for breast cancer patients with high risk of locoregional recurrence. However, for patients receiving mastectomy and autologous tissue immediate breast reconstruction (IBR), RT to the neobreast is associated with higher complication rates and poorer esthetics. Administering preoperative RT before mastectomy and autologous tissue reconstruction may be an alternative therapeutic sequence to improve patient outcomes.

METHODS

Patients with invasive breast carcinoma treated with therapeutic-dose RT before receiving mastectomy and autologous tissue IBR (pedicled transverse rectus abdominis myocutaneous flap or latissimus dorsi flap) were identified from a single high-volume breast clinic in Hong Kong. Propensity score matching was done to select an equal number of patients who received RT after mastectomy and autologous tissue IBR. Clinical records of each patient were then retrospectively reviewed.

RESULTS

50 patients (25 in the preoperative RT arm, and 25 in the postoperative RT arm) were included in this study. Minor complications occurred in similar frequencies between patients who received preoperative RT and postoperative RT. However, pigmentation occurred significantly more frequently in patients who received post-autologous reconstruction RT. There were no instances of flap failure in either arm. Rates of disease recurrence (p = 0.48) and death (p = 0.30) between the two arms were not significantly different.

CONCLUSIONS

Preoperative RT before mastectomy and autologous tissue IBR is safe and feasible, and has the potential to reduce RT-related complications on autologous flaps without compromising oncological safety in a select group of patients.