Immediate 2-Stage breast reconstruction outcomes after proton or photon postmastectomy radiotherapy
Purpose: To evaluate the impact of postmastectomy radiotherapy (PMRT) on immediate breast reconstruction (IBR) outcomes among patients treated with proton or photon radiotherapy. Material and Methods: Patients who had undergone mastectomy, immediate breast reconstruction, and PMRT at our institution...
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Elsevier
2025-09-01
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| Series: | Clinical and Translational Radiation Oncology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405630825001077 |
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| author | Robert W. Gao William S. Harmsen Na L. Smith Trey C. Mullikin Adam C. Amundson Feven Abraha Kimberly G. Gergelis Arslan Afzal Christin A. Harless Aparna Vijayasekaran Minh-Doan T. Nguyen Judy C. Boughey Nicholas B. Remmes Hok S. Wan Chan Tseung May Elbanna Allison E. Garda Mark R. Waddle Safia K. Ahmed Sean S. Park Kimberly S. Corbin Robert W. Mutter Dean A. Shumway |
| author_facet | Robert W. Gao William S. Harmsen Na L. Smith Trey C. Mullikin Adam C. Amundson Feven Abraha Kimberly G. Gergelis Arslan Afzal Christin A. Harless Aparna Vijayasekaran Minh-Doan T. Nguyen Judy C. Boughey Nicholas B. Remmes Hok S. Wan Chan Tseung May Elbanna Allison E. Garda Mark R. Waddle Safia K. Ahmed Sean S. Park Kimberly S. Corbin Robert W. Mutter Dean A. Shumway |
| author_sort | Robert W. Gao |
| collection | DOAJ |
| description | Purpose: To evaluate the impact of postmastectomy radiotherapy (PMRT) on immediate breast reconstruction (IBR) outcomes among patients treated with proton or photon radiotherapy. Material and Methods: Patients who had undergone mastectomy, immediate breast reconstruction, and PMRT at our institution were included in a retrospective analysis of risk factors for surgical site infection (SSI), unplanned reoperation, and reconstruction failure. Univariate Cox models were used to examine associations of variables with reconstruction outcomes. Results: Two-hundred thirty-one women were included, of whom 224 (97.0 %) underwent two-stage IBR with placement of a tissue expander and 7 (3 %) had direct-to-implant IBR. One-hundred sixty-five patients (71.4 %) received proton and 65 (28.6 %) received photon therapy. Twenty-nine patients (12.6 %) received hypofractionation. Median follow-up was 1.8 years. Two-year cumulative risk of SSI was 17.83 % (95 % CI 12.27–24.41 %); unplanned reoperation was 16.19 % (95 % CI 10.06–22.10 %); and reconstruction failure was 7.60 % (95 % CI 3.55–12.11). On multivariable analysis, prophylactic use of Mepitel Film reduced the risk of SSI [HR: 0.35 (95 % CI: 0.18–0.69), p = 0.002] and unplanned reoperation [HR: 0.39 (95 % CI: 0.20–0.79), p = 0.008]. The small number of events (n = 16) precluded multivariable analysis of reconstruction failure; on univariate analysis, receipt of a chest wall boost [HR: 4.98 (95 % CI: 1.12–22.10), p = 0.035] and/or lymph node boost [HR: 3.66 (95 % CI: 1.25–10.73), p = 0.018] were associated with reconstruction failure. Conclusions: Although approximately one-fifth of women experienced SSI or unplanned reoperation, the rate of reconstruction failure was low (7.6%) and most women achieved a successful reconstruction outcome with PMRT using photons or protons. The lower rate of SSI and unplanned reoperation with use of Mepitel Film highlights the need for further evaluation. |
| format | Article |
| id | doaj-art-81af4aeb70e840479bb92edbfec00b63 |
| institution | Kabale University |
| issn | 2405-6308 |
| language | English |
| publishDate | 2025-09-01 |
| publisher | Elsevier |
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| series | Clinical and Translational Radiation Oncology |
| spelling | doaj-art-81af4aeb70e840479bb92edbfec00b632025-08-20T03:38:59ZengElsevierClinical and Translational Radiation Oncology2405-63082025-09-015410101510.1016/j.ctro.2025.101015Immediate 2-Stage breast reconstruction outcomes after proton or photon postmastectomy radiotherapyRobert W. Gao0William S. Harmsen1Na L. Smith2Trey C. Mullikin3Adam C. Amundson4Feven Abraha5Kimberly G. Gergelis6Arslan Afzal7Christin A. Harless8Aparna Vijayasekaran9Minh-Doan T. Nguyen10Judy C. Boughey11Nicholas B. Remmes12Hok S. Wan Chan Tseung13May Elbanna14Allison E. Garda15Mark R. Waddle16Safia K. Ahmed17Sean S. Park18Kimberly S. Corbin19Robert W. Mutter20Dean A. Shumway21Department of Radiation Oncology, Mayo Clinic, 200 1st St SW, Rochester, MN, USADepartment of Biostatistics & Information, Mayo Clinic, 200 1st St SW, Rochester, MN, USA; Corresponding authors.Sanford Cancer Center, 1309 W 17th St, Sioux Falls, SD, USADepartment of Radiation Oncology, Duke University, 20 Duke Medicine Cir, Durham, NC, USADepartment of Radiation Oncology, Mayo Clinic, 200 1st St SW, Rochester, MN, USADepartment of Biostatistics & Information, Mayo Clinic, 200 1st St SW, Rochester, MN, USADepartment of Radiation Oncology, University of Rochester, 601 Elmwood Ave, Rochester, NY, USADepartment