Anatomical assessment of local recurrence site in breast cancer patients after breast reconstruction and post-mastectomy radiotherapy: implications for radiation volumes and techniques.

Local regional relapse Post-mastectomy radiotherapy Target volume

Journal

La Radiologia medica
ISSN: 1826-6983
Titre abrégé: Radiol Med
Pays: Italy
ID NLM: 0177625

Informations de publication

Date de publication:
11 Apr 2024
Historique:
received: 26 06 2023
accepted: 19 03 2024
medline: 11 4 2024
pubmed: 11 4 2024
entrez: 11 4 2024
Statut: aheadofprint

Résumé

Post-mastectomy radiotherapy (PMRT) improves local control rates and survival in patients with adverse prognostic features. The dose coverage to target volumes is critical to yield maximum benefit to treated patients, increasing local control and reducing risk of toxicity. This study aims to assess patterns of breast cancer relapse in patients treated with mastectomy, breast reconstruction and PMRT. Breast cancer patients treated with PMRT between 1992 and 2017 were retrospectively reviewed. Clinical and pathological characteristics of patients were collected. Recurrences were defined as "in field," "marginal" or "out of field." Survival analyses were performed in relation to progression-free survival (PFS) and overall survival (OS). Correlation between baseline features was explored. Data of 140 patients are collected. After a median follow-up time of 72 months, median PFS and OS of 63 and 74 months were detected, respectively. Neoadjuvant chemotherapy, lympho-vascular space invasion (LVI) and size of primary tumor were all significantly associated with worst PFS and OS. Ten patients developed local recurrence: 30% "in field," 30% marginal recurrences, 20% "out of field" and 20% both "in field" and "out of field." No recurrence was detected under the expander, 80% above the device and 20% patients relapsed on IMN chain. The mean distant relapse-free survival was 39 months. Overall, 39 of 140 patients developed distant metastases. The onset of local-regional relapses occurred mainly above the expander/prosthesis, underlying the importance of inclusion of the subcutaneous tissues within the target volume. In order to refine new contouring recommendations for PMRT and breast reconstruction, future prospective studies are needed.

Identifiants

DOI: 10.1007/s11547-024-01812-z PMID: 38602657
pubmed: 38602657
doi: 10.1007/s11547-024-01812-z
pii: 10.1007/s11547-024-01812-z
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2024. The Author(s).

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Auteurs

Viola Salvestrini (V)

Radiation Oncology Unit, Oncology Department, Careggi University Hospital, Viale Morgagni 85, 50134, Florence, Italy. salvestrini.viola@gmail.com.
ORCID: 0000-0002-9793-500X

Marianna Valzano (M)

Radiation Oncology Unit, Oncology Department, Careggi University Hospital, Viale Morgagni 85, 50134, Florence, Italy.
Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy.

Icro Meattini (I)

Radiation Oncology Unit, Oncology Department, Careggi University Hospital, Viale Morgagni 85, 50134, Florence, Italy.
Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy.

Carlotta Becherini (C)

Radiation Oncology Unit, Oncology Department, Careggi University Hospital, Viale Morgagni 85, 50134, Florence, Italy.

Luca Visani (L)

Radiation Oncology Unit, Oncology Department, Careggi University Hospital, Viale Morgagni 85, 50134, Florence, Italy.

Giulio Francolini (G)

Radiation Oncology Unit, Oncology Department, Careggi University Hospital, Viale Morgagni 85, 50134, Florence, Italy.

Ilaria Morelli (I)

Radiation Oncology Unit, Oncology Department, Careggi University Hospital, Viale Morgagni 85, 50134, Florence, Italy.
Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy.

Niccolò Bertini (N)

Radiation Oncology Unit, Oncology Department, Careggi University Hospital, Viale Morgagni 85, 50134, Florence, Italy.
Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy.

Lorenzo Orzalesi (L)

Breast Surgery Unit, Careggi University Hospital, Florence, Italy.

Marco Bernini (M)

Breast Surgery Unit, Careggi University Hospital, Florence, Italy.

Simonetta Bianchi (S)

Division of Pathological Anatomy, Department of Health Sciences, University of Florence, Florence, Italy.

Gabriele Simontacchi (G)

Radiation Oncology Unit, Oncology Department, Careggi University Hospital, Viale Morgagni 85, 50134, Florence, Italy.

Lorenzo Livi (L)

Radiation Oncology Unit, Oncology Department, Careggi University Hospital, Viale Morgagni 85, 50134, Florence, Italy.
Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy.

Isacco Desideri (I)

Radiation Oncology Unit, Oncology Department, Careggi University Hospital, Viale Morgagni 85, 50134, Florence, Italy.
Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy.

Classifications MeSH