Are Radiation Target Volumes for Postmastectomy Radiation Therapy Too Large? Initial Report of the Complication Avoidance of Reconstruction Implant Radiation Therapy (CARIT) Study
Following mastectomy for breast cancer, women may choose implant-based reconstruction for many reasons, such as cosmesis, self-identity, and the ability to wear particular items of clothing. However, postmastectomy radiation therapy (PMRT) can compromise these cosmetic goals, including as much as a...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-02-01
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| Series: | Current Oncology |
| Subjects: | |
| Online Access: | https://www.mdpi.com/1718-7729/30/2/175 |
| _version_ | 1797621569438089216 |
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| author | Aruni Jayatilaka Ashira Lokhandwala Kimya Manouchehri Muriel Brackstone Michael Lock |
| author_facet | Aruni Jayatilaka Ashira Lokhandwala Kimya Manouchehri Muriel Brackstone Michael Lock |
| author_sort | Aruni Jayatilaka |
| collection | DOAJ |
| description | Following mastectomy for breast cancer, women may choose implant-based reconstruction for many reasons, such as cosmesis, self-identity, and the ability to wear particular items of clothing. However, postmastectomy radiation therapy (PMRT) can compromise these cosmetic goals, including as much as a 40% loss of implant rate. To minimize the risk of radiation toxicity, it is important to consider how clinical target volumes (CTVs) can be optimized in PMRT to preserve the implant and reduce complications. Typically, guidelines from organizations such as the Radiation Oncology Group are used, which include regions previously encompassed by tangential fields. This includes all structures below the pectoralis muscle, such as the chest wall, where the risk of recurrence is negligible; this technique often requires incidental inclusion of portions of the lung and heart plus circumferential radiation of the implant. We present the preliminary single institution case series of a technique of complication avoidance of reconstruction implant radiation therapy, called CARIT, where the chest wall, and a large proportion of the implant, is not irradiated. In a retrospective review of 30 cases in which CARIT has been attempted, it was found that 24% of patients treated required a second surgery due to Baker grade III/IV capsular contracture. Using the Modified Harvard Harris Cosmetic Scale, 66.5% of patients had cosmetic outcomes rated as “good” or “excellent”. CARIT could offer a technique to reduce complications in postmastectomy implant-based reconstruction patients, with our next steps focusing on improving dosimetry, and formally comparing the cosmesis and tumor control aspects with commonly used techniques. |
| first_indexed | 2024-03-11T08:57:52Z |
| format | Article |
| id | doaj.art-5f17b0089be446b387d97bf17a090b20 |
| institution | Directory Open Access Journal |
| issn | 1198-0052 1718-7729 |
| language | English |
| last_indexed | 2024-03-11T08:57:52Z |
| publishDate | 2023-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Current Oncology |
| spelling | doaj.art-5f17b0089be446b387d97bf17a090b202023-11-16T19:58:23ZengMDPI AGCurrent Oncology1198-00521718-77292023-02-013022271227610.3390/curroncol30020175Are Radiation Target Volumes for Postmastectomy Radiation Therapy Too Large? Initial Report of the Complication Avoidance of Reconstruction Implant Radiation Therapy (CARIT) StudyAruni Jayatilaka0Ashira Lokhandwala1Kimya Manouchehri2Muriel Brackstone3Michael Lock4Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, CanadaSchulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, CanadaSchulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, CanadaDepartment of Oncology, London Regional Cancer Program, London, ON N6A 5W9, CanadaDepartment of Oncology, London Regional Cancer Program, London, ON N6A 5W9, CanadaFollowing mastectomy for breast cancer, women may choose implant-based reconstruction for many reasons, such as cosmesis, self-identity, and the ability to wear particular items of clothing. However, postmastectomy radiation therapy (PMRT) can compromise these cosmetic goals, including as much as a 40% loss of implant rate. To minimize the risk of radiation toxicity, it is important to consider how clinical target volumes (CTVs) can be optimized in PMRT to preserve the implant and reduce complications. Typically, guidelines from organizations such as the Radiation Oncology Group are used, which include regions previously encompassed by tangential fields. This includes all structures below the pectoralis muscle, such as the chest wall, where the risk of recurrence is negligible; this technique often requires incidental inclusion of portions of the lung and heart plus circumferential radiation of the implant. We present the preliminary single institution case series of a technique of complication avoidance of reconstruction implant radiation therapy, called CARIT, where the chest wall, and a large proportion of the implant, is not irradiated. In a retrospective review of 30 cases in which CARIT has been attempted, it was found that 24% of patients treated required a second surgery due to Baker grade III/IV capsular contracture. Using the Modified Harvard Harris Cosmetic Scale, 66.5% of patients had cosmetic outcomes rated as “good” or “excellent”. CARIT could offer a technique to reduce complications in postmastectomy implant-based reconstruction patients, with our next steps focusing on improving dosimetry, and formally comparing the cosmesis and tumor control aspects with commonly used techniques.https://www.mdpi.com/1718-7729/30/2/175postmastectomy radiation therapyclinical target volumescapsular contracturecosmesis |
| spellingShingle | Aruni Jayatilaka Ashira Lokhandwala Kimya Manouchehri Muriel Brackstone Michael Lock Are Radiation Target Volumes for Postmastectomy Radiation Therapy Too Large? Initial Report of the Complication Avoidance of Reconstruction Implant Radiation Therapy (CARIT) Study Current Oncology postmastectomy radiation therapy clinical target volumes capsular contracture cosmesis |
| title | Are Radiation Target Volumes for Postmastectomy Radiation Therapy Too Large? Initial Report of the Complication Avoidance of Reconstruction Implant Radiation Therapy (CARIT) Study |
| title_full | Are Radiation Target Volumes for Postmastectomy Radiation Therapy Too Large? Initial Report of the Complication Avoidance of Reconstruction Implant Radiation Therapy (CARIT) Study |
| title_fullStr | Are Radiation Target Volumes for Postmastectomy Radiation Therapy Too Large? Initial Report of the Complication Avoidance of Reconstruction Implant Radiation Therapy (CARIT) Study |
| title_full_unstemmed | Are Radiation Target Volumes for Postmastectomy Radiation Therapy Too Large? Initial Report of the Complication Avoidance of Reconstruction Implant Radiation Therapy (CARIT) Study |
| title_short | Are Radiation Target Volumes for Postmastectomy Radiation Therapy Too Large? Initial Report of the Complication Avoidance of Reconstruction Implant Radiation Therapy (CARIT) Study |
| title_sort | are radiation target volumes for postmastectomy radiation therapy too large initial report of the complication avoidance of reconstruction implant radiation therapy carit study |
| topic | postmastectomy radiation therapy clinical target volumes capsular contracture cosmesis |
| url | https://www.mdpi.com/1718-7729/30/2/175 |
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