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O' Halloran, N,McVeigh, T,Martin, J,Keane, M,Lowery, A,Kerin, M
2019
February
Irish Journal Of Medical Science
Neoadjuvant chemoradiation and breast reconstruction: the potential for improved outcomes in the treatment of breast cancer
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Breast cancer Breast reconstruction Mastectomy Neoadjuvant chemoradiation Neoadjuvant radiotherapy PATHOLOGICAL COMPLETE RESPONSE SKIN-SPARING MASTECTOMY RADIATION-THERAPY POSTMASTECTOMY RADIOTHERAPY CAPSULAR CONTRACTURE CONSERVING SURGERY RECTAL-CANCER CHEMOTHERAPY CHEMORADIOTHERAPY SURVIVAL
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BackgroundImmediate breast reconstruction (IBR) improves psychosocial and quality of life outcomes. Post-mastectomy radiation therapy is indicated for patients with a high risk of locoregional recurrence including locally advanced tumours (5cm) or greater than or equal to four axillary nodes positive for breast cancer and can be a relative contraindication to IBR. Administration of radiation therapy pre-operatively, analogous to neoadjuvant chemotherapy, may reduce time to completion of treatment and facilitate better access to IBR.MethodsThis is a prospective pilot study in a tertiary referral breast cancer unit, comparing surgical, pathological response and oncological outcomes and time to completion of therapy for a prospective group of patients who received neoadjuvant radiotherapy with a cohort of age- and stage-matched patients requiring post-mastectomy ( reconstruction) radiation between 2010 and 2016.ResultsSixteen patients with locally advanced breast cancer underwent neoadjuvant radiation and were age- and stage-matched to 32 patients who received post-mastectomy radiation therapy (PMRT) between 2010 and 2016. Neoadjuvant radiotherapy resulted in shorter time between diagnosis and treatment completion (245.6 +/- 44.2days in the neoadjuvant group, 291.2 +/- 36.7days in the adjuvant group, p=0.001). A higher proportion of patients undergoing neoadjuvant chemoradiation therapy underwent breast reconstruction (14/16 patients in the neoadjuvant group, 15/32 patients in the adjuvant group, p=0.007) without an increase in complication rate (p=0.117). There was a trend towards improved pathological complete response and survival in the neoadjuvant group.Conclusion This pilot study confirms that neoadjuvant chemoradiation is a feasible way of delivering breast cancer treatment and may facilitate improved access to IBR.
10.1007/s11845-018-1846-6
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