Breast reconstruction and post-mastectomy radiation practice

• Type of Material: Article
• Authors: Susie A. Chen, University of Texas; Crispin Hiley, The Institute of Cancer Research; Dana Nickleach, Emory University; Janjira Petsuksiri, Mahidol University; Fundagul Andic, Cukurova University; Oliver Riesterer, University Hospital Zurich; Jeffrey M. Switchenko, Emory University; Mylin Torres, Emory University
• Language: English
• Date: 2013-03-02
• Publisher: BioMed Central
• Publication Version: Final Published Version
• Copyright Statement: © 2013 Chen et al; licensee BioMed Central Ltd.
• License: Creative Commons Attribution 2.0 Generic
• Final Published Version (URL): http://www.ro-journal.com/content/8/1/45
• Title of Journal or Parent Work: Radiation Oncology
• ISSN: 1748-717X
• Volume: 8
• Issue: 45
• Start Page: 1
• End Page: 9
• Research Categories: Health Sciences, Oncology

Abstract

Purpose The goal of this study was to explore the perspectives and practice of radiation oncologists who treat breast cancer patients who have had breast reconstruction. Methods In 2010, an original electronic survey was sent to all physician members of the American Society of Radiation Oncology, National Cancer Research Institute-Breast Cancer Studies Group in the United Kingdom, Thai Society of Therapeutic Radiology and Oncology, Swiss Society of Radiation Oncology, and Turkish Radiation Oncology Society. We identified factors associated with radiation oncologists who treat breast cancer patients with reconstruction performed prior to radiation and obtained information regarding radiation management of the breast reconstruction. Results 358 radiation oncologists responded, and 60% of the physicians were from the United States. While 64% of participants agree or strongly agree that breast image affects a woman’s quality of life during radiation, 57% feel that reconstruction challenges their ability to deliver effective breast radiation. Compared with other countries, treatment within the United States was associated with a high reconstruction rate (>/= 50% of mastectomy patients) prior to radiation (p < 0.05). Delayed-immediate reconstruction with a temporary tissue expander was more common in the United States than in other countries (52% vs. 23%, p = 0.01). Among physicians who treat patients with tissue expanders, the majority (60%) prefer a moderately inflated implant with 150-250 cc of fluid rather than a completely deflated (13%) or inflated expander (28%) during radiation. Among radiation oncologists who treat reconstructions, 49% never use bolus and 40% never boost a breast reconstruction. United States physicians were more likely than physicians from other countries to boost or bolus the reconstruction irrespective of the type of reconstruction seen in their clinic patients (p < 0.01). Conclusions Great variation in practice is evident from our study of radiation treatment for breast cancer patients with reconstruction. Further research on the impact and delivery of radiation to a reconstructed breast may validate some of the observed practices, highlight the variability in treatment practice, and help create a treatment consensus.