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Post-mastectomy radiation therapy in breast reconstruction: a patterns of care study of the Korean Radiation Oncology Group

Radiation Oncology Journal 2020년 38권 4호 p.236 ~ 243
양고운, 장지석, 신경환, 김진호, 박원, 김해영, 김규보, 이익재, 윤원섭, 차지혜, 이규찬, 김진희, 최진화, 안성자, 하보람, 이선영, 이동수, 이정심, 신세원, 김용배,
소속 상세정보
양고운 ( Yang Go-Woon ) - Yonsei University College of Medicine Yonsei Cancer Center Department of Radiation Oncology
장지석 ( Chang Jee-Suk ) - Yonsei University College of Medicine Yonsei Cancer Center Department of Radiation Oncology
신경환 ( Shin Kyung-Hwan ) - Seoul National University College of Medicine Department of Radiation Oncology
김진호 ( Kim Jin-Ho ) - Seoul National University College of Medicine Department of Radiation Oncology
박원 ( Park Won ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Radiation Oncology
김해영 ( Kim Hae-Young ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Radiation Oncology
김규보 ( Kim Kyu-Bo ) - Ewha Womans University School of Medicine Department of Radiation Oncology
이익재 ( Lee Ik-Jae ) - Yonsei University College of Medicine Gangnam Severance Hospital Department of Radiation Oncology
윤원섭 ( Yoon Won-Sup ) - Korea University College of Medicine Korea University Ansan Hospital Department of Radiation Oncology
차지혜 ( Cha Ji-Hye ) - Yonsei University Wonju College of Medicine Wonju Severance Christian Hospital Department of Radiation Oncology
이규찬 ( Lee Kyu-Chan ) - Gachon University Gil Medical Center Department of Radiation Oncology
김진희 ( Kim Jin-Hee ) - Keimyung University School of Medicine Keimyung University Dongsan Medical Center Department of Radiation Oncology
최진화 ( Choi Jin-Hwa ) - Chung-Ang University Hospital Department of Radiation Oncology
안성자 ( Ahn Sung-Ja ) - Chonnam National University Medical School Chonnam National University Hwasun Hospital Department of Radiation Oncology
하보람 ( Ha Bo-Ram ) - Hallym University Dongtan Sacred Heart Hospital Department of Radiation Oncology
이선영 ( Lee Sun-Young ) - Jeonbuk National University Hospital Department of Radiation Oncology
이동수 ( Lee Dong-Soo ) - Catholic University College of Medicine Uijeongbu St. Mary’s Hospital Department of Radiation Oncology
이정심 ( Lee Jeong-Shim ) - Inha University College of Medicine Inha University Hospital Department of Radiation Oncology
신세원 ( Shin Sei-One ) - Andong Medical Group Andong Hospital Department of Radiation Oncology
김용배 ( Kim Yong-Bae ) - Yonsei University College of Medicine Yonsei Cancer Center Department of Radiation Oncology

Abstract


Purpose: The details of breast reconstruction and radiation therapy (RT) vary between institutions; therefore, we sought to investigate the practice patterns of radiation oncologists who specialize in breast