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Title: Neoadjuvant radiotherapy for locally advanced and high-risk breast cancer.
Austin Authors: Chidley, Phoebe;Foroudi, Farshad ;Tacey, Mark A ;Khor, Richard ;Yeh, Janice;Bevington, Elaine;Hyett, Anthony;Loh, Su Wen;Chew, Grace ;McCracken, James;Neoh, Derek E ;Yeo, Belinda ;Baker, Caroline;Jassal, Sunil;Law, Michael;Zantuck, Natalie;Cokelek, Margaret;Guerrieri, Mario;Brown, Belinda;Stoney, David;Ng, Michael;Chao, Michael 
Affiliation: Peninsula Health, Frankston, Victoria, Australia
Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
Eastern Health, Melbourne, Victoria, Australia
Genesis Care Victoria, Ringwood Private Hospital, Ringwood East, Victoria, Australia
St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
Olivia Newton-John Cancer Wellness and Research Centre
University of Melbourne, Melbourne, Victoria, Australia
Issue Date: Jun-2021
Date: 2021-04-06
Publication information: Journal of Medical Imaging and Radiation Oncology 2021; 65(3): 345-353
Abstract: Neoadjuvant radiotherapy (NART) as part of a multi-modality approach for locally advanced breast cancer (LABC) requires further investigation. Importantly, this approach may allow for a single-staged surgical procedure, with mastectomy and immediate autologous reconstruction. Multiple other potential benefits of NART include improved pathological downstaging of breast disease, reduced overall treatment time, elimination of time period with breast tissue deficit and improved patient satisfaction. This is a retrospective multi-institutional review of patients with LABC and high-risk breast disease undergoing NART. Eligible patients sequentially underwent neoadjuvant chemotherapy (NACT) with or without HER2-targeted therapy, NART, followed by mastectomy with immediate autologous breast reconstruction (BR) 4- to 6 weeks post-completion of radiotherapy. Patient and tumour characteristics were analysed using descriptive statistics. Surgical complications were assessed using the Clavien-Dindo Classification (Ann Surg 2004; 240: 205). From 3/2013 to 9/2019, 153 patients were treated with NART. The median age was 47 years (IQR 42-52), with median body mass index of 27. Eighteen patients experienced Grade 3 acute surgical complications. This included 13 Grade 3B breast-site events and 9 Grade 3B donor-site events, where further surgical intervention was required for management of wound infection, wound dehiscence, flap or mastectomy skin necrosis, haematoma and internal mammary venous anastomotic thrombosis. No autologous flap loss was observed. Neoadjuvant radiotherapy facilitates a single-stage surgical procedure with mastectomy and immediate autologous BR, eliminating the delay to reconstructive surgery and thus shortening a woman's breast cancer journey. The findings of this review support the use of NART, with comparable rates of surgical complications to standard sequencing.
DOI: 10.1111/1754-9485.13180
ORCID: 0000-0002-5691-7446
Journal: Journal of Medical Imaging and Radiation Oncology
PubMed URL: 33821576
Type: Journal Article
Subjects: breast
neoadjuvant therapy
reconstructive surgical procedures
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