Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Typ-2-Diabetes und Adipositas Klimawandel und Gesundheit Neues aus dem Markt Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende Patientenratgeber
Erweiterte Suche
Anmelden
nach oben
Current Breast Cancer Reports
Erschienen in:

05.08.2023

Postmastectomy Radiation Modalities (Protons, Chest Wall Boost, Skin Bolus, Fractionation, and Timing) and Breast Reconstruction Complications: The Role of Radiation Oncologist

verfasst von: George E. Naoum, Alphonse G. Taghian

Erschienen in: Current Breast Cancer Reports | Ausgabe 3/2023

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

Integrating postmastectomy radiotherapy (PMRT) and breast reconstruction remains a multidisciplinary clinical challenge. While PMRT improves tumor outcomes in patients with locally advanced breast cancers, it increases breast reconstruction complications. Therefore, understanding the nuances of different surgical and PMRT techniques and their dynamic interaction is crucial to overcome such challenge.

Recent Findings

Introduction of new reconstruction techniques including single-stage implant reconstruction, different types of surgical mesh and pre-pectoral implants placement, allowed different approaches for the caregivers and patients. In parallel to this surgical progress, there were PMRT advances such as intensity-modulated radiotherapy (IMRT), protons, different types of skin bolus, and more knowledge about usage of chest wall boost.

