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• W2585453407 abstract "Radiotherapy (RT) to the breast reconstructed with an expander technique is controversial, with concern expressed for cosmesis and timing of RT. At our center, we have reported good to excellent cosmetic outcomes with this technique, and now examine disease control as related to timing of surgery, chemotherapy (CT), and RT. To retrospectively evaluate treatment intervals between surgery and adjuvant CT and RT in patients with locally advanced breast cancer treated with mastectomy with immediate expander-implant reconstruction, and to determine if these intervals result in acceptable local, regional, and distant control. Between 5/1996 and 3/2004, 104 patients with locally advanced breast cancer were treated under the following algorithm: 1. Definitive surgery with axillary dissection and immediate tissue expander placement. 2. Expansion during CT. 3. Exchange for permanent implant. 4. RT. Median age was 45 (range 27-72). Tumor and nodal stages were T1 (n=19), T2 (n=56), T3 (n=21), T4 (n=8), and N0 (n=3), N1 (n=33), N2 (n=39), N3 (n=29). ER staining was (+) in 77%. HER2 was not tested in 19%, negative in 62%, and positive in 19%. CT was doxorubicin/ cyclophosphamide/ paclitaxel-based (n=87), fluoruracil/ epirubicin/ cyclophosphamide-based (n=10), cyclophosphamide/ methotrexate/ fluorouracil-based (n=4), or other combinations (n=3). Three patients received Trastuzumab. Post-CT, 80 patients received hormone therapy. The indication for RT was T3/T4 and/or N2/N3 disease (n=79), extranodal extension (n=10), large tumor <5cm (n=9), multifocality (n=3), positive margin (n=2), and 1-3 lymph nodes involved (n=1). RT was delivered with tangent chest wall (CW) fields and a supraclavicular field (SCV); the internal mammary chain (IMC) was not specifically included. One patient did not receive SCV treatment, and 10 patients received a posterior axillary boost (PAB). One patient received a 1000 cGy electron scar boost. Median radiation dose was 5040 cGy (range 4500 - 6040). A 0.5 cm bolus was used daily over the CW. The median interval between completion of CT and expander exchange was 4.0 weeks (range 1.9-13.0), between exchange and initiation of RT was 3.6 weeks (range 1.4-11.1), and between completion of CT and initiation of RT was 7.9 weeks (range 4.4 - 15.6). Median interval from mastectomy to initiation of RT was 8 months (range 5-14). At a median followup of 56 months (range 11-115) from date of mastectomy, local and regional disease control was 100%. Twelve patients developed distant metastases and the five year distant metastasis-free survival rate was 90%. Four patients died and the five year overall survival rate was 96%. Among the factors examined, only ER (+) status was significantly associated with improved distant metastasis-free survival (p=0.001). Mastectomy with immediate expander-implant reconstruction followed by CT, exchange, and RT is feasible. With a median interval of 7.9 weeks between completion of CT and initiation of RT, and 8 months between surgery and initiation of RT, and with RT delivered to the CW and SCV +/-PAB, but not IMC, no compromise in outcome was observed with 100% local and regional disease control." @default.
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• W2585453407 date "2006-11-01" @default.
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• W2585453407 doi "https://doi.org/10.1016/j.ijrobp.2006.07.226" @default.
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