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Is radiotherapy feasible before breast reconstruction?
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Is radiotherapy feasible before breast reconstruction? PRADA results announced.
Lancet Oncolony 丨 Primary radiotherapy and deep inferior epigastric perforator flap reconstruction (PRADA) in breast cancer patients: a multicenter, prospective, nonrandomized, feasibility study
Background: Pre-mastectomy radiotherapy and autologous free flap breast reconstruction can avoid adverse radiation effects on healthy donor tissue and delay adjuvant radiotherapy.
However, there is little evidence for this sequence of treatment. We aimed to investigate the feasibility of preoperative radiotherapy followed by skin-sparing mastectomy and deep inferior epigastric perforator (DIEP) flap reconstruction in breast cancer patients requiring mastectomy.
METHODS: We conducted a prospective, nonrandomized feasibility study at two National Health Service Trusts in the United Kingdom. Eligible patients were women older than 18 years with laboratory-diagnosed primary breast cancer requiring mastectomy and post-mastectomy radiotherapy who were candidates for DIEP flap reconstruction.
Preoperative radiotherapy was started 3-4 weeks after neoadjuvant chemotherapy and irradiated the breast in 15 fractions of 40 Gy (over 3 weeks) or 42.72 Gy in 16 fractions (over 3.2 weeks) as needed, plus regional lymph nodes as needed.
Adverse cutaneous radiation toxicity was assessed preoperatively using the Radiation Therapy Oncology Group Toxicity Grading System.
Skin-sparing mastectomy and DIEP flap reconstruction were planned 2-6 weeks after completion of preoperative radiotherapy.
The primary endpoint was the proportion of open breast wounds greater than 1 cm in width that required bandaging at 4 weeks postoperatively as assessed in all participants.
This study is registered with ClinicalTrials.gov, NCT02771938, and recruitment has stopped.
- Between January 25, 2016, and December 11, 2017, a total of 33 patients were enrolled.
- Four out of 33 patients (12.1%, 95% CI: 3.4–28.2) had an open breast wound greater than 1 cm at 4 weeks postoperatively. Confluent wet desquamation (grade 3) was present in 1 (3%) patient.
- There were no treatment-related serious adverse events and no treatment-related deaths.
Skin-sparing mastectomy and immediate DIEP flap reconstruction after preoperative radiotherapy is feasible and technically safe, with rates of open breast wounds similar to those reported for post-mastectomy radiotherapy.
A randomized trial comparing preoperative radiotherapy with postmastectomy radiotherapy is needed to precisely determine and compare surgical, oncological, and breast reconstruction outcomes, including quality of life.
(source:internet, reference only)
Important Note: The information provided is for informational purposes only and should not be considered as medical advice.