Post-Mastectomy Radiation Can Cause Complications

Radiation therapy increased complications and lowered patient-reported satisfaction in patients with breast cancer who undergone breast reconstruction surgery, according to a recent study presented at the 2016 San Antonio Breast Cancer Symposium (SABCS).

However, it should be noted that this was not the case for patients who received autologous reconstruction whereby the woman’s own body tissues are used to create a new breast.

Many challenging decisions are involved for women diagnosed with early-stage breast cancer, ones that will affect their long-term disease control and quality of life, according to study author Reshma Jagsi, M.D., D.Phil., who presented the findings of this prospective multicenter cohort study at SABCS.

Despite evidence supporting the benefits of post-mastectomy radiotherapy in some patients, “Many patients must still decide whether they feel that the benefits, given their particular circumstances, outweigh the risks,” explained Jagsi, professor and deputy chair in the Department of Radiation Oncology at the University of Michigan. “One of the risks of radiation therapy is that it may affect the options and outcomes for breast reconstruction, which many women who receive mastectomy desire.”

This Mastectomy Reconstruction Outcomes Consortium study collected medical and patient-reported outcomes data from women who were a median age of 49 and diagnosed with breast cancer and elected different types of reconstruction between 2012 and 2015: 553 of these patients received radiotherapy and 1461 patients did not. Thirty-eight percent of women who received radiation and 25 percent who did not have autologous reconstruction, with remaining patients undergoing implant reconstruction.

From there, researchers determined whether radiotherapy was associated with complications developed post-reconstruction, such as hematoma or wound infection. They also measured patient satisfaction using a BREAST-Q patient-reported outcome instrument, one and two years after reconstruction.

At one-year of follow-up, 28.8 percent of patients who had radiotherapy and 22.3 percent who did not, had at least one of the measured complications. At two years of follow up, 34.1 percent and 22.5 percent of those who did and did not receive radiotherapy, respectively, experienced a complication with their breast reconstruction.

After accounting for several variables, the researchers determined that radiotherapy was linked to more than double the odds of developing complications in patients who received implants. However, for those patients who received autologous reconstruction, radiotherapy was not associated with complications.

Additionally, the BREAST-Q scores of patients who had received radiation showed significantly lower patient-reported satisfaction than those of the patients who did not receive radiation. Once more, these differences were not shown among the patients with autologous reconstruction.

Patients who undergo mastectomy often become long-term survivors, meaning that breast reconstruction can have a lasting impact on their quality of life. Currently, well-established approaches to integrate post-mastectomy radiotherapy and breast reconstruction are lacking, noted Jagsi:

“Although women must still weigh multiple factors, including the differences in operative time and rehabilitation required for different approaches when selecting their preferred type of reconstruction, those who plan to receive post-mastectomy radiation therapy should be informed of the substantial and significant impact of radiotherapy observed in the current study among patients who received implant reconstruction.”

On the other hand, she added that those patients who intended to pursue autologous reconstruction could be reassured by these findings insofar as, “outcomes among patients receiving autologous reconstruction did not appear substantially worse than those of unirradiated patients by two years.”

Researchers noted that because these findings are from an observational study, a cause—effect relationship cannot be established. Additionally, patients who were treated at centers particularly skilled at integrating implant-based approaches with radiotherapy could still do well with such an approach.