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Neoadjuvant Radiotherapy to Facilitate Immediate Breast Reconstruction: A Systematic Review and Current Clinical
Puneet Singh1, Karen Hoffman2, Mark V Schaverien3
1Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Annals of Surgical Oncology
|July 26, 2019
Summary
Neoadjuvant radiotherapy (NART) before immediate breast reconstruction (IBR) shows promising safety and feasibility for locally advanced breast cancer patients. Further research is needed to establish NART and IBR as a standard treatment.
Area of Science:
- Oncology
- Plastic Surgery
- Radiotherapy
Background:
- Postmastectomy radiotherapy is standard for high-risk breast cancer but can harm immediate breast reconstruction (IBR).
- Neoadjuvant radiotherapy (NART) followed by IBR is an emerging sequence to mitigate these effects.
Purpose of the Study:
- To systematically review the current evidence on the feasibility and safety of neoadjuvant radiotherapy (NART) followed by immediate breast reconstruction (IBR).
Main Methods:
- A comprehensive literature search was conducted across major databases (MEDLINE, EMBASE, Cochrane, Web of Science, ClinicalTrials.gov) up to 2018.
- Included 18 retrospective and prospective studies evaluating NART and IBR outcomes.
Main Results:
- NART typically involved whole-breast radiotherapy (50 Gy) with a 6-8 week delay before IBR (implant or autologous).
- Postoperative complication rates varied (3-36%), with low flap loss. Cosmetic outcomes were generally good to excellent.
- Pathologic complete response rates were 17-55%, and locoregional recurrence rates were low (≤10%) with short follow-up.
Conclusions:
- NART followed by IBR appears technically and oncologically safe in initial studies.
- Larger prospective trials and longer follow-up are necessary to establish this sequence as a standard of care.
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