Breast Cancer

SS 12 - Breast 1 - Toxicity

86 - Chest Wall Boost in Post-Mastectomy Radiation and the Impact on Reconstruction Complications

Monday, October 22
11:15 AM - 11:25 AM
Location: Room 214 C/D

Chest Wall Boost in Post-Mastectomy Radiation and the Impact on Reconstruction Complications
G. E. Naoum1, L. W. Salama2, A. Mina3, O. T. Oladeru4, H. E. Sayegh5, K. M. Daniell5, T. C. Gillespie5, M. L. Abouegylah3,6, C. L. Brunelle5, W. O. Arafat7,8, and A. G. Taghian9; 1Harvard Medical School, Radiation oncology department, Massachusetts general hospital, Boston, MA, 2Charles E Schmidit COM(FAU), Boca Raton, FL, 3Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, 4Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA, 5Massachusetts General Hospital- Department of Radiation Oncology, Boston, MA, 6Faculty of medicine,Alexandria University, Alexandria, Egypt, 7Alexandria comprehensive cancer center, Alexandria, alexandria, Egypt, 8University of Alexandria, Alexandria, Egypt, 9Harvard Medical School, Boston, MA

Purpose/Objective(s): Integration of post-mastectomy radiation therapy (PMRT) in the setting of breast reconstruction remains a topic under investigation. While many studies have evaluated the effect of PMRT on reconstruction outcomes, there is a lack of evidence about the effects of adding a chest wall boost (CWB) to patients who undergo reconstruction. The goal of this study is to evaluate whether CWB is an independent predictor for reconstruction complications and its efficacy in disease control in the setting of breast reconstruction.

Materials/Methods: We conducted a retrospective chart review of 730 breast cancer patients who underwent a total of 743 mastectomies, breast reconstructions and PMRT; all treated at a single academic institution from 1997-2017. Clinico-pathological factors were well balanced. Each mastectomy was analyzed individually. 321 breasts (43.2%) received PMRT with CWB, while 422 (56.7%) received PMRT without CWB. Various reconstruction techniques were included: autologous reconstruction (n=228/743; 30.6%), single-stage direct-to-implant reconstruction (n=196/743; 26.3%), two-stage tissue expander/implant (n=283/743; 38%) and other types of reconstruction (n=36/743; 4.8%). The primary outcome was development of reconstruction complications including skin necrosis, fat necrosis, infection, seroma/hematoma, capsular contracture, and implant failure. The secondary outcome was disease free survival (DFS). Generalized estimating equations were used in both univariate and multivariate analyses to determine the association between the primary outcomes and the potential clinical risk factors, such as CWB. Cumulative incidences were calculated to assess differential risk of secondary outcome.

Results: The median follow-up was 62 months for patients receiving PMRT & CWB compared to 75 months for control group receiving PMRT without CWB. CWB was not predictive of seroma/hematoma and fat necrosis. The rate of skin necrosis in PMRT & CWB was 8.4% vs 2.84% in non-CWB cohort (p=0.0003). 11.5% of CWB patients developed skin infection vs 2.84% in non-CWB (p=0.0004). On univariate analysis, CWB was significantly associated with implant failure and capsular contracture (OR= 1.75 p=0.0075 and OR=2.26 p=0.0059, respectively); whereas no significance was noted on multivariate analysis. The CWB was a significant predictor for skin necrosis and infection requiring surgical intervention (OR=2.26, p=0.0059; OR=2.4, p=0.0039;) on multivariate analysis. The five-year cumulative local-regional recurrence rate in patients with CWB and no CWB was 6.6% and 6.5%, respectively (p=0.4265). The five-year disease-free survival was 80.8% for CWB and 84.1% for non-CWB patients (p=0.6599).

Conclusion: Our findings suggest that omission of chest wall boost in post-mastectomy radiation improves breast reconstruction outcomes while preserving local tumor control. We highlighted the increased risk of morbidity which delays overall wound healing and impacts quality of life.

Author Disclosure: G.E. Naoum: None. L.W. Salama: None. A. Mina: None. O.T. Oladeru: None. T.C. Gillespie: None. M.L. Abouegylah: None. C.L. Brunelle: None. A.G. Taghian: Research Grant; Impedimed. Honoraria; UpToDate. Consultant; VisionRT.

George Naoum, MD

No relationships to disclose.


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86 - Chest Wall Boost in Post-Mastectomy Radiation and the Impact on Reconstruction Complications

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