Is Radiation Before Mastectomy Better for Breast Cancer Patients?
Altering the sequence of breast cancer treatments to give radiation prior to mastectomy cuts down on time delays for reconstruction and improves quality of life, according to a new study.
The study, conducted at The University of Texas MD Anderson Cancer Center and published in JAMA Network Open, evaluated 49 patients who received radiation therapy before mastectomy with immediate breast reconstruction. Researchers found there were no complete flap losses or disease recurrences more than two years after treatment.
Currently, women have a tissue expander placed during the initial surgery. They then usually undergo more than a month of radiation therapy before waiting six months to one year for reconstructive surgery.
Ronica Nanda, MD
“Post-mastectomy radiation represents a significant challenge for women with locally advanced breast cancer,” said Ronica Nanda, MD, a radiation oncologist in the Department of Radiation Oncology at Moffitt Cancer Center. “Women requiring post-mastectomy radiation, particularly if they desire reconstruction, undergo multiple surgeries, often have delays until radiation can be administered to allow for sufficient expansion of the chest wall prior to radiation and have poor quality of life while waiting for reconstruction.”
By administering radiation first, patients can have the mastectomy and reconstruction done in one surgery. This reduced the reconstructive timeline for patients on the trial to just 23 days on average. The rate of surgical complications was similar to the rate of complications from standard-of-care reconstructive surgery.
Roberto Diaz, MD, PhD
The study also highlights the effectiveness of a condensed three-week radiation regimen instead of the standard five-week treatment. Despite this higher-dose treatment, patients experienced fewer adverse skin side effects and reported better cosmetic outcomes.
“In essence, this study emphasizes the potential for expedited treatment completion without compromising efficacy or increasing side effects,” said radiation oncologist Roberto Diaz, MD, PhD. “With no instances of local, regional or distant recurrences noted at almost 30 months post-treatment, these findings represent a promising stride towards enhancing patient care.”
While this study represents a potential paradigm shift in breast cancer surgery and reconstruction, Diaz says a larger phase 3 study is needed to validate results and evaluate long-term outcomes.
