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Post-mastectomy radiation therapy in breast reconstruction: a patterns of care study of the Korean Radiation Oncology Group

 Gowoon Yang  ;  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  ;  Yong Bae Kim 
 RADIATION ONCOLOGY JOURNAL, Vol.38(4) : 236-243, 2020-12 
Journal Title
Issue Date
Breast neoplasm ; Mammaplasty ; Radiotherapy
Purpose: The details of breast reconstruction and radiation therapy (RT) vary between institutions; therefore, we sought to investigate the practice patterns of radiation oncologists who specialize in breast cancer.

Materials and methods: We identified the practice patterns and inter-hospital variations from a multi-center cohort of women with breast cancer who underwent post-mastectomy RT (PMRT) to the reconstructed breast at 16 institutions between 2015 and 2016. The institutions were requested to contour the target volume and produce RT plans for one representative case with five different clinical scenarios and answer questionnaires which elicited infrastructural information. We assessed the inter-institutional variations in RT in terms of the target, normal organ delineation, and dose-volume histograms.

Results: Three hundred fourteen patients were included; 99% of them underwent immediate reconstruction. The most irradiated material was tissue expander (36.9%) followed by transverse rectus abdominis musculocutaneous flap (23.9%) and silicone implant (12.1%). In prosthetic-based reconstruction with tissue expander, most patients received PMRT following partial deflation. Conventional fractionation and hypofractionation RT were used in 66.6% and 33.4% patients, respectively (commonest: 40.05 Gy in 15 fractions [17.5%]). Furthermore, 15.6% of the patients received boost RT and 53.5% were treated with bolus. Overall, 15 physicians responded to the questionnaires and six submitted their contours and RT plans. There was a significant variability in target delineations and RT plans between physicians, and between clinical scenarios.

Conclusion: Adjuvant RT following post-mastectomy reconstruction has become a common practice in Korea. The details vary significantly between institutions, which highlights an urgent need for standard protocol in this clinical setting.
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1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
Yonsei Authors
Kim, Yong Bae(김용배) ORCID logo https://orcid.org/0000-0001-7573-6862
Lee, Ik Jae(이익재) ORCID logo https://orcid.org/0000-0001-7165-3373
Chang, Jee Suk(장지석) ORCID logo https://orcid.org/0000-0001-7685-3382
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