Medical Radiology and Radiation Safety. 2023. Vol. 68. № 3
DOI: 10.33266/1024-6177-2023-68-3-39-45
E. Rasskazova1, A. Zikiryakhodzhaev1, 2, 3, E. Khmelevsky1
Radiation Therapy for Breast Cancer pT1–3N0–1M0 after Mastectomy or Subcutaneous/Skin-Preserving Mastectomy with Reconstruction. Literature Review
1P.A. Hertsen Moscow Oncology Research Institute – Branch of the National Medical Research Radiological Centre, Moscow, Russia
2I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
3Peoples’ Friendship University of Russia, (RUDN University), Moscow, Russia
Contact person: E. Rasskazova, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
ABSTRACT
Purpose: The literature review analyzes publications over the past decades on the need for radiation therapy after mastectomy or subcutaneous/skin-preserving mastectomy with reconstruction.
Results: Risk factors for breast cancer recurrence were analyzed. The effect of radiation therapy on the recurrence of breast cancer after mastectomy, subcutaneous and skin-preserving mastectomy with reconstruction was evaluated depending on the stage, lymph node lesions, and the presence of unfavorable molecular biological types. Indications for radiation therapy are described. The effect of radiation therapy on early and late complications of the reconstructed breast and options for reducing the percentage of complications were analyzed.
Conclusion: The exclusion of radiation therapy from the breast cancer treatment plan is a decrease in the percentage of complications caused by radiation therapy, for example, during implant reconstruction – a decrease in capsular contractures. And, as a result, improving the quality of life of patients, reducing repeated operations in case of complications, which means it is economically profitable. In recent years, due to the increasing need for various breast reconstruction options, the surgeon and radiotherapist have faced the task of choosing the optimal sequence of breast reconstruction, as well as reducing the risk of post-radiation complications. Radiation therapy, along with reducing the risk of relapse of the disease, increases the risk of complications after breast reconstruction, and vice versa, the reconstructed mammary gland can cause difficulties for the radiologist to correctly deliver the required dose of radiation. Minimizing the frequency and severity of complications after radiation therapy on the reconstructed gland without compromising oncological or cosmetic results is an important and common interdisciplinary goal for oncologists and radiotherapists.
Keywords: breast cancer, mastectomy, subcutaneous mastectomy, skin-preserving mastectomy, breast reconstruction, simultaneous reconstruction, radiation therapy, relapse, rehabilitation, capsular contracture, quality of life
For citation: Rasskazova E, Zikiryakhodzhaev A, Khmelevsky E.Radiation Therapy for Breast Cancer pT1–3N0–1M0 after Mastectomy or Subcutaneous/Skin-Preserving Mastectomy with Reconstruction. Literature Review. Medical Radiology and Radiation Safety. 2023;68(3):39-45. (In Russian). DOI: 10.33266/1024-6177-2023-68-3-39-45
References
1. Montero A., Ciérvide R., García-Aranda M., Rubio C. Postmastectomy Radiation Therapy in Early Breast Cancer: Utility or Futility? Critical Reviews in Oncology/Hematology. 2020;147:10288. https://doi.org/10.1016/j.critrevonc.2020.102887.
2. Agha R.A., Omran Y.Al., Wellstead G., Sagoo H. Systematic Review of Therapeutic Nipple-Sparing Versus Skin-Sparing Mastectomy. BJS Open. 2018;3;2:135-145. doi: 10.1002/bjs5.50119.
3. McGale P., Taylor C., Correa C. et al. Effect of Radiotherapy after Mastectomy and Axillary Surgery on 10-Year Recurrence and 20-Year Breast Cancer Mortality: Meta-Analysis of Individual Patient Data For 8135 Women in 22 Randomised Trials. Lancet. 2014;383;9935:2127-2135. doi: 10.1016/S0140-6736(14)60488-8.
4. Wang K., Jin X., Wang W.J., et al. The Role of Postmastectomy Radiation in Patients with Ypn0 Breast Cancer after Neoadjuvant Chemotherapy: A Meta-Analysis. BMC Cancer. 202;21;1:728. doi: 10.1186/s12885-021-08423-1.
5. Nikyara N., Tegneliusb E., Valachis A. Adjuvant Locoregional Radiation Therapy in Breast Cancer Patients with Pathologic Complete Response after Neoadjuvant Chemotherapy: A Systematic Review and Meta-Analysis. Clinical and Translational Radiation Oncology. 2022;33:45-52. https://doi.org/10.1016/j.ctro.2021.12.010.
6. Weber W.P., Shaw J., Pusic A., et al. Oncoplastic Breast Consortium Recommendations for Mastectomy and Whole Breast Reconstruction in the Setting of Post-Mastectomy Radiation Therapy. Breast. 2022;63:123-139. doi: 10.1016/j.breast.2022.03.008.
7. Hehr Th., Baumann R., Budach W. Radiotherapy after Skin-Sparing Mastectomy with Immediate Breast Reconstruction in Intermediate-Risk Breast Cancer: Indication and Technical Considerations. Strahlenther Onkol. 2019;195;11:949-963. doi: 10.1007/s00066-019-01507-9.
8. Cihan Y.B., Sarigoz T. Role of Postmastectomy Radiation Therapy in Breast Cancer Patients with T1-2 And 1-3 Positive Lymph Nodes. Onco. Targets. Ther. 2016;9:5587-5595. doi: 10.2147/OTT.S106871.
