Quantifying the impact of immediate reconstruction in postmastectomy radiation: A large, dose-volume histogram-based analysis Journal Article


Authors: Ohri, N.; Cordeiro, P. G.; Keam, J.; Ballangrud, A.; Shi, W.; Zhang, Z.; Nerbun, C. T.; Woch, K. M.; Stein, N. F.; Zhou, Y.; McCormick, B.; Powell, S. N.; Ho, A. Y.
Article Title: Quantifying the impact of immediate reconstruction in postmastectomy radiation: A large, dose-volume histogram-based analysis
Abstract: Purpose: To assess the impact of immediate breast reconstruction on postmastectomy radiation (PMRT) using dose-volume histogram (DVH) data. Methods and Materials: Two hundred forty-seven women underwent PMRT at our center, 196 with implant reconstruction and 51 without reconstruction. Patients with reconstruction were treated with tangential photons, and patients without reconstruction were treated with en-face electron fields and customized bolus. Twenty percent of patients received internal mammary node (IMN) treatment. The DVH data were compared between groups. Ipsilateral lung parameters included V20 (% volume receiving 20 Gy), V40 (% volume receiving 40 Gy), mean dose, and maximum dose. Heart parameters included V25 (% volume receiving 25 Gy), mean dose, and maximum dose. IMN coverage was assessed when applicable. Chest wall coverage was assessed in patients with reconstruction. Propensity-matched analysis adjusted for potential confounders of laterality and IMN treatment. Results: Reconstruction was associated with lower lung V20, mean dose, and maximum dose compared with no reconstruction (all P<.0001). These associations persisted on propensity-matched analysis (all P<.0001). Heart doses were similar between groups (P=NS). Ninety percent of patients with reconstruction had excellent chest wall coverage (D95 >98%). IMN coverage was superior in patients with reconstruction (D95 >92.0 vs 75.7%, P<.001). IMN treatment significantly increased lung and heart parameters in patients with reconstruction (all P<.05) but minimally affected those without reconstruction (all P>.05). Among IMN-treated patients, only lower lung V20 in those without reconstruction persisted (P=.022), and mean and maximum heart doses were higher than in patients without reconstruction (P=.006, P=.015, respectively). Conclusions: Implant reconstruction does not compromise the technical quality of PMRT when the IMNs are untreated. Treatment technique, not reconstruction, is the primary determinant of target coverage and normal tissue doses. © 2012 Elsevier Inc. © 2012 Elsevier Inc.
Keywords: major clinical study; cancer radiotherapy; radiation dose; mastectomy; cohort analysis; breast reconstruction; statistical significance; lung; patient treatment; normal tissue; thorax wall; biological organs; heart; tissue; histogram; mean dose; internal mammary nodes; chest wall; dose-volume; graphic methods; target coverage; treatment techniques; dose volume histogram; postmastectomy radiation therapy; dose-volume histograms; electron field; ipsilateral lungs; technical quality
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 84
Issue: 2
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2012-10-01
Start Page: e153
End Page: e159
Language: English
DOI: 10.1016/j.ijrobp.2012.03.026
PROVIDER: scopus
PUBMED: 22560544
DOI/URL:
Notes: --- - "Export Date: 1 October 2012" - "CODEN: IOBPD" - "Source: Scopus"
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MSK Authors
  1. Alice Yoosun Ho
    115 Ho
  2. Zhigang Zhang
    261 Zhang
  3. Simon Nicholas Powell
    188 Powell
  4. Weiji Shi
    120 Shi
  5. Claire T Nerbun
    3 Nerbun
  6. Ying Zhou
    20 Zhou
  7. Nicholas F Stein
    4 Stein
  8. Peter G Cordeiro
    251 Cordeiro
  9. Jennifer Choi Keam
    8 Keam
  10. Katherine Marie Woch
    3 Woch
  11. Beryl McCormick
    283 McCormick
  12. Nisha Ohri
    5 Ohri