Summary

In this review article, we discuss the different surgical and PMRT advances through a comprehensive literature review. We also discuss personalized approach to this problem using machine learning nomograms and risk score calculators.
Literatur
1.
2.
Gradishar WJ, Moran MS, Abraham J, et al. Breast cancer, version 3.2022, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2022;20:691–722.PubMedCrossRef
3.
Howard-McNatt MM. Patients opting for breast reconstruction following mastectomy: an analysis of uptake rates and benefit. Breast Cancer. 2013;5:9–15.PubMedPubMedCentral
4.
Pačarić S, Orkić Ž, Babić M, et al. Impact of immediate and delayed breast reconstruction on quality of life of breast cancer patients. Int J Environ Res Public Health. 2022;19
5.
Shiraishi M, Sowa Y, Tsuge I, et al. Long-term patient satisfaction and quality of life following breast reconstruction using the BREAST-Q: a prospective cohort study. Frontiers. Oncology. 2022;12
6.
Kummerow KL, Du L, Penson DF, et al. Nationwide trends in mastectomy for early-stage breast cancer. JAMA Surg. 2015;150:9–16.PubMedCrossRef
7.
Fefferman M, Nicholson K, Kuchta K, et al. Rates of bilateral mastectomy in patients with early-stage breast cancer. JAMA Netw Open. 2023;6:e2251348.PubMedPubMedCentralCrossRef
8.
9.
Headon HL, Kasem A, Mokbel K. The oncological safety of nipple-sparing mastectomy: a systematic review of the literature with a pooled analysis of 12,358 procedures. Arch Plast Surg. 2016;43:328–38.PubMedPubMedCentralCrossRef
10.
Tokin C, Weiss A, Wang-Rodriguez J, et al. Oncologic safety of skin-sparing and nipple-sparing mastectomy: a discussion and review of the literature. Int J Surg Oncol. 2012;2012:921821.PubMedPubMedCentral
11.
Galimberti V, Vicini E, Corso G, et al. Nipple-sparing and skin-sparing mastectomy: review of aims, oncological safety and contraindications. Breast. 2017;34:S82–4.PubMedCrossRef
12.
Satteson ES, Brown BJ, Nahabedian MY. Nipple-areolar complex reconstruction and patient satisfaction: a systematic review and meta-analysis. Gland Surg. 2017;6:4–13.PubMedPubMedCentralCrossRef
13.
Chatterjee A, Nahabedian MY, Gabriel A, et al. Early assessment of post-surgical outcomes with pre-pectoral breast reconstruction: a literature review and meta-analysis. J Surg Oncol. 2018;117:1119–30.PubMedCrossRef
14.
Dominici L, Hu J, Zheng Y, et al. Association of local therapy with quality-of-life outcomes in young women with breast cancer. JAMA Surg. 2021;156:e213758.PubMedPubMedCentralCrossRef
15.
Recht A, Comen EA, Fine RE, et al. Postmastectomy radiotherapy: an American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Focused Guideline Update. Ann Surg Oncol. 2017;24:38–51.PubMedCrossRef
16.
Recht A, Comen EA, Fine RE, et al. Postmastectomy radiotherapy: an American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Focused Guideline Update. J Clin Oncol. 2016;34:4431–42.PubMedCrossRef
17.
Sittenfeld SMC, Zabor EC, Hamilton SN, et al. A multi-institutional prediction model to estimate the risk of recurrence and mortality after mastectomy for T1-2N1 breast cancer. Cancer. 2022;128:3057–66.PubMedCrossRef
18.
Shah C, Al-Hilli Z, Vicini F. Advances in breast cancer radiotherapy: implications for current and future practice. JCO Oncol Pract. 2021;17:697–706.PubMedCrossRef
19.
20.
Shumway DA, Momoh AO, Sabel MS, et al. Integration of breast reconstruction and postmastectomy radiotherapy. J Clin Oncol. 2020;38:2329–40.PubMedCrossRef
21.
Ho AY, Hu ZI, Mehrara BJ, et al. Radiotherapy in the setting of breast reconstruction: types, techniques, and timing. Lancet Oncol. 2017;18:e742–53.PubMedCrossRef
22.
Seth AK, Hirsch EM, Kim JY, et al. Two surgeons, one patient: the impact of surgeon-surgeon familiarity on patient outcomes following mastectomy with immediate reconstruction. Breast. 2013;22:914–8.PubMedCrossRef
23.
Morrow M, Li Y, Alderman AK, et al. Access to breast reconstruction after mastectomy and patient perspectives on reconstruction decision making. JAMA Surg. 2014;149:1015–21.PubMedPubMedCentralCrossRef
24.
Morrow M, Mujahid M, Lantz PM, et al. Correlates of breast reconstruction: results from a population-based study. Cancer. 2005;104:2340–6.PubMedCrossRef
