Radiotherapy linked to complications after mastectomy with reconstruction
MedWire News: Nearly half of women who have radiation therapy following a mastectomy with immediate breast reconstruction (IBR) suffer complications that require further surgery, study findings indicate.
Rates of mastectomy, IBR, and postmastectomy radiotherapy (PMRT) are increasing among women with low-stage breast cancer, note Rodney Pommier (Oregon Health and Science University, Portland, USA) and colleagues.
To identify factors independently associated with postmastectomy surgical complications, Pommier and team reviewed data from 302 patients with stage I to III breast cancer.
In total, 152 (50%) patients underwent breast reconstruction, with IBR performed in 131 patients. There were 100 patients who required PMRT.
The researchers report that significantly more patients who underwent IBR and PMRT needed a further operation due to complications than those who received PMRT but did not undergo reconstruction (44% vs 7%).
Multivariate analyses revealed that PMRT was associated with a 3.3-fold increased risk for unplanned reoperation compared with no PMRT, while IBR was associated with an 8-fold increased risk compared with no IBR.
Patients are typically advised to undergo delayed reconstruction if they are likely to require PMRT, the authors note.
Despite this, seven (18%) of 39 patients, who were considered at low enough risk for PMRT to undergo IBR with tissue, required PMRT once final pathology results were available, say Pommier and team.
"Conversely, some women are unnecessarily directed away from IBR because of an overestimation of their risk for PMRT. In this series, 12 (55%) of 22 patients who underwent delayed reconstruction did not undergo PMRT," they say.
The researchers found that knowledge of axillary lymph node (LN) status could improve the prediction of PMRT.
Only 3% of patients with T2 or smaller tumors and no positive LNs required PMRT, compared with 49% of patients with at least one positive LN.
In multivariate analyses, positive axillary LN status increased the risk for PMRT 15.5-fold, while each positive sentinel LN increased the risk 2.1-fold.
"Therefore, while the data gained from a positive sentinel LN biopsy specimen do not yield a final answer as to whether indications for PMRT will be met, it does quantify a significant risk for PMRT that should be considered during surgical decision making," conclude Pommier et al in the Archives of Surgery.
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By Laura Dean