of Internal Medicine, NYC Health and Hospitals, 461 First Avenue, New York, New York, USADivision of Plastic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, USADivision of Plastic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, USADivision of Plastic & Reconstructive Surgery, University of Minnesota Medical School, 319 15th Ave SE, Minneapolis, MN, USADivision of Breast and Melanoma Surgical Oncology, Mayo Clinic, 200 1st St SW, Rochester, MN, USADepartment of Radiation Oncology, Mayo Clinic, 200 1st St SW, Rochester, MN, USADepartment of Radiation Oncology, Mayo Clinic, 200 1st St SW, Rochester, MN, USADepartment of Radiation Oncology, Mayo Clinic, 200 1st St SW, Rochester, MN, USADepartment of Radiation Oncology, Mayo Clinic, 200 1st St SW, Rochester, MN, USADepartment of Radiation Oncology, Mayo Clinic, 200 1st St SW, Rochester, MN, USADepartment of Radiation Oncology, Mayo Clinic, 200 1st St SW, Rochester, MN, USADepartment of Radiation Oncology, Mayo Clinic, 200 1st St SW, Rochester, MN, USADepartment of Radiation Oncology, Mayo Clinic, 200 1st St SW, Rochester, MN, USADepartment of Radiation Oncology, Mayo Clinic, 200 1st St SW, Rochester, MN, USA; Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, 200 1st St SW, Rochester, MN, USADepartment of Radiation Oncology, Mayo Clinic, 200 1st St SW, Rochester, MN, USA; Corresponding authors.Purpose: To evaluate the impact of postmastectomy radiotherapy (PMRT) on immediate breast reconstruction (IBR) outcomes among patients treated with proton or photon radiotherapy. Material and Methods: Patients who had undergone mastectomy, immediate breast reconstruction, and PMRT at our institution were included in a retrospective analysis of risk factors for surgical site infection (SSI), unplanned reoperation, and reconstruction failure. Univariate Cox models were used to examine associations of variables with reconstruction outcomes. Results: Two-hundred thirty-one women were included, of whom 224 (97.0 %) underwent two-stage IBR with placement of a tissue expander and 7 (3 %) had direct-to-implant IBR. One-hundred sixty-five patients (71.4 %) received proton and 65 (28.6 %) received photon therapy. Twenty-nine patients (12.6 %) received hypofractionation. Median follow-up was 1.8 years. Two-year cumulative risk of SSI was 17.83 % (95 % CI 12.27–24.41 %); unplanned reoperation was 16.19 % (95 % CI 10.06–22.10 %); and reconstruction failure was 7.60 % (95 % CI 3.55–12.11). On multivariable analysis, prophylactic use of Mepitel Film reduced the risk of SSI [HR: 0.35 (95 % CI: 0.18–0.69), p = 0.002] and unplanned reoperation [HR: 0.39 (95 % CI: 0.20–0.79), p = 0.008]. The small number of events (n = 16) precluded multivariable analysis of reconstruction failure; on univariate analysis, receipt of a chest wall boost [HR: 4.98 (95 % CI: 1.12–22.10), p = 0.035] and/or lymph node boost [HR: 3.66 (95 % CI: 1.25–10.73), p = 0.018] were associated with reconstruction failure. Conclusions: Although approximately one-fifth of women experienced SSI or unplanned reoperation, the rate of reconstruction failure was low (7.6%) and most women achieved a successful reconstruction outcome with PMRT using photons or protons. The lower rate of SSI and unplanned reoperation with use of Mepitel Film highlights the need for further evaluation.http://www.sciencedirect.com/science/article/pii/S2405630825001077Postmastectomy radiotherapyBreast reconstructionProton therapyPhoton therapyMepitel FilmBreast cancer |
| spellingShingle | Robert W. Gao William S. Harmsen Na L. Smith Trey C. Mullikin Adam C. Amundson Feven Abraha Kimberly G. Gergelis Arslan Afzal Christin A. Harless Aparna Vijayasekaran Minh-Doan T. Nguyen Judy C. Boughey Nicholas B. Remmes Hok S. Wan Chan Tseung May Elbanna Allison E. Garda Mark R. Waddle Safia K. Ahmed Sean S. Park Kimberly S. Corbin Robert W. Mutter Dean A. Shumway Immediate 2-Stage breast reconstruction outcomes after proton or photon postmastectomy radiotherapy Clinical and Translational Radiation Oncology Postmastectomy radiotherapy Breast reconstruction Proton therapy Photon therapy Mepitel Film Breast cancer |
| title | Immediate 2-Stage breast reconstruction outcomes after proton or photon postmastectomy radiotherapy |
| title_full | Immediate 2-Stage breast reconstruction outcomes after proton or photon postmastectomy radiotherapy |
| title_fullStr | Immediate 2-Stage breast reconstruction outcomes after proton or photon postmastectomy radiotherapy |
| title_full_unstemmed | Immediate 2-Stage breast reconstruction outcomes after proton or photon postmastectomy radiotherapy |
| title_short | Immediate 2-Stage breast reconstruction outcomes after proton or photon postmastectomy radiotherapy |
| title_sort | immediate 2 stage breast reconstruction outcomes after proton or photon postmastectomy radiotherapy |
| topic | Postmastectomy radiotherapy Breast reconstruction Proton therapy Photon therapy Mepitel Film Breast cancer |
| url | http://www.sciencedirect.com/science/article/pii/S2405630825001077 |
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