25.
Pinel-Giroux FM, Khoury MME, Trop I, et al. Breast reconstruction: review of surgical methods and spectrum of imaging findings. RadioGraphics. 2013;33:435–53.PubMedCrossRef
26.
Salibian AA, Olson B, Shauly O, et al. Oncoplastic breast reconstruction: principles, current techniques, and future directions. J Surg Oncol. 2022;126:450–9.PubMedCrossRef
27.
Shiah E, Laikhter E, Comer CD, et al. Neurotization in innervated breast reconstruction: a systematic review of techniques and outcomes. J Plast Reconstr Aesthet Surg. 2022;75:2890–913.PubMedCrossRef
28.
DeLong MR, Tandon VJ, Bertrand AA, et al. Review of outcomes in prepectoral prosthetic breast reconstruction with and without surgical mesh assistance. Plast Reconstr Surg. 2021;147:305–15.PubMedCrossRef
29.
Temple-Oberle C, Shea-Budgell MA, Tan M, et al. Consensus review of optimal perioperative care in breast reconstruction: Enhanced Recovery after Surgery (ERAS) Society recommendations. Plast Reconstr Surg. 2017;139:1056e–71e.PubMedPubMedCentralCrossRef
30.
Kelley BP, Ahmed R, Kidwell KM, et al. A systematic review of morbidity associated with autologous breast reconstruction before and after exposure to radiotherapy: are current practices ideal? Ann Surg Oncol. 2014;21:1732–8.PubMedPubMedCentralCrossRef
31.
Weinzierl A, Schmauss D, Brucato D, et al. Implant-based breast reconstruction after mastectomy, from the subpectoral to the prepectoral approach: aneEvidence-based change of mind? J Clin Med. 2022;11:3079.PubMedPubMedCentralCrossRef
32.
Saldanha IJ, Broyles JM, Adam GP, et al. Autologous reconstruction after mastectomy for breast cancer. Plast Reconstr Surg Glob Open. 2022;10:e4181.PubMedPubMedCentralCrossRef
33.
Bonde C, Khorasani H, Eriksen K, et al. Introducing the fast track surgery principles can reduce length of stay after autologous breast reconstruction using free flaps: a case control study. J Plast Surg Hand Surg. 2015;49:367–71.PubMedCrossRef
34.
Nelson JA, Allen RJ Jr, Polanco T, et al. Long-term patient-reported outcomes following postmastectomy breast reconstruction: an 8-year examination of 3268 patients. Ann Surg. 2019;270:473–83.PubMedCrossRef
35.
Clemens MW, Kronowitz SJ. Current perspectives on radiation therapy in autologous and prosthetic breast reconstruction. Gland Surg. 2015;4:222–31.PubMedPubMedCentral
36.
Jagsi R, Jiang J, Momoh AO, et al. Trends and variation in use of breast reconstruction in patients with breast cancer undergoing mastectomy in the United States. J Clin Oncol. 2014;32:919–26.PubMedPubMedCentralCrossRef
37.
38.
Billig JI, Lu Y, Momoh AO, et al. A nationwide analysis of cost variation for autologous free flap breast reconstruction. JAMA Surg. 2017;152:1039–47.PubMedPubMedCentralCrossRef
39.
Berlin NL, Abrahamse P, Momoh AO, et al. Perceived financial decline related to breast reconstruction following mastectomy in a diverse population-based cohort. Cancer. 2022;128:1284–93.PubMedCrossRef
40.
Alderman AK, Hawley ST, Waljee J, et al. Correlates of referral practices of general surgeons to plastic surgeons for mastectomy reconstruction. Cancer. 2007;109:1715–20.PubMedCrossRef
41.
Hershenhouse KS, Bick K, Shauly O, et al. Systematic review and meta-analysis of immediate versus delayed autologous breast reconstruction in the setting of post-mastectomy adjuvant radiation therapy. J Plast Reconstr Aesthet Surg. 2021;74:931–44.PubMedCrossRef
42.
Matar DY, Wu M, Haug V, et al. Surgical complications in immediate and delayed breast reconstruction: a systematic review and meta-analysis. J Plast Reconstr Aesthet Surg. 2022;75:4085–95.PubMedCrossRef
43.
Tomita K, Kubo T. Recent advances in surgical techniques for breast reconstruction. Int J Clin Oncol. 2023;
44.
Kuerer HM, Cordeiro PG, Mutter RW. Optimizing breast cancer adjuvant radiation and integration of breast and reconstructive surgery. American Society of Clinical Oncology Educational Book; 2017. p. 93–105.
45.
Frey JD, Choi M, Salibian AA, et al. Comparison of outcomes with tissue expander, immediate implant, and autologous breast reconstruction in greater than 1000 nipple-sparing mastectomies. Plast Reconstr Surg. 2017;139:1300–10.PubMedCrossRef
