Mastectomy with immediate expander-implant reconstruction, adjuvant chemotherapy, and radiation for stage II-III breast cancer: Treatment intervals and clinical outcomes Journal Article
| Authors: | Wright, J. L.; Cordeiro, P. G.; Ben-Porat, L.; Van Zee, K. J.; Hudis, C.; Beal, K.; McCormick, B. |
| Article Title: | Mastectomy with immediate expander-implant reconstruction, adjuvant chemotherapy, and radiation for stage II-III breast cancer: Treatment intervals and clinical outcomes |
| Abstract: | Purpose: To determine intervals between surgery and adjuvant chemotherapy and radiation in patients treated with mastectomy with immediate expander-implant reconstruction, and to evaluate locoregional and distant control and overall survival in these patients. Methods and Materials: Between May 1996 and March 2004, 104 patients with Stage II-III breast cancer were routinely treated at our institution under the following algorithm: (1) definitive mastectomy with axillary lymph node dissection and immediate tissue expander placement, (2) tissue expansion during chemotherapy, (3) exchange of tissue expander for permanent implant, (4) radiation. Patient, disease, and treatment characteristics and clinical outcomes were retrospectively evaluated. Results: Median age was 45 years. Twenty-six percent of patients were Stage II and 74% Stage III. All received adjuvant chemotherapy. Estrogen receptor staining was positive in 77%, and 78% received hormone therapy. Radiation was delivered to the chest wall with daily 0.5-cm bolus and to the supraclavicular fossa. Median dose was 5040 cGy. Median interval from surgery to chemotherapy was 5 weeks, from completion of chemotherapy to exchange 4 weeks, and from exchange to radiation 4 weeks. Median interval from completion of chemotherapy to start of radiation was 8 weeks. Median follow-up was 64 months from date of mastectomy. The 5-year rate for locoregional disease control was 100%, for distant metastasis-free survival 90%, and for overall survival 96%. Conclusions: Mastectomy with immediate expander-implant reconstruction, adjuvant chemotherapy, and radiation results in a median interval of 8 weeks from completion of chemotherapy to initiation of radiation and seems to be associated with acceptable 5-year locoregional control, distant metastasis-free survival, and overall survival. © 2008 Elsevier Inc. All rights reserved. |
| Keywords: | survival; adult; cancer survival; treatment outcome; aged; middle aged; survival analysis; cancer surgery; retrospective studies; major clinical study; overall survival; surgical flaps; doxorubicin; fluorouracil; advanced cancer; multimodality cancer therapy; paclitaxel; cancer adjuvant therapy; cancer radiotherapy; radiation dose; chemotherapy, adjuvant; chemotherapy; methotrexate; follow up; lymph node dissection; neoplasm staging; lymph node excision; breast cancer; mastectomy; antineoplastic combined chemotherapy protocols; radiotherapy dosage; recurrence; cyclophosphamide; patient monitoring; breast neoplasms; breast reconstruction; mammaplasty; oncology; algorithms; tissue expansion; distant metastasis; time factors; cancer hormone therapy; axillary lymph node; dosimetry; adjuvant chemotherapy; epirubicin; receptors, estrogen; breast endoprosthesis; breast implants; estrogen receptor; trastuzumab; analysis of variance; biological organs; image reconstruction; immediate reconstruction; postmastectomy radiation; implants (surgical) |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 70 |
| Issue: | 1 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2008-01-01 |
| Start Page: | 43 |
| End Page: | 50 |
| Language: | English |
| DOI: | 10.1016/j.ijrobp.2007.05.032 |
| PUBMED: | 17855006 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 13" - "Export Date: 17 November 2011" - "CODEN: IOBPD" - "Source: Scopus" |
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