The effects of post mastectomy radiation therapy to breast reconstruction: a systematic review and meta-analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHEN Cheng ¹ , GU Cheng ² , DING Fanghui ¹ , MA Dachang ¹ , PAN Qing ¹ ,  WU Li ¹

1. Department of Breast Diseases, The First Hospital of Lanzhou University, Lanzhou 730030, P. R. China;
2. Department of Neurology, Gansu Provincial Hospital, Lanzhou 730030, P. R. China;

Corresponding author：

WU Li, Email: wuli86@126.com

Keywords：

breast cancer; breast reconstruction; radiation therapy; systematic evaluation; meta-analysis

DOI：

10.7507/1007-9424.202103084

Video：

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Objective To evaluate the effect of post mastectomy radiation therapy (PMRT) on breast reconstruction after mastectomy in breast cancer patients, in order to provide evidence support for clinical treatment decision.Methods Five databases searched in the current study include the Cochrane Library, PubMed, CNKI, VIP and WanFang database. A systematic search for control trials was performed in each database from the starting date of each database to March 1, 2021. After the two evaluators independently selected literatures, extracted data and conducted quality evaluation according to the inclusion and exclusion criteria, the meta analysis was carried out by Revman 5.3 software.Results A total of 9 cohort studies (3 447 cases) were included, including 699 cases in PMRT group and2 748 cases in non-radiotherapy group. The results of meta-analysis showed that: PMRT was associated with significant increase in capsular contracture. The incidence of capsular contracture increased from 4.34% in the non-radiotherapy group to 34.10% in patients receiving PMRT [OR=9.25, 95%CI (3.76, 22.78), P<0.000 01]. In addition, PMRT was associated with a significant increase in incidences of reconstructive failure [OR=2.55, 95%CI (1.74, 3.74), P<0.000 01] and revisional surgery [OR=2.24, 95%CI (1.58, 3.18), P<0.000 01]. Moreover it was associated with a significant reduction in patient satisfaction [OR=0.29, 95%CI (0.15, 0.57), P=0.000 30] and cosmetic outcome [OR=0.26, 95%CI (0.15, 0.43), P<0.000 01].Conclusion This meta-analysis demonstrates that breast cancer patients who received PMRT after breast reconstruction, the rate of adverse events is increased and patients’ satisfaction and cosmetic outcome are decreased.

Citation： CHEN Cheng, GU Cheng, DING Fanghui, MA Dachang, PAN Qing, WU Li. The effects of post mastectomy radiation therapy to breast reconstruction: a systematic review and meta-analysis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(1): 78-84. doi: 10.7507/1007-9424.202103084 Copy

