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Postmastectomy radiotherapy: indications and implications.
S M Walsh1, A J Lowery1, R S Prichard1
1Department of Breast Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
Summary
Postmastectomy radiotherapy (PMRT) is crucial for high-risk breast cancer patients but can affect breast reconstruction outcomes. Careful patient counseling is essential before immediate reconstruction if PMRT is likely needed.
Area of Science:
- Oncology
- Surgical Oncology
- Radiation Oncology
Background:
- Mastectomy is required for about one-third of breast cancer patients.
- Immediate reconstruction is often offered to these patients.
- Postmastectomy radiotherapy (PMRT) can have side effects on reconstructed breasts.
Purpose of the Study:
- Review issues surrounding PMRT.
- Discuss patient selection for PMRT.
- Analyze the effect of PMRT on reconstructive decisions.
Main Methods:
- Literature review conducted.
- Medline database utilized.
Main Results:
- PMRT is indicated for high risk of loco-regional recurrence.
- PMRT strongly recommended for >=4 positive lymph nodes; other indications debated.
- Immediate reconstruction generally has favorable outcomes, but PMRT may necessitate revision surgery.
Conclusions:
- Careful patient counseling is vital before immediate reconstruction when PMRT is anticipated.
- Evidence largely from retrospective studies; few randomized trials exist.
- PMRT's impact on breast reconstruction requires careful consideration.