46.
Tsoi B, Ziolkowski NI, Thoma A, et al. Safety of tissue expander/implant versus autologous abdominal tissue breast reconstruction in postmastectomy breast cancer patients: a systematic review and meta-analysis. Plast Reconstr Surg. 2014;133:234–49.PubMedCrossRef
47.
Bloom JA, Shah SA, Long EA, et al. Post-mastectomy tissue expander placement followed by radiation therapy: a cost-effectiveness analysis of staged autologous versus implant-based unilateral reconstruction. Ann Surg Oncol. 2023;30:1075–83.PubMedCrossRef
48.
Jagsi R, Momoh AO, Qi J, et al. Impact of radiotherapy on complications and patient-reported outcomes after breast reconstruction. J Natl Cancer Inst. 2018;110:157–65.PubMedCrossRef
49.
Bennett KG, Qi J, Kim HM, et al. Comparison of 2-year complication rates among common techniques for postmastectomy breast teconstruction. JAMA Surg. 2018;153:901–8.PubMedPubMedCentralCrossRef
50.
Hu ES, Pusic AL, Waljee JF, et al. Patient-reported aesthetic satisfaction with breast reconstruction during the long-term survivorship period. Plast Reconstr Surg. 2009;124:1–8.PubMedCrossRef
51.
Saulis AS, Mustoe TA, Fine NA. A retrospective analysis of patient satisfaction with immediate postmastectomy breast reconstruction: comparison of three common procedures. Plast Reconstr Surg. 2007;119:1669–76.PubMedCrossRef
52.
Avraham T, Clavin N, Mehrara BJ. Microsurgical breast reconstruction. Cancer J. 2008;14:241–7.PubMedCrossRef
53.
Lopez CD, Bluebond-Langner R, Houssock CA, et al. Plastic and reconstructive surgeons’ knowledge and comfort of contralateral prophylactic mastectomy: a survey of the American Society of Plastic Surgeons. Front Oncol. 2018;8:647.PubMedCrossRef
54.
Wilkins EG, Hamill JB, Kim HM, et al.: Complications in postmastectomy breast reconstruction: one-year outcomes of the mastectomy reconstruction outcomes consortium (MROC) study. Ann Surg 267:164-170, 2018
55.
56.
57.
Dikmans RE, Negenborn VL, Bouman MB, et al. Two-stage implant-based breast reconstruction compared with immediate one-stage implant-based breast reconstruction augmented with an acellular dermal matrix: an open-label, phase 4, multicentre, randomised, controlled trial. Lancet Oncol. 2017;18:251–8.PubMedCrossRef
58.
Potter S, Wilson RL, Harvey J, et al. Results from the BRIOS randomised trial. Lancet Oncol. 2017;18:e189.PubMedCrossRef
59.
60•.
. Naoum GE, Salama L, Niemierko A, et al. Single stage direct-to-implant breast reconstruction has lower complication rates than tissue expander and implant and comparable rates to autologous reconstruction in patients receiving postmastectomy radiation. Int J Radiat Oncol Biol Phys. 2020;106:514–24. Large series comparing complications with and without PMRT across different reconstruction types.PubMedCrossRef
61.
Naoum GE, Oladeru OT, Niemierko A, et al. Optimal breast reconstruction type for patients treated with neoadjuvant chemotherapy, mastectomy followed by radiation therapy. Breast Cancer Res Treat. 2020;183:127–36.PubMedCrossRef
62.
63.
Brunbjerg ME, Jensen TB, Overgaard J, et al. Comparison of one-stage direct-to-implant with acellular dermal matrix and two-stage immediate implant-based breast reconstruction—a cohort study. Gland Surg. 2020;10:207–18.CrossRef
64.
Colwell AS, Damjanovic B, Zahedi B, et al. Retrospective review of 331 consecutive immediate single-stage implant reconstructions with acellular dermal matrix: indications, complications, trends, and costs. Plast Reconstr Surg. 2011;128:1170–8.PubMedCrossRef
65.
Lin AM, Christensen JM, Liao EC, et al. Postmastectomy radiation therapy on permanent implants or tissue expanders: which is better? Ann Surg. 2021;274:e974–9.PubMedCrossRef
66••.
. Ostapenko E, Nixdorf L, Devyatko Y, et al. Prepectoral versus subpectoral implant-based breast reconstruction: a systemic review and meta-analysis. Ann Surg Oncol. 2023;30:126–36. Recent metanalysis regarding prepectoral and subpectoral implant placementsPubMedCrossRef
67.