1.	孙建伟, 刘春生, 赖明华, 等. 保留NAC的改良根治术并一期乳房重建术治疗早期乳腺癌的临床效果. 中国普通外科杂志, 2015, 24(11): 1530-1535.
2.	EBCTCG (Early Breast Cancer Trialists’ Collaborative Group); McGale P, Taylor C, et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8 135 women in 22 randomised trials. Lancet, 2014, 383(9935): 2127-2135.
3.	Magill LJ, Robertson FP, Jell G, et al. Determining the outcomes of post-mastectomy radiation therapy delivered to the definitive implant in patients undergoing one- and two-stage implant-based breast reconstruction: a systematic review and meta-analysis. J Plast Reconstr Aesthet Surg, 2017, 70(10): 1329-1335.
4.	Berbers J, van Baardwijk A, Houben R, et al. ‘Reconstruction: before or after postmastectomy radiotherapy?’ A systematic review of the literature. Eur J Cancer, 2014, 50(16): 2752-2762.
5.	Moher D, Liberati A, Tetzlaff J, et al. Reprint—preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Phys Ther, 2009, 89(9): 873-880.
6.	Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
7.	岳亚玲. 即刻乳房再造后放疗对美容效果的影响及再造乳房放疗剂量分布的研究. 石家庄: 河北医科大学, 2013.
8.	Benediktsson K, Perbeck L. Capsular contracture around saline-filled and textured subcutaneously-placed implants in irradiated and non-irradiated breast cancer patients: five years of monitoring of a prospective trial. J Plast Reconstr Aesthet Surg, 2006, 59(1): 27-34.
9.	Cordeiro PG, Albornoz CR, McCormick B, et al. What is the optimum timing of postmastectomy radiotherapy in two-stage prosthetic reconstruction: radiation to the tissue expander or permanent implant? Plast Reconstr Surg, 2015, 135(6): 1509-1517.
10.	Vandeweyer E, Deraemaecker R. Radiation therapy after immediate breast reconstruction with implants. Plast Reconstr Surg, 2000, 106(1): 56-58.
11.	Nava MB, Pennati AE, Lozza L, et al. Outcome of different timings of radiotherapy in implant-based breast reconstructions. Plast Reconstr Surg, 2011, 128(2): 353-359.
12.	Rella L, Telegrafo M, Nardone A, et al. MRI evaluation of post-mastectomy irradiated breast implants: prevalence and analysis of complications. Clin Radiol, 2015, 70(9): 948-953.
13.	Cordeiro PG, Pusic AL, Disa JJ, et al. Irradiation after immediate tissue expander/implant breast reconstruction: outcomes, complications, aesthetic results, and satisfaction among 156 patients. Plast Reconstr Surg, 2004, 113(3): 877-881.
14.	McCarthy CM, Pusic AL, Disa JJ, et al. Unilateral postoperative chest wall radiotherapy in bilateral tissue expander/implant reconstruction patients: a prospective outcomes analysis. Plast Reconstr Surg, 2005, 116(6): 1642-1647.
15.	路忠志, 肖春花, 李东生, 等. 放疗对上蒂横行腹直肌肌皮瓣乳房再造的影响. 中华普通外科杂志, 2015, 30(8): 627-630.
16.	Zheng Y, Zhong M, Ni C, et al. Radiotherapy and nipple-areolar complex necrosis after nipple-sparing mastectomy: a systematic review and meta-analysis. Radiol Med, 2017, 122(3): 171-178.
17.	Rochlin DH, Jeong AR, Goldberg L, et al. Postmastectomy radiation therapy and immediate autologous breast reconstruction: integrating perspectives from surgical oncology, radiation oncology, and plastic and reconstructive surgery. J Surg Oncol, 2015, 111(3): 251-257.
18.	杜向慧, 裘国勤. 乳腺癌术后乳房重建与放射治疗. 中华乳腺病杂志 (电子版), 2013, 7(1): 57-60.
19.	Peled AW, Foster RD, Esserman LJ, et al. Increasing the time to expander-implant exchange after postmastectomy radiation therapy reduces expander-implant failure. Plast Reconstr Surg, 2012, 130(3): 503-509.
20.	Spear SL, Masden D, Rao SS, et al. Long-term outcomes of failed prosthetic breast reconstruction. Ann Plast Surg, 2013, 71(3): 286-291.
21.	Ho AL, Bovill ES, Macadam SA, et al. Postmastectomy radiation therapy after immediate two-stage tissue expander/implant breast reconstruction: a University of British Columbia perspective. Plast Reconstr Surg, 2014, 134(1): 1e-10e.
22.	钟志如. 乳房切除术后放疗对植入物乳房重建手术影响的Meta分析. 南昌: 南昌大学, 2020.
23.	Tan BK, Chim H, Ng ZY, et al. Aesthetic design of skin-sparing mastectomy incisions for immediate autologous tissue breast reconstruction in asian women. Arch Plast Surg, 2014, 41(4): 366-373.
24.	李文涛. 乳腺癌综合治疗对乳房重建的影响. 中华实用诊断与治疗杂志, 2019, 33(8): 729-731.
25.	Zhong T, Hu J, Bagher S, et al. A comparison of psychological response, body image, sexuality, and quality of life between immediate and delayed autologous tissue breast reconstruction: a prospective long-term outcome study. Plast Reconstr Surg, 2016, 138(4): 772-780.
26.	Khouri RK Jr, Khouri RK. Current clinical applications of fat grafting. Plast Reconstr Surg, 2017, 140(3): 466e-486e.
27.	Bennett KG, Qi J, Kim HM, et al. Comparison of 2-year complication rates among common techniques for postmastectomy breast reconstruction. JAMA Surg, 2018, 153(10): 901-908.
28.	Donovan E, Bleakley N, Denholm E, et al. Randomised trial of standard 2D radiotherapy (RT) versus intensity modulated radiotherapy (IMRT) in patients prescribed breast radiotherapy. Radiother Oncol, 2007, 82(3): 254-264.
29.	Kindts I, Laenen A, Depuydt T, et al. Tumour bed boost radiotherapy for women after breast-conserving surgery. Cochrane Database Syst Rev, 2017, 11(11): CD011987.
30.	Ryan JL. Ionizing radiation: the good, the bad, and the ugly. J Invest Dermatol, 2012, 132(3 Pt 2): 985-993.
31.	Coles CE, Moody AM, Wilson CB, et al. Reduction of radiotherapy-induced late complications in early breast cancer: the role of intensity-modulated radiation therapy and partial breast irradiation. Part Ⅱ—Radiotherapy strategies to reduce radiation-induced late effects. Clin Oncol (R Coll Radiol), 2005, 17(2): 98-110.
32.	Vidya R, Iqbal FM. A guide to prepectoral breast reconstruction: a new dimension to implant-based breast reconstruction. Clin Breast Cancer, 2017, 17(4): 266-271.
33.	Moyer HR, Pinell-White X, Losken A. The effect of radiation on acellular dermal matrix and capsule formation in breast reconstruction: clinical outcomes and histologic analysis. Plast Reconstr Surg, 2014, 133(2): 214-221.

