Post-Mastectomy Radiation Associated With Increased Complications for Some Patients

Reshma Jagsi, MD, DPhil

Patients with breast cancer who received radiation therapy after undergoing a mastectomy reported increased complications and lower satisfaction, according to the results of a large, multicenter study, which were presented at the 2016 San Antonio Breast Cancer Symposium (SABCS).

Women diagnosed with early-stage breast cancer face several challenging decisions that will affect their long-term disease control and quality of life, says study author Reshma Jagsi, MD, DPhil. Jagsi, who is a professor and deputy chair in the Department of Radiation Oncology at the University of Michigan, presented these data at SABCS.

“Many patients must still decide whether they feel that the benefits, given their particular circumstances, outweigh the risks,” said Jagsi. “One of the risks of radiation therapy is that it may affect the options and outcomes for breast reconstruction, which many women who receive mastectomy desire.”

The Mastectomy Reconstruction Outcomes Consortium study collected medical and patient-reported outcomes data from women who were a median age of 49 and diagnosed with breast cancer and elected different types of reconstruction between 2012 and 2015: 553 of these patients received radiotherapy and 1461 patients did not. Thirty-eight percent of women who received radiation and 25% who did not had autologous reconstruction, with remaining patients undergoing implant reconstruction.

From there, researchers determined whether radiotherapy was associated with complications developed post-reconstruction, such as hematoma or wound infection. They also measured patient satisfaction using a BREAST-Q patient-reported outcome instrument, 1 and 2 years after reconstruction.

At 1 year of follow-up, 28.8% of patients who had radiotherapy and 22.3% who did not, had at least 1 of the measured complications. At 2 years of follow up, 34.1% and 22.5% of those who did and did not receive radiotherapy, respectively, experienced a complication with their breast reconstruction.

After accounting for several variables, the researchers determined that radiotherapy was linked to more than double the odds of developing complications in patients who received implants. However, for those patients who received autologous reconstruction, radiotherapy was not associated with complications.

Additionally, the BREAST-Q scores of patients who had received radiation showed significantly lower patient-reported satisfaction than those of the patients who did not receive radiation. Once more, these differences were not shown among the patients with autologous reconstruction.

Patients who undergo mastectomy often become long-term survivors, meaning that breast reconstruction can have a lasting impact on their quality of life. Currently, well-established approaches to integrate post-mastectomy radiotherapy and breast reconstruction are lacking, noted Jagsi.

“Although women must still weigh multiple factors, including the differences in operative time and rehabilitation required for different approaches when selecting their preferred type of reconstruction, those who plan to receive post-mastectomy radiation therapy should be informed of the substantial and significant impact of radiotherapy observed in the current study among patients who received implant reconstruction.”

On the other hand, she added that those patients who intended to pursue autologous reconstruction could be reassured by these findings insofar as, “outcomes among patients receiving autologous reconstruction did not appear substantially worse than those of unirradiated patients by 2 years.”

Researchers noted that because these findings are from an observational study, a cause—effect relationship cannot be established. Additionally, patients who were treated at centers particularly skilled at integrating implant-based approaches with radiotherapy could still do well with such an approach.

Jagsi R, Momoh AO, Qi J, et al. Impact of radiotherapy and patient-reported satisfaction with breast reconstruction: findings from the prospective multicenter MROC study. Presented at: 2016 San Antonio Breast Cancer Symposium; December 6-10, 2016; San Antonio, TX. Abstract S3-07.