Speed Up Recovery: Radiation Before Mastectomy Streamlines Breast Reconstruction
Revolutionizing the journey through breast cancer treatment, a groundbreaking study from esteemed researchers has shown that flipping the script on traditional treatment sequences can lead to remarkable outcomes. By administering radiation before a mastectomy, patients can now undergo simultaneous breast reconstruction surgery. This innovative approach not only streamlines the treatment process but also enhances patient satisfaction and significantly cuts down on the number of required surgeries.
The results of this Phase II trial, recently unveiled in JAMA Network Open, showcased the experiences of 49 women who received radiation therapy followed by a mastectomy and immediate breast reconstruction. Remarkably, at a median follow-up of 29.7 months, there were no complete flap losses or recurrences of the disease.
“This trial marks a significant milestone in the U.S., demonstrating the safety and effectiveness of this innovative treatment sequence for breast cancer patients,” stated the lead author, who serves as an associate professor of Plastic Surgery. “Not only does this new sequence improve surgical outcomes, but it also allows patients to avoid the frustrating delays typically associated with breast reconstruction, vastly improving their quality of life.”
Traditionally, when planning breast reconstruction for those requiring radiation therapy after a mastectomy, the primary focus has been on protecting the reconstruction site from radiation exposure to minimize long-term side effects. This often involves placing a tissue expander during the mastectomy, which is later expanded with saline. Then, patients undergo approximately six weeks of daily radiation before the final reconstruction can be scheduled—a wait that can stretch between 6 to 12 months.
During this interim period, many women experience diminished quality of life due to not having a reconstructed breast and may face medical complications from the tissue expander, with one in five women suffering issues severe enough to necessitate its removal.
By reversing the order of treatment—starting with radiation followed by a mastectomy and immediate reconstruction in one procedure—patients can enjoy immediate benefits. This fresh approach positions women to reclaim their lives more quickly, feeling confident and empowered in their bodies.
The study enrolled women from the SAPHIRE trial, with a median age of 48 years, and a notable 94% had received neoadjuvant systemic therapy. Participants were randomized into two groups, receiving either short course (40.05 Gy/15 fractions) or standard course (50 Gy/25 fractions) radiation therapy, followed by mastectomy with immediate reconstruction a median of 23 days post-radiation.
What’s impressive is that the surgical complication rates observed were on par with those from standard reconstructive surgeries, indicating a favorable outcome. Patients who underwent hypofractionated radiation therapy experienced comparable complications to those receiving conventional treatment. All patients who received tissue-based reconstruction had successful outcomes, with no significant complications reported during follow-up.
“For numerous patients, this approach signifies a monumental breakthrough,” remarked a co-author and professor of Radiation Oncology. “It empowers women to swiftly move on with their lives post-treatment, restoring their confidence and appearance without prolonged waiting periods for reconstruction.”
These groundbreaking findings have sparked the launch of the Phase III TOPAz trial, which is now actively enrolling participants. This study aims to compare the traditional radiation treatment schedule with a reduced dose given prior to mastectomy and reconstruction.
This significant research was made possible through funding from the National Cancer Institute/National Institutes of Health (P30 CA016672), the Rising Tide Foundation, and the Biostatistics Resource Group. The lead researcher has disclosed no conflicts of interest. A comprehensive list of collaborating authors and their disclosures can be found in the study results here.