Timing Of Autologous Breast Reconstruction And Radiation Therapy: A Meta-analysis And Systematic Review
Shelby Nathan, MD, Merisa Piper, MD, Cutler Whitely, BS, Joshua Fosnot, MD.
University of Pennsylvania, Philadelphia, PA, USA.
PURPOSE: Determining optimal timing of radiation therapy (RT) for patients undergoing autologous breast reconstruction (ABR) continues to be controversial. This systematic review and meta-analysis aim to compare clinical outcomes with either pre- or post-ABR RT.
METHODS: A literature search was performed by two independent reviewers via PubMed and Cochrane library databases pertaining to ABR and either pre- or postoperative RT. Primary outcomes included fat necrosis, delayed healing, reoperation rate, revision rate and flap failure rate.
RESULTS: The initial search yielded 586 articles, narrowed to 154 after title review, with 76 remaining following abstract review. After exclusion, 53 articles were statistically analyzed with a total of 8,089 subjects who underwent ABR. 2,809 subjects received pre-operative and 2,173 subjects received postoperative radiation therapy. Average follow-up time was 30.3 months (+/-14.9 months). Fat necrosis rates were significantly higher in the post-ABR RT group compared to the pre-RT group (13.1 % vs. 9.9%, p=0.003). Delayed healing was also significantly greater in the post-ABR RT group (17.1% compared to 13.8%; p=0.019). There were no significant differences between revision (28.3% vs. 31.2%, p=0.246), reoperation (9.5% vs. 9.7%, p=0.832) or flap failure (2.3% vs. 2.3%, p=0.98) rates between the groups.
CONCLUSION: This meta-analysis suggests a higher incidence of fat necrosis and delayed healing in patients receiving radiation after ABR. Additionally, radiation timing has no significant effect on the need for additional surgeries or flap failure rates. Based on these results, we recommend timing of RT should be determined based on individual patient circumstances and surgeon preference.
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