1. 孙建伟, 刘春生, 赖明华, 等. 保留NAC的改良根治术并一期乳房重建术治疗早期乳腺癌的临床效果. 中国普通外科杂志, 2015, 24(11): 1530-1535.
2. EBCTCG (Early Breast Cancer Trialists’ Collaborative Group); McGale P, Taylor C, et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8 135 women in 22 randomised trials. Lancet, 2014, 383(9935): 2127-2135.
3. Magill LJ, Robertson FP, Jell G, et al. Determining the outcomes of post-mastectomy radiation therapy delivered to the definitive implant in patients undergoing one- and two-stage implant-based breast reconstruction: a systematic review and meta-analysis. J Plast Reconstr Aesthet Surg, 2017, 70(10): 1329-1335.
4. Berbers J, van Baardwijk A, Houben R, et al. ‘Reconstruction: before or after postmastectomy radiotherapy?’ A systematic review of the literature. Eur J Cancer, 2014, 50(16): 2752-2762.
5. Moher D, Liberati A, Tetzlaff J, et al. Reprint—preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Phys Ther, 2009, 89(9): 873-880.
6. Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
7. 岳亚玲. 即刻乳房再造后放疗对美容效果的影响及再造乳房放疗剂量分布的研究. 石家庄: 河北医科大学, 2013.
8. Benediktsson K, Perbeck L. Capsular contracture around saline-filled and textured subcutaneously-placed implants in irradiated and non-irradiated breast cancer patients: five years of monitoring of a prospective trial. J Plast Reconstr Aesthet Surg, 2006, 59(1): 27-34.
9. Cordeiro PG, Albornoz CR, McCormick B, et al. What is the optimum timing of postmastectomy radiotherapy in two-stage prosthetic reconstruction: radiation to the tissue expander or permanent implant? Plast Reconstr Surg, 2015, 135(6): 1509-1517.
10. Vandeweyer E, Deraemaecker R. Radiation therapy after immediate breast reconstruction with implants. Plast Reconstr Surg, 2000, 106(1): 56-58.
11. Nava MB, Pennati AE, Lozza L, et al. Outcome of different timings of radiotherapy in implant-based breast reconstructions. Plast Reconstr Surg, 2011, 128(2): 353-359.
12. Rella L, Telegrafo M, Nardone A, et al. MRI evaluation of post-mastectomy irradiated breast implants: prevalence and analysis of complications. Clin Radiol, 2015, 70(9): 948-953.
13. Cordeiro PG, Pusic AL, Disa JJ, et al. Irradiation after immediate tissue expander/implant breast reconstruction: outcomes, complications, aesthetic results, and satisfaction among 156 patients. Plast Reconstr Surg, 2004, 113(3): 877-881.
14. McCarthy CM, Pusic AL, Disa JJ, et al. Unilateral postoperative chest wall radiotherapy in bilateral tissue expander/implant reconstruction patients: a prospective outcomes analysis. Plast Reconstr Surg, 2005, 116(6): 1642-1647.
15. 路忠志, 肖春花, 李东生, 等. 放疗对上蒂横行腹直肌肌皮瓣乳房再造的影响. 中华普通外科杂志, 2015, 30(8): 627-630.
16. Zheng Y, Zhong M, Ni C, et al. Radiotherapy and nipple-areolar complex necrosis after nipple-sparing mastectomy: a systematic review and meta-analysis. Radiol Med, 2017, 122(3): 171-178.
17. Rochlin DH, Jeong AR, Goldberg L, et al. Postmastectomy radiation therapy and immediate autologous breast reconstruction: integrating perspectives from surgical oncology, radiation oncology, and plastic and reconstructive surgery. J Surg Oncol, 2015, 111(3): 251-257.