Sorkin M, Qi J, Kim HM, et al. Acellular dermal matrix in immediate expander/implant breast reconstruction: a multicenter assessment of risks and benefits. Plast Reconstr Surg. 2017;140:1091–100.PubMedPubMedCentralCrossRef
68.
Martin L, O'Donoghue JM, Horgan K, et al. Acellular dermal matrix (ADM) assisted breast reconstruction procedures: joint guidelines from the Association of Breast Surgery and the British Association of Plastic, Reconstructive and Aesthetic Surgeons. Eur J Surg Oncol. 2013;39:425–9.PubMedCrossRef
69.
Onesti MG, Di Taranto G, Ribuffo D, et al. ADM-assisted prepectoral breast reconstruction and skin reduction mastectomy: expanding the indications for subcutaneous reconstruction. J Plast Reconstr Aesthet Surg. 2020;73:673–80.PubMedCrossRef
70.
Scheflan M, Allweis TM, Ben Yehuda D, et al. Meshed acellular dermal matrix in immediate prepectoral implant-based breast reconstruction. Plast Reconstr Surg Glob Open. 2020;8:e3265.PubMedPubMedCentralCrossRef
71.
Mangialardi ML, Salgarello M, Cacciatore P, et al. Complication rate of prepectoral implant-based breast reconstruction using human acellular dermal matrices. Plast Reconstr Surg Glob Open. 2020;8:e3235.PubMedPubMedCentralCrossRef
72.
Wagner RD, Braun TL, Zhu H, et al. A systematic review of complications in prepectoral breast reconstruction. J Plast Reconstr Aesthet Surg. 2019;72:1051–9.PubMedCrossRef
73.
Nealon KP, Weitzman RE, Sobti N, et al. Prepectoral direct-to-implant breast reconstruction: safety outcome endpoints and delineation of risk factors. Plast Reconstr Surg. 2020;145:898e–908e.PubMedCrossRef
74••.
. Naoum GE, Ho AY, Shui A, et al. Risk of developing breast reconstruction complications: a machine-learning nomogram for individualized risk estimation with and without postmastectomy radiation therapy. Plast Reconstr Surg. 2022;149:1e–12e. First machine learning nomogram predicting individualized projected complication rates with and without PMRT. External Validation needed.PubMedCrossRef
75.
Naoum GE, Ioakeim MI, Shui AM, et al. Radiation modality (proton/photon), timing, and complication rates in patients with breast cancer receiving 2-stages expander/implant reconstruction. Pract Radiat Oncol. 2022;12:475–86.PubMedCrossRef
76•.
. Naoum GE, Salama L, Ho A, et al. The impact of chest wall boost on reconstruction complications and local control in patients treated for breast cancer. Int J Radiat Oncol Biol Phys. 2019;105:155–64. Dedicated series regarding boost and no boost and the impact on reconstruction complications.PubMedCrossRef
77.
Kim N, Kim YB. Journey to hypofractionation in radiotherapy for breast cancer: critical reviews for recent updates. Radiat Oncol J. 2022;40:216–24.PubMedPubMedCentralCrossRef
78.
Murray Brunt A, Haviland JS, Wheatley DA, et al. Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5-year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial. The Lancet. 2020;395:1613–26.CrossRef
79.
Sayan M, Yehia ZA, Ohri N, et al. Hypofractionated postmastectomy radiation therapy. Adv Radiat Oncol. 2021;6:100618.PubMedCrossRef
80.
Wang SL, Fang H, Song YW, et al. Hypofractionated versus conventional fractionated postmastectomy radiotherapy for patients with high-risk breast cancer: a randomised, non-inferiority, open-label, phase 3 trial. Lancet Oncol. 2019;20:352–60.PubMedCrossRef
81••.
. Khan AJ, Poppe MM, Goyal S, et al. Hypofractionated postmastectomy radiation therapy is safe and effective: first results from a prospective phase II trial. J Clin Oncol. 2017;35:2037–43. First prospective trial for hypofractionation and reeconstruction providing the basis of RT CHARM and FABREC.PubMedPubMedCentralCrossRef
82.
Bartelink H, Maingon P, Poortmans P, et al. Whole-breast irradiation with or without a boost for patients treated with breast-conserving surgery for early breast cancer: 20-year follow-up of a randomised phase 3 trial. Lancet Oncol. 2015;16:47–56.PubMedCrossRef
83.
Taghian A, Jeong J-H, Mamounas E, et al. Patterns of locoregional failure in patients with operable breast cancer treated by mastectomy and adjuvant chemotherapy with or without tamoxifen and without radiotherapy: results from five national surgical adjuvant breast and bowel project randomized clinical trials. J Clin Oncol. 2004;22:4247–54.PubMedCrossRef
