Long-term outcomes in breast cancer patients undergoing immediate 2-stage expander/implant reconstruction and postmastectomy radiation

Alice Ho, Peter Cordeiro, Joseph Disa, Babak Mehrara, Jean Wright, Kimberly J. Van Zee, Clifford Hudis, Amanda McLane, Joanne Chou, Zhigang Zhang, Simon Powell, Beryl McCormick

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Breast reconstruction with tissue expander (TE)/permanent implant (PI) followed by postmastectomy radiation (PMRT) is an increasingly popular treatment for breast cancer patients. The long-term rates of permanent implant removal or replacement (PIRR) and clinical outcomes in patients treated with a uniform reconstructive surgery and radiation regimen were evaluated. METHODS: Between 1996 and 2006, 1639 patients with stage II-III breast cancer received modified radical mastectomy (MRM) at Memorial Sloan-Kettering Cancer Center. A total of 751 received TE placement at the time of mastectomy. Of these, 151 patients went on to receive chemotherapy and exchange of the TE for a permanent implant, followed by PMRT. Clinical outcomes and PIRR-free rates were estimated by Kaplan-Meier methods. Cox regression model was used to examine patient, disease, and treatment characteristics associated with PIRR. RESULTS: Median follow-up was 86 months (range, 11-161 months). The 7-year PIRR-free rate was 71% (38 PIRRs in 35 patients). The 7-year rate of PI replacement was 17.1% (21), and removal was 13.3% (17). Reasons for PIRR included infection (15); implant extrusion, shift, leak, or rupture (4); patient request (1), or multifactorial (17). On univariate analysis, no factor was significantly associated with PIRR. Two patients experienced local recurrence in the chest wall, both after 7 years. The 7-year distant metastasis-free survival rate was 81% and overall survival 93%. CONCLUSIONS: Favorable 7-year PIRR rates and clinical outcomes were achieved in a sizable cohort of patients treated with homogeneous sequencing, radiation, and reconstructive surgery and lengthy follow-up. Factors predictive for high risk of PIRR were not identifiable in this population.

Original languageEnglish
Pages (from-to)2552-2559
Number of pages8
JournalCancer
Volume118
Issue number9
DOIs
StatePublished - May 1 2012

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Radiation
Breast Neoplasms
Tissue Expansion Devices
Reconstructive Surgical Procedures
Modified Radical Mastectomy
Mammaplasty
Mastectomy
Thoracic Wall
Proportional Hazards Models
Rupture
Survival Rate
Neoplasm Metastasis
Recurrence
Drug Therapy
Survival
Therapeutics
Infection
Population
Neoplasms

Keywords

  • immediate reconstruction
  • implant
  • outcomes
  • postmastectomy
  • radiation

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Ho, A., Cordeiro, P., Disa, J., Mehrara, B., Wright, J., Van Zee, K. J., ... McCormick, B. (2012). Long-term outcomes in breast cancer patients undergoing immediate 2-stage expander/implant reconstruction and postmastectomy radiation. Cancer, 118(9), 2552-2559. https://doi.org/10.1002/cncr.26521

Long-term outcomes in breast cancer patients undergoing immediate 2-stage expander/implant reconstruction and postmastectomy radiation. / Ho, Alice; Cordeiro, Peter; Disa, Joseph; Mehrara, Babak; Wright, Jean; Van Zee, Kimberly J.; Hudis, Clifford; McLane, Amanda; Chou, Joanne; Zhang, Zhigang; Powell, Simon; McCormick, Beryl.

In: Cancer, Vol. 118, No. 9, 01.05.2012, p. 2552-2559.

Research output: Contribution to journalArticle

Ho, A, Cordeiro, P, Disa, J, Mehrara, B, Wright, J, Van Zee, KJ, Hudis, C, McLane, A, Chou, J, Zhang, Z, Powell, S & McCormick, B 2012, 'Long-term outcomes in breast cancer patients undergoing immediate 2-stage expander/implant reconstruction and postmastectomy radiation', Cancer, vol. 118, no. 9, pp. 2552-2559. https://doi.org/10.1002/cncr.26521
Ho, Alice ; Cordeiro, Peter ; Disa, Joseph ; Mehrara, Babak ; Wright, Jean ; Van Zee, Kimberly J. ; Hudis, Clifford ; McLane, Amanda ; Chou, Joanne ; Zhang, Zhigang ; Powell, Simon ; McCormick, Beryl. / Long-term outcomes in breast cancer patients undergoing immediate 2-stage expander/implant reconstruction and postmastectomy radiation. In: Cancer. 2012 ; Vol. 118, No. 9. pp. 2552-2559.
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abstract = "BACKGROUND: Breast reconstruction with tissue expander (TE)/permanent implant (PI) followed by postmastectomy radiation (PMRT) is an increasingly popular treatment for breast cancer patients. The long-term rates of permanent implant removal or replacement (PIRR) and clinical outcomes in patients treated with a uniform reconstructive surgery and radiation regimen were evaluated. METHODS: Between 1996 and 2006, 1639 patients with stage II-III breast cancer received modified radical mastectomy (MRM) at Memorial Sloan-Kettering Cancer Center. A total of 751 received TE placement at the time of mastectomy. Of these, 151 patients went on to receive chemotherapy and exchange of the TE for a permanent implant, followed by PMRT. Clinical outcomes and PIRR-free rates were estimated by Kaplan-Meier methods. Cox regression model was used to examine patient, disease, and treatment characteristics associated with PIRR. RESULTS: Median follow-up was 86 months (range, 11-161 months). The 7-year PIRR-free rate was 71{\%} (38 PIRRs in 35 patients). The 7-year rate of PI replacement was 17.1{\%} (21), and removal was 13.3{\%} (17). Reasons for PIRR included infection (15); implant extrusion, shift, leak, or rupture (4); patient request (1), or multifactorial (17). On univariate analysis, no factor was significantly associated with PIRR. Two patients experienced local recurrence in the chest wall, both after 7 years. The 7-year distant metastasis-free survival rate was 81{\%} and overall survival 93{\%}. CONCLUSIONS: Favorable 7-year PIRR rates and clinical outcomes were achieved in a sizable cohort of patients treated with homogeneous sequencing, radiation, and reconstructive surgery and lengthy follow-up. Factors predictive for high risk of PIRR were not identifiable in this population.",
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AU - Van Zee, Kimberly J.

AU - Hudis, Clifford

AU - McLane, Amanda

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