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Influence of Radiation Dose to Reconstructed Breast Following Mastectomy on Complication in Breast Cancer Patients Undergoing Two-Stage Prosthetic Breast Reconstruction

 Jee Suk Chang  ;  Seung Yong Song  ;  Joo Hyun Oh  ;  Dae Hyun Lew  ;  Tai Suk Roh  ;  Se Young Kim  ;  Ki Chang Keum  ;  Dong Won Lee  ;  Yong Bae Kim 
 Frontiers in Oncology, Vol.9 : 243, 2019 
Journal Title
 Frontiers in Oncology 
Issue Date
breast reconstruction ; dosimetric analysis ; hypofractionated RT ; implant ; mastectomy ; radiation dose
Purpose: This study investigated the association between radiation dose and complication rate in patients who underwent breast reconstruction to understand the role of radiation hypofractionated regimen, boost radiation therapy (RT), and RT techniques. Methods: We retrospectively evaluated 75 patients treated with post-mastectomy adjuvant RT for breast cancer in the setting of two-stage prosthetic breast reconstruction. Near maximum radiation dose (Dmax) in the 2 or 0.03 cc of reconstructed breast or overlying breast skin was obtained from dose-volume histograms. Results: Post-RT complications occurred in 22.7% of patients. Receiver operating characteristic analysis showed that all near Dmax parameters were able to predict complication risk, which retained statistical significance after adjusting other variables (odds ratio 1.12 per Gy, 95% confidence interval 1.02-1.23) with positive dose-response relationship. In multiple linear regression model (R 2 = 0.92), conventional fractionation (β = 11.7) and 16 fractions in 2.66 Gy regimen (β = 3.9) were the major determinants of near Dmax compared with 15 fractions in 2.66 Gy regimen, followed by utilization of boost RT (β = 3.2). The effect of bolus and dose inhomogeneity seemed minor (P > 0.05). The location of hot spot was not close to the high density metal area of the expander, but close to the surrounding areas of partially deflated expander bag. Conclusions: This study is the first to demonstrate a dose-response relationship between risk of complications and near Dmax, where hypofractionated regimen or boost RT can play an important role. Rigorous RT-quality assurance program and modification of dose constraints could be considered as a critically important component for ongoing trials of hypofractionation. Based on our findings, we initiated a multi-center retrospective study (KROG 18-04) and a prospective study (NCT03523078) to validate our findings.
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1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Plastic and Reconstructive Surgery (성형외과학교실) > 1. Journal Papers
Yonsei Authors
Keum, Ki Chang(금기창) ORCID logo https://orcid.org/0000-0003-4123-7998
Kim, Yong Bae(김용배) ORCID logo https://orcid.org/0000-0001-7573-6862
Roh, Tai Suk(노태석) ORCID logo https://orcid.org/0000-0001-8681-159X
Song, Seung Yong(송승용) ORCID logo https://orcid.org/0000-0002-3145-7463
Oh, Joo Hyun(오주현)
Lew, Dae Hyun(유대현)
Lee, Dong Won(이동원) ORCID logo https://orcid.org/0000-0003-0046-3139
Chang, Jee Suk Paul(장지석) ORCID logo https://orcid.org/0000-0001-7685-3382
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