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Is Postmastectomy Irradiation Technically Safe for Patients with Immediate Breast Reconstruction?

2011; Elsevier BV; Volume: 81; Issue: 2 Linguagem: Inglês

10.1016/j.ijrobp.2011.06.1704

1879-355X

P. Murina, L. Caussa, S. Gutiérrez, P. Castro Peña, C. Casado Sánchez, E Garrigó, S. Zunino,

Cancer survivorship and care

To evaluate the feasibility of irradiation technique in breast cancer patients who underwent Modified Radical Mastectomy (MRM) and immediate breast reconstruction (IBR) with temporary expander (TE) or permanent implant (PI), followed by adjuvant radiotherapy. Twenty breast cancer patients, stage I to III, mean age 47.2 (31-67) years were enrolled between November 2005 and May 2010. They underwent MRM followed by IBR, which consisted in placing TE (n = 6) or PI (n = 14). All the patients had CT-assisted virtual simulation. PCRT 3D v5.0 (Técnica Radiofísica España) was used for volume delineation and 3-D planning. The dose arrangement was based on the volume percentage involved in the 50Gy prescribed dose. The volumes for 3DCRT were: reconstruction volume, internal mammary (IMC), supraclavicular and axillary nodes depending on cancer staging. A Primus Lineal Accelerator with MLC Optifocus Siemens was used for irradiation. Patients with negative nodes had irradiation only to the reconstruction volume, while those with positive nodes received irradiation also to the regional nodes. Two of the 6 patients with negative nodes and breast reconstruction using TE presented no technical problems (D95 = 95% of the prescribed dose). The remaining 4, with involved nodes were planned for irradiation to the regional nodes and to the reconstruction volume. Volume dose (D95) using standard institutional technique could be delivered to only one of these 4 patients, due to expander deflation. Reconstruction volume with tangential fields was planned for the other 3; however, it was impossible to irradiate the IMC with electrons. Of the 14 patients with PI, 7 with negative nodes were prescribed irradiation limited to reconstruction volume. Six of them with unilateral implant had no technical problems. One patient had a very large bilateral implant, which did not allow irradiation to the target volume with tangential fields. Three of the remaining 7 patients with involved nodes could not receive irradiation to the IMC because of the implant proximity to the parasternal line. The other 4 women could be planned to receive the prescribed dose (D95) to all the volumes, including the IMC, as the implant anatomical position as adequate (≥ 2cm from the parasternal line). Considering all the 20 patients, irradiation to the reconstruction volume was only indicated for 9. The technique with tangential fields was not feasible in 1/9 (11%). Of the remaining 11, with positive nodes, 6 (55%) could not receive IMC irradiation with electrons. Despite the few patients in our study, we suggest that reconstruction volume might adversely affect the radiotherapy technique on at least a group of patients, which appears to be worrying taking into account local control and survival.