84.
Wong AC, Huo D, Hasan Y. Postmastectomy radiation therapy chest wall boost patterns of care and survival outcomes: analysis of the National Cancer Data Base. Int J Radiat Oncol Biol Phys. 2016;96:E46.CrossRef
85.
Mayadev J, Fish K, Valicenti R, et al. Utilization and impact of a postmastectomy radiation boost for invasive breast cancer. Pract Radiat Oncol. 2014;4:e269–78.PubMedCrossRef
86.
Shah PK, De Wees TA, Ochoa LL, et al. Postmastectomy radiation therapy (PMRT): should all patients receive a chest wall scar boost? Int J Radiat Oncol Biol Phys. 2015;93:E30.CrossRef
87••.
. Dahn HM, Boersma LJ, de Ruysscher D, et al. The use of bolus in postmastectomy radiation therapy for breast cancer: a systematic review. Crit Rev Oncol Hematol. 2021;163:103391. Important metanalysis regarding bolus usage.PubMedCrossRef
88•.
. Sapienza LG, Maia MAC, Gomes MJL, et al. Randomized clinical trial of tissue equivalent bolus prescription in postmastectomy radiotherapy stratified by skin involvement status. Clin Transl Radiat Oncol. 2023;39:100570. Randomized trial regarding usage of boost but randomization was bolus schedules not usage of boost.PubMed
89.
Sayan M, Hathout L, Kilic SS, et al. Reconstructive complications and early toxicity in breast cancer patients treated with proton-based postmastectomy radiation therapy. Frontiers. Oncology. 2023;13
90.
Gao RW, Mullikin TC, Aziz KA, et al. Postmastectomy intensity modulated proton therapy: 5-year oncologic and patient-reported outcomes. Int J Radiat Oncol Biol Phys. 2023;
91.
Collier P, Williams J, Edhayan G, et al.: The effect of timing of postmastectomy radiation on implant-based breast reconstruction: a retrospective comparison of complication outcomes. Am J Surg 207:408-11; discussion 410-1, 2014
92.
Anderson PR, Freedman G, Nicolaou N, et al. Postmastectomy chest wall radiation to a temporary tissue expander or permanent breast implant--is there a difference in complication rates? Int J Radiat Oncol Biol Phys. 2009;74:81–5.PubMedCrossRef
93.
Fowble B, Park C, Wang F, et al. Rates of reconstruction failure in patients undergoing immediate reconstruction with tissue expanders and/or implants and postmastectomy radiation therapy. Int J Radiat Oncol Biol Phys. 2015;92:634–41.PubMedCrossRef
94.
Ogita M, Nagura N, Kawamori J, et al. Risk factors for complications among breast cancer patients treated with post-mastectomy radiotherapy and immediate tissue-expander/permanent implant reconstruction: a retrospective cohort study. Breast Cancer. 2018;25:167–75.PubMedCrossRef
95.
Aristei C, Falcinelli L, Bini V, et al. Expander/implant breast reconstruction before radiotherapy: outcomes in a single-institute cohort. Strahlenther Onkol. 2012;188:1074–9.PubMedCrossRef
96.
Santosa KB, Chen X, Qi J, et al. Postmastectomy radiation therapy and two-stage implant-based breast reconstruction: is there a better time to irradiate? Plast Reconstr Surg. 2016;138:761–9.PubMedPubMedCentralCrossRef
97.
Nava MB, Pennati AE, Lozza L, et al. Outcome of different timings of radiotherapy in implant-based breast reconstructions. Plast Reconstr Surg. 2011;128:353–9.PubMedCrossRef
98.
Cordeiro PG, Albornoz CR, McCormick B, et al. What is the optimum timing of postmastectomy radiotherapy in two-stage prosthetic reconstruction: radiation to the tissue expander or permanent implant? Plast Reconstr Surg. 2015;135:1509–17.PubMedPubMedCentralCrossRef
99.
Yoon AP, Qi J, Kim HM, et al. Patient-reported outcomes after irradiation of tissue expander versus permanent implant in breast reconstruction: a multicenter prospective study. Plast Reconstr Surg. 2020;145:917e–26e.PubMedPubMedCentralCrossRef
Metadaten
Titel
Postmastectomy Radiation Modalities (Protons, Chest Wall Boost, Skin Bolus, Fractionation, and Timing) and Breast Reconstruction Complications: The Role of Radiation Oncologist
verfasst von
George E. Naoum
Alphonse G. Taghian
Publikationsdatum
05.08.2023
Verlag
Springer US
Erschienen in
Current Breast Cancer Reports / Ausgabe 3/2023
Print ISSN: 1943-4588
Elektronische ISSN: 1943-4596
DOI
https://doi.org/10.1007/s12609-023-00505-2

