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ASTRO 2017: Neoadjuvant Radiation Therapy Before Surgery in Locally Advanced Breast Cancer

By: Meg Barbor, MPH
Posted: Monday, October 9, 2017

In patients with locally advanced breast cancer, neoadjuvant radiotherapy prior to surgery may safely allow for definitive oncologic surgery and autologous reconstruction to be performed in a single operation, according to research presented by Margaret Cokelek, MD, of Genesis Care, Melbourne, Australia, and colleagues, at the 2017 American Society for Radiation Oncology (ASTRO) Annual Meeting (Abstract 1103). Delayed breast reconstruction is typically preferred for patients who undergo postmastectomy radiotherapy, due to superior cosmetic outcomes and lower complication rates compared with immediate reconstruction.

“Sequence reversal can achieve a shorter, simpler reconstructive journey for patients,” without leading to an increase in surgical complication rates, suggested the investigators.

The investigators conducted a prospective review of 47 patients with locally advanced breast cancer who underwent this “sequence reversal” protocol. All patients had neoadjuvant chemotherapy followed by neoadjuvant radiotherapy; about 6 weeks after completing radiotherapy, patients underwent definitive surgery (skin-sparing mastectomy and axillary dissection or skin-sparing mastectomy alone) and autologous reconstruction.

A total of 13 patients (all with either a triple-negative or HER2-positive phenotype) achieved a pathologic complete response, and 10 patients achieved downstaging. According to the researchers, cosmetic outcome was not adversely impacted by the sequence reversal.