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Published on: May 17, 2024
Hypofractionated Versus Conventional Postmastectomy Radiotherapy in Implant-Based Breast Reconstruction: A Systematic
Ji Hyeon Joo1, Yongkan Ki1, Youn-Joo Jung2
1Department of Radiation Oncology, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea.
Hypofractionated postmastectomy radiotherapy (HF-PMRT) shows reduced risks of capsular contracture and wound dehiscence compared to conventionally fractionated PMRT in implant-based breast reconstruction. This suggests HF-PMRT is a safe option, though further research is needed.
Area of Science:
- Oncology
- Radiotherapy
- Plastic Surgery
- Breast Reconstruction
Background:
- Safety of hypofractionated postmastectomy radiotherapy (HF-PMRT) in implant-based breast reconstruction is uncertain due to concerns about complications.
- Need to compare reconstructive outcomes between HF-PMRT and conventionally fractionated PMRT (CF-PMRT).
Purpose of the Study:
- To systematically review and meta-analyze reconstructive complications following HF-PMRT versus CF-PMRT in patients undergoing implant-based breast reconstruction.
Main Methods:
- Systematic review and meta-analysis of studies comparing HF-PMRT and CF-PMRT in implant-based breast reconstruction.
- Databases searched: PubMed, Cochrane Library, EMBASE. Outcomes: capsular contracture, implant removal, infection, wound dehiscence.
- Risk of bias assessed using RoB 2 and ROBINS-I; pooled using Mantel-Haenszel method.
Main Results:
- Seven studies (2200 patients) analyzed; HF-PMRT showed significantly lower risk of capsular contracture (OR 0.65) and wound dehiscence (OR 0.39) than CF-PMRT.
- No significant difference in implant removal (OR 0.90) or infection (OR 0.98) between HF-PMRT and CF-PMRT.
- Reduced capsular contracture risk was most pronounced when HF-PMRT was delivered during tissue expansion.
Conclusions:
- Moderate hypofractionation appears to be a reasonable option for implant-based breast reconstruction without increasing reconstructive complications.
- Findings suggest HF-PMRT is safe, but evidence certainty is limited.
- Prospective validation is warranted to confirm these findings.