9. Chen F., Pu F. Role of Postmastectomy Radiotherapy in Early-Stage (T1-2N0-1M0) Triple-Negative Breast Cancer: A Systematic Review. Onco. Targets. Ther. 2017;10:2009-2016. doi: 10.2147/OTT.S123803.
10. Jaoude J.A., Azambuja E., Makki M., et al. Post-Mastectomy Radiation Therapy in Human Epidermal Growth Factor Receptor 2 Positive Breast Cancer Patients: Analysis of the HERA Trial. Int. J. Radiat. Oncol. Biol. Phys. 2020;106;3)503-510. doi: 10.1016/j.ijrobp.2019.10.022.
11. Деньгина Н.В. Особые показания к адъювантной лучевой терапии при раке молочной железы T2N1M0 после радикальной мастэктомии // Эффективная фармакотерапия. 2017. № 6. С. 12-15. [Dengina N.V. Special Indications for Adjuvant Radiation Therapy for Breast Cancer T2N1M0 after Radical Mastectomy. Effektivnaya Farmakoterapiya = Effective Pharmacotherapy. 2017;6:12-15 (In Russ.)].
12. Forissier V., Tallet A., Cohen M. ,et al. Is Post-Mastectomy Radiation Therapy Contributive in pN0-1mi Breast Cancer Patients? Results of a French Multi-Centric Cohort. Eur. J. Cancer. 2017;87:47-57. doi: 10.1016/j.ejca.2017.10.004
13. Xu F-F., Cao L., Xu Ch., et al. Practical Model to Optimize the Strategy of Adjuvant Postmastectomy Radiotherapy in T1-2N1 Breast Cancer With Modern Systemic Therapy. Front Oncol. 2022;12:789198. doi: 10.3389/fonc.2022.789198.
14. Frandsen J.E., Cannon G., Kokeny K.E., et al. Is Radiation Indicated for Young Women with Early Stage, Node-Negative Breast Cancer after Mastectomy? A Multi-Institution, Retrospective Review. Breast J. 2018;24;1:7-11. doi: 10.1111/tbj.12827.
15. Miyashita M., Tada H., Suzuki A. Minimal Impact of Postmastectomy Radiation Therapy on Locoregional Recurrence for Breast Cancer Patients with 1 to 3 Positive Lymph Nodes in the Modern Treatment Era. Surg. Oncol. 2017;26;2:163-170. doi: 10.1016/j.suronc.2017.03.003.
16. Галченко Л.И., Маточкин В.В. Лучевые осложнения при лучевой терапии: Учебное пособие для студентов. Иркутск: ИГМУ, 2015. 30 с. [Galchenko L.I., Matochkin V.V. Luchevyye Oslozhneniya pri Luchevoy Terapii = Radiation Complications in Radiation Therapy. A Textbook for Students. Irkutsk Publ., 2015. 30 p. (In Russ.)].
17. Montero A., Ciérvide R., García-Aranda M., Rubio C. Postmastectomy Radiation Therapy in Early Breast Cancer: Utility or Futility? Critical Reviews in Oncology/Hematology. 2020;147:10288. https://doi.org/10.1016/j.critrevonc.2020.102887.
18. Гулян И.С., Никифорова Н.О., Кустов В.Н. и др. Генерация вторичного излучения на поверхности эндопротезов, используемых для реконструкции молочной железы при мастэктомии, после проведения лучевой терапии // Тихоокеанский медицинский журнал. 2020. № 4. С. 59–62. doi: 10.34215/1609-1175-2020-4-59-62. [Gulyan I.S., Nikiforova N.O., Kustov V.N., et al. Generation of Secondary Radiation on the Surface of Endoprostheses Used for Breast Reconstruction During Mastectomy, after Radiation Therapy. Tikhookeanskiy Meditsinskiy Zhurnal = Pacific Medical Journal. 2020;4:59–62. doi: 10.34215/1609-1175-2020-4-59-62 (In Russ.)].
19. Mitchell M.P., Wagner J., Butterworth J. Subcutaneous Implant-Based Breast Reconstruction, a Modern Challenge in Postmastectomy Radiation Planning. Pract. Radiat. Oncol. 2018;8;3:153-156. doi: 10.1016/j.prro.2017.09.001.
20. Elswick S.M., Harless Ch.A., Bishop S.N., et al. Prepectoral Implant-Based Breast Reconstruction with Postmastectomy Radiation Therapy. Plast. Reconstr. Surg. 2018;142;1:1-12. doi: 10.1097/PRS.0000000000004453.
21. Chopra Sh., Al-Ishaq Z., Vidya R. The Journey of Prepectoral Breast Reconstruction Through Time. World J. Plast. Surg. 2021;10;2:3-13. doi: 10.29252/wjps.10.2.3.
22. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Breast Cancer. Version 4.2022. 2022.
23. Hershenhouse K.S., Bick K., Shauly O., et al. Systematic Review and Meta-Analysis of Immediate Versus Delayed Autologous Breast Reconstruction in the Setting of Post-Mastectomy Adjuvant Radiation Therapy. J. Plast Reconstr Aesthet Surg. 2021;74;5:931-944. doi: 10.1016/j.bjps.2020.11.027.
24. Zernov K.Y., Dashyan G.A., Krivorotko P.V., et al. Breast Reconstruction and Radiotherapy. Malignant Tumours. 2017;1:30–36. DOI: 10.18027/2224–5057–2017–1–30–36.
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Conflict of interest. The authors declare no conflict of interest.
Financing. The study had no sponsorship.
Contribution. Article was prepared with equal participation of the authors.
Article received: 20.01.2022. Accepted for publication: 25.02.2023.