Influence of Radiation Dose to Reconstructed Breast Following Mastectomy on Complication in Breast Cancer Patients Undergoing Two-Stage Prosthetic Breast Reconstruction
Purpose: This study investigated the association between radiation dose and complication rate in patients who underwent breast reconstruction to understand the role of radiation hypofractionated regimen, boost radiation therapy (RT), and RT techniques.Methods: We retrospectively evaluated 75 patient...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2019-04-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fonc.2019.00243/full |
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| author | Jee Suk Chang Seung Yong Song Joo Hyun Oh Dae Hyun Lew Tai Suk Roh Se Young Kim Ki Chang Keum Dong Won Lee Yong Bae Kim |
| author_facet | Jee Suk Chang Seung Yong Song Joo Hyun Oh Dae Hyun Lew Tai Suk Roh Se Young Kim Ki Chang Keum Dong Won Lee Yong Bae Kim |
| author_sort | Jee Suk Chang |
| collection | DOAJ |
| description | Purpose: This study investigated the association between radiation dose and complication rate in patients who underwent breast reconstruction to understand the role of radiation hypofractionated regimen, boost radiation therapy (RT), and RT techniques.Methods: We retrospectively evaluated 75 patients treated with post-mastectomy adjuvant RT for breast cancer in the setting of two-stage prosthetic breast reconstruction. Near maximum radiation dose (Dmax) in the 2 or 0.03 cc of reconstructed breast or overlying breast skin was obtained from dose-volume histograms.Results: Post-RT complications occurred in 22.7% of patients. Receiver operating characteristic analysis showed that all near Dmax parameters were able to predict complication risk, which retained statistical significance after adjusting other variables (odds ratio 1.12 per Gy, 95% confidence interval 1.02–1.23) with positive dose-response relationship. In multiple linear regression model (R2 = 0.92), conventional fractionation (β = 11.7) and 16 fractions in 2.66 Gy regimen (β = 3.9) were the major determinants of near Dmax compared with 15 fractions in 2.66 Gy regimen, followed by utilization of boost RT (β = 3.2). The effect of bolus and dose inhomogeneity seemed minor (P > 0.05). The location of hot spot was not close to the high density metal area of the expander, but close to the surrounding areas of partially deflated expander bag.Conclusions: This study is the first to demonstrate a dose-response relationship between risk of complications and near Dmax, where hypofractionated regimen or boost RT can play an important role. Rigorous RT-quality assurance program and modification of dose constraints could be considered as a critically important component for ongoing trials of hypofractionation. Based on our findings, we initiated a multi-center retrospective study (KROG 18-04) and a prospective study (NCT03523078) to validate our findings. |
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| id | doaj.art-1c957bb191b04799bd473abe893d776a |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-12T22:23:49Z |
| publishDate | 2019-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-1c957bb191b04799bd473abe893d776a2022-12-22T00:09:49ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2019-04-01910.3389/fonc.2019.00243430590Influence of Radiation Dose to Reconstructed Breast Following Mastectomy on Complication in Breast Cancer Patients Undergoing Two-Stage Prosthetic Breast ReconstructionJee Suk Chang0Seung Yong Song1Joo Hyun Oh2Dae Hyun Lew3Tai Suk Roh4Se Young Kim5Ki Chang Keum6Dong Won Lee7Yong Bae Kim8Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South KoreaDepartment of Plastic and Reconstructive Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South KoreaDepartment of Plastic and Reconstructive Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South KoreaDepartment of Plastic and Reconstructive Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South KoreaDepartment of Plastic and Reconstructive Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South KoreaDepartment of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South KoreaDepartment of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South KoreaDepartment of Plastic and Reconstructive Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South KoreaDepartment of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South KoreaPurpose: This study investigated the association between radiation dose and complication rate in patients who underwent breast reconstruction to understand the role of radiation hypofractionated regimen, boost radiation therapy (RT), and RT techniques.Methods: We retrospectively evaluated 75 patients treated with post-mastectomy adjuvant RT for breast cancer in the setting of two-stage prosthetic breast reconstruction. Near maximum radiation dose (Dmax) in the 2 or 0.03 cc of reconstructed breast or overlying breast skin was obtained from dose-volume histograms.Results: Post-RT complications occurred in 22.7% of patients. Receiver operating characteristic analysis showed that all near Dmax parameters were able to predict complication risk, which retained statistical significance after adjusting other variables (odds ratio 1.12 per Gy, 95% confidence interval 1.02–1.23) with positive dose-response relationship. In multiple linear regression model (R2 = 0.92), conventional fractionation (β = 11.7) and 16 fractions in 2.66 Gy regimen (β = 3.9) were the major determinants of near Dmax compared with 15 fractions in 2.66 Gy regimen, followed by utilization of boost RT (β = 3.2). The effect of bolus and dose inhomogeneity seemed minor (P > 0.05). The location of hot spot was not close to the high density metal area of the expander, but close to the surrounding areas of partially deflated expander bag.Conclusions: This study is the first to demonstrate a dose-response relationship between risk of complications and near Dmax, where hypofractionated regimen or boost RT can play an important role. Rigorous RT-quality assurance program and modification of dose constraints could be considered as a critically important component for ongoing trials of hypofractionation. Based on our findings, we initiated a multi-center retrospective study (KROG 18-04) and a prospective study (NCT03523078) to validate our findings.https://www.frontiersin.org/article/10.3389/fonc.2019.00243/fullbreast reconstructionmastectomyimplantradiation dosehypofractionated RTdosimetric analysis |
| spellingShingle | Jee Suk Chang Seung Yong Song Joo Hyun Oh Dae Hyun Lew Tai Suk Roh Se Young Kim Ki Chang Keum Dong Won Lee Yong Bae Kim Influence of Radiation Dose to Reconstructed Breast Following Mastectomy on Complication in Breast Cancer Patients Undergoing Two-Stage Prosthetic Breast Reconstruction Frontiers in Oncology breast reconstruction mastectomy implant radiation dose hypofractionated RT dosimetric analysis |
| title | Influence of Radiation Dose to Reconstructed Breast Following Mastectomy on Complication in Breast Cancer Patients Undergoing Two-Stage Prosthetic Breast Reconstruction |
| title_full | Influence of Radiation Dose to Reconstructed Breast Following Mastectomy on Complication in Breast Cancer Patients Undergoing Two-Stage Prosthetic Breast Reconstruction |
| title_fullStr | Influence of Radiation Dose to Reconstructed Breast Following Mastectomy on Complication in Breast Cancer Patients Undergoing Two-Stage Prosthetic Breast Reconstruction |
| title_full_unstemmed | Influence of Radiation Dose to Reconstructed Breast Following Mastectomy on Complication in Breast Cancer Patients Undergoing Two-Stage Prosthetic Breast Reconstruction |
| title_short | Influence of Radiation Dose to Reconstructed Breast Following Mastectomy on Complication in Breast Cancer Patients Undergoing Two-Stage Prosthetic Breast Reconstruction |
| title_sort | influence of radiation dose to reconstructed breast following mastectomy on complication in breast cancer patients undergoing two stage prosthetic breast reconstruction |
| topic | breast reconstruction mastectomy implant radiation dose hypofractionated RT dosimetric analysis |
| url | https://www.frontiersin.org/article/10.3389/fonc.2019.00243/full |
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