Implant-based reconstruction and adjuvant radiotherapy in breast cancer patients-current status and DEGRO recommendations.
M D Piroth, D Krug, R Baumann, V Strnad, K Borm, S Combs, S Corradini, M N Duma, J Dunst, G Fastner, P Feyer, R Fietkau, W Harms, T Hehr, J Hörner-Rieber, C Matuschek, C Schmeel, W Budach, Breast Cancer Expert Panel of the German Society of Radiation Oncology (DEGRO)
Author Information
M D Piroth: Department of Radiation Oncology, HELIOS University Hospital Wuppertal, Witten/Herdecke University, Heusnerstraße 40, 42283, Wuppertal, Germany. marc.piroth@helios-gesundheit.de. ORCID
D Krug: Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
R Baumann: Department of Radiation Oncology, St. Marien-Krankenhaus, Siegen, Germany.
V Strnad: Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany.
K Borm: TUM School of Medicine, Department of Radiation Oncology, Technical University of Munich, Munich, Germany.
S Combs: TUM School of Medicine, Department of Radiation Oncology, Technical University of Munich, Munich, Germany.
S Corradini: Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.
M N Duma: Department of Radiation Oncology, Helios Clinics of Schwerin-University Campus of MSH Medical School Hamburg, Schwerin, Germany.
J Dunst: Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany.
G Fastner: Department of Radiotherapy and Radio-Oncology, University Hospital Salzburg, Landeskrankenhaus, Paracelsus Medical University, Salzburg, Austria.
P Feyer: Formerly Department of Radiation Oncology, Vivantes Hospital Neukölln, Berlin, Germany.
R Fietkau: Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany.
W Harms: Department of Radiation Oncology, St. Claraspital, Basel, Switzerland.
T Hehr: Department of Radiation Oncology, Marienhospital Stuttgart, Stuttgart, Germany.
J Hörner-Rieber: Department of Radiation Oncology, University Hospital Düsseldorf, Düsseldorf, Germany.
C Matuschek: Department of Radiotherapy and Radiation Oncology, Bielefeld University, Medical School and University Medical Center OWL, Campus Klinikum Mitte, Bielefeld, Germany.
C Schmeel: Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany.
W Budach: Department of Radiation Oncology, University Hospital Düsseldorf, Düsseldorf, Germany.
PURPOSE: The aim of this review is to give an overview of the results of prospective and retrospective studies using allogenic reconstruction and postmastectomy radiotherapy (PMRT) in breast cancer and to make recommendations regarding this interdisciplinary approach. MATERIALS AND METHODS: A PubMed search was conducted to extract relevant articles from 2000 to 2024. The search was performed using the following terms: (breast cancer) AND (reconstruction OR implant OR expander) AND (radiotherapy OR radiation). Data from the literature on allogenic breast reconstruction and radiation are presented and discussed in relation to toxicity and cosmesis. CONCLUSION AND RECOMMENDATIONS: Breast reconstruction is also feasible if PMRT is necessary. Patients need to be informed about the relevant risk of capsular fibrosis and implant failure. A planned reconstruction is no reason to forgo PMRT nor is an indication for PMRT a reason to forego implant-based breast reconstruction if desired by the patient. It is important to provide detailed information here to enable shared decision-making. There is still no clear consensus regarding implant-based reconstruction (IBR) and PMRT. However, in clinical practice, both a one-stage (immediate "implant-direct" IBR) procedure with PMRT up to the final implant and a two-stage (immediate-delayed IBR) procedure with PMRT up to the tissue expander (TE) and later exchange of the TE are used; both approaches have their specific advantages and disadvantages. Depending on patient-specific factors and the surgeon's experience and estimates, both IBR procedures are also possible in combination with PMRT. When using a TE/implant approach, completing skin stretching by adequately filling the expander before PMRT may be favorable. This approach is particularly practical when adjuvant chemotherapy is planned but may lead to postponement of radiotherapy when primary systemic therapy is given. According to the latest data, moderate hypofractionation also appears to be safe in the context of the IBR approach. It is important to have a closely coordinated interdisciplinary approach and to fully inform patients about the increased rate of potential side effects.
