B15: Neoadjuvant Chemoradiation for Locally Advanced Breast Cancer (LABC) with Single-Stage Mastectomy and Autologous Reconstruction: Outcomes of a Single Institution
1Nottingham Breast Institute, City Hospital, Nottingham, UK
The sequence for locally advanced primary breast cancer (LABC) in our institution is currently neoadjuvant chemotherapy, mastectomy with axillary surgery, adjuvant radiotherapy and delayed reconstruction.
In centers that perform neoadjuvant chemoradiation, (chemotherapy followed by radiotherapy), a subsequent one-stage mastectomy / axillary surgery with immediate breast reconstruction using autologous tissue such as a pedicled extended latissimus dorsi (ELD) or free deep inferior epigastric perforator (DIEP) flap can be performed in suitable patients thus combining the mastectomy and reconstruction into a single operation. This has the advantage of preserving the skin envelope which is important for a good aesthetic outcome. In non-responders to neoadjuvant chemotherapy(= 25% shrinkage of tumour size), these patients are treated with mastectomy and axillary surgery, with post-operative radiotherapy. Reconstruction is subsequently undertaken in a delayed fashion.
We study the difference in outcomes neoadjuvant chemoradiation and subsequent mastectomy / axillary surgery and immediate breast reconstruction and patients undergoing neoadjuvant chemotherapy, mastectomy and axillary surgery followed by postoperative radiotherapy and delayed reconstruction.
This study is a single institution retrospective analysis of 24 patients who have had previous neoadjuvant chemotherapy. Of the 24 patients, 7 patients underwent neoadjuvant radiotherapy after they showed response to neoadjuvant chemotherapy. The remaining 17 patients had progression of disease with neoadjuvant chemotherapy and underwent mastectomy / axillary surgery and postoperative radiotherapy. Our primary endpoints are toxicity, morbidity and cost-effectiveness. Secondary endpoints include patient satisfaction and cosmesis.
Performing upfront radiation therapy does not appear to have higher morbidity than postoperative radiotherapy. It is beneficial in terms of decreased number of clinic visits and number of operations. This will likely be associated with greater patient satisfaction and decreased cost with equivalent morbidity.