Weitere Artikel der Ausgabe 3/2023

Management of Local–Regional Recurrence of Breast Cancer

The Relevant Work of Breast Cancer Patient Associations in the Search for Quality Access to Care and Guarantee of Rights in Brazil

Metastatic Triple-Negative Breast Cancer

  • Open Access

De-escalation of Surgical Intervention and Contemporary Management Recommendations for Lobular Neoplasia, Atypical Ductal Hyperplasia, and Ductal Carcinoma In Situ

  • Clinical Trial Report

Partial Breast Radiation

Radiation Therapy in Patients with Germline Mutations: a Review of the Current Evidence

Neu im Fachgebiet Onkologie

Knochenmarktransplantat als Chance für ältere AML-Patienten

Lange Zeit ist die Transplantation von hämatopoetischen Stammzellen nur bei jüngeren Patienten mit akuter myeloischer Leukämie praktiziert worden. Inzwischen profitieren auch Ältere davon. Ergebnisse einer Studie unterstützen dieses Vorgehen.

Nierenzellkarzinom: Kein Nachteil durch subkutan appliziertes Nivolumab

Die subkutane Applikation von Nivolumab ist nach Daten einer Phase-3-Studie ähnlich gut wirksam wie die intravenöse: Die Pharmakokinetik ist vergleichbar, die objektive Response war in der Studie sogar leicht besser als in der Gruppe mit Infusionen.

Vorteile für Androgenentzug plus Androgenrezeptorblockade

Für Männer mit metastasiertem hormonsensitivem Prostata-Ca. (mHSPC), die keine Hormonchemotherapie wollen oder vertragen, ist der Androgenentzug plus Darolutamid eine Alternative: Das Progressionsrisiko wird im Vergleich zum alleinigen Androgenentzug fast halbiert.

CDK4/6-Inhibitoren bei Brustkrebs in die Zweitlinie aufschieben?

Ergebnisse einer Phase-III-Studie sprechen dafür, dass die Behandlung mit CDK4/6-Inhibitoren bei fortgeschrittenem HR-positivem, HER2-negativem Brustkrebs auch auf die Zweitlinie verschoben werden könnte, ohne die onkologischen Ergebnisse zu kompromittieren.

Update Onkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen
Bildnachweise