18. 杜向慧, 裘国勤. 乳腺癌术后乳房重建与放射治疗. 中华乳腺病杂志 (电子版), 2013, 7(1): 57-60.
19. Peled AW, Foster RD, Esserman LJ, et al. Increasing the time to expander-implant exchange after postmastectomy radiation therapy reduces expander-implant failure. Plast Reconstr Surg, 2012, 130(3): 503-509.
20. Spear SL, Masden D, Rao SS, et al. Long-term outcomes of failed prosthetic breast reconstruction. Ann Plast Surg, 2013, 71(3): 286-291.
21. Ho AL, Bovill ES, Macadam SA, et al. Postmastectomy radiation therapy after immediate two-stage tissue expander/implant breast reconstruction: a University of British Columbia perspective. Plast Reconstr Surg, 2014, 134(1): 1e-10e.
22. 钟志如. 乳房切除术后放疗对植入物乳房重建手术影响的Meta分析. 南昌: 南昌大学, 2020.
23. Tan BK, Chim H, Ng ZY, et al. Aesthetic design of skin-sparing mastectomy incisions for immediate autologous tissue breast reconstruction in asian women. Arch Plast Surg, 2014, 41(4): 366-373.
24. 李文涛. 乳腺癌综合治疗对乳房重建的影响. 中华实用诊断与治疗杂志, 2019, 33(8): 729-731.
25. Zhong T, Hu J, Bagher S, et al. A comparison of psychological response, body image, sexuality, and quality of life between immediate and delayed autologous tissue breast reconstruction: a prospective long-term outcome study. Plast Reconstr Surg, 2016, 138(4): 772-780.
26. Khouri RK Jr, Khouri RK. Current clinical applications of fat grafting. Plast Reconstr Surg, 2017, 140(3): 466e-486e.
27. Bennett KG, Qi J, Kim HM, et al. Comparison of 2-year complication rates among common techniques for postmastectomy breast reconstruction. JAMA Surg, 2018, 153(10): 901-908.
28. Donovan E, Bleakley N, Denholm E, et al. Randomised trial of standard 2D radiotherapy (RT) versus intensity modulated radiotherapy (IMRT) in patients prescribed breast radiotherapy. Radiother Oncol, 2007, 82(3): 254-264.
29. Kindts I, Laenen A, Depuydt T, et al. Tumour bed boost radiotherapy for women after breast-conserving surgery. Cochrane Database Syst Rev, 2017, 11(11): CD011987.
30. Ryan JL. Ionizing radiation: the good, the bad, and the ugly. J Invest Dermatol, 2012, 132(3 Pt 2): 985-993.
31. Coles CE, Moody AM, Wilson CB, et al. Reduction of radiotherapy-induced late complications in early breast cancer: the role of intensity-modulated radiation therapy and partial breast irradiation. Part Ⅱ—Radiotherapy strategies to reduce radiation-induced late effects. Clin Oncol (R Coll Radiol), 2005, 17(2): 98-110.
32. Vidya R, Iqbal FM. A guide to prepectoral breast reconstruction: a new dimension to implant-based breast reconstruction. Clin Breast Cancer, 2017, 17(4): 266-271.
33. Moyer HR, Pinell-White X, Losken A. The effect of radiation on acellular dermal matrix and capsule formation in breast reconstruction: clinical outcomes and histologic analysis. Plast Reconstr Surg, 2014, 133(2): 214-221.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The effects of post mastectomy radiation therapy to breast reconstruction: a systematic review and meta-analysis

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