Impact of radiation dose on complications among women with breast cancer who underwent breast reconstruction and post-mastectomy radiotherapy: A multi-institutional validation study
Seung Yeun Chung,
Jee Suk Chang,
Kyung Hwan Shin,
Jin Ho Kim,
Won Park,
Haeyoung Kim,
Kyubo Kim,
Ik Jae Lee,
Won Sup Yoon,
Jihye Cha,
Kyu-Chan Lee,
Jin Hee Kim,
Jin Hwa Choi,
Sung-Ja Ahn,
Boram Ha,
Sun Young Lee,
Dong Soo Lee,
Jeongshim Lee,
Sei One Shin,
Sea-Won Lee,
Jinhyun Choi,
Mi Young Kim,
Yeon Joo Kim,
Jung Ho Im,
Chang-Ok Suh,
Yong Bae Kim
Affiliations
Seung Yeun Chung
Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Republic of Korea
Jee Suk Chang
Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
Kyung Hwan Shin
Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea; Co-corresponding author. Department of Radiation Oncology, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
Jin Ho Kim
Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
Won Park
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
Haeyoung Kim
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
Kyubo Kim
Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Republic of Korea
Ik Jae Lee
Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
Won Sup Yoon
Department of Radiation Oncology, Korea University Ansan Hospital, Korea University Medical College, Seoul, Republic of Korea
Jihye Cha
Department of Radiation Oncology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Republic of Korea
Kyu-Chan Lee
Department of Radiation Oncology, Gachon University Gil Medical Center, Incheon, Republic of Korea
Jin Hee Kim
Department of Radiation Oncology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea
Jin Hwa Choi
Department of Radiation Oncology, Chung-Ang University Hospital, Seoul, Republic of Korea
Sung-Ja Ahn
Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Republic of Korea
Boram Ha
Department of Radiation Oncology, Hallym University Dongtan Sacred Heart Hospital, Hwasung, Republic of Korea
Sun Young Lee
Department of Radiation Oncology, Chonbuk National University Hospital, Jeonju, Republic of Korea
Dong Soo Lee
Department of Radiation Oncology, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Uijeongbu, Republic of Korea
Jeongshim Lee
Department of Radiation Oncology, Inha University Hospital, Inha University of Medicine, Incheon, Republic of Korea
Sei One Shin
Department of Radiation Oncology, Andong Medical Group Andong Hospital, Andong, Republic of Korea
Sea-Won Lee
Department of Radiation Oncology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
Jinhyun Choi
Department of Radiation Oncology, Jeju National University Hospital, Jeju, Republic of Korea
Mi Young Kim
Department of Radiation Oncology, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
Yeon Joo Kim
Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Jung Ho Im
Department of Radiation Oncology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
Chang-Ok Suh
Department of Radiation Oncology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
Yong Bae Kim
Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea; Corresponding author. Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
Purpose: Emerging data suggest that higher radiation doses in post-mastectomy radiotherapy may be associated with an increased risk of reconstruction complications. This study aimed to validate previous findings regarding the impact of radiation dose on complications among women with breast cancer using a multi-center dataset. Methods: Fifteen institutions participated, and women with breast cancer who received radiotherapy after either autologous or prosthetic breast reconstruction were included. The primary endpoint was major post-radiation therapy complications requiring re-operation for explantation, flap failure, or bleeding control. Results: In total, 314 patients were included. Radiotherapy was performed using both conventional fractionation and hypofractionation in various schedules. The range of the radiation therapy dose in Equivalent Dose in 2 Gy fractions (EQD2; α/β = 3.5) varied from 43.4 to 71.0 Gy (median dose: 48.6 Gy). Boost radiation therapy was administered to 49 patients. Major post-radiation therapy complications were observed in 24 (7.6%) patients. In multivariate analysis, an increasing EQD2 per Gy (odds ratio [OR]: 1.58, 95% confidence interval [CI]: 1.26–1.98; p < 0.001), current smoking status (OR: 25.48, 95% CI: 1.56–415.65; p = 0.023), and prosthetic breast reconstruction (OR: 9.28, 95% CI: 1.84–46.70; p = 0.007) were independently associated with an increased risk of major complications. Conclusion: A dose-response relationship between radiation dose and the risk of complications was validated in this multi-center dataset. In this context, we hypothesize that the use of hypofractionated radiotherapy (40 Gy in 15 fractions) may improve breast reconstruction outcomes. Our multi-center prospective observational study (NCT03523078) is underway to further validate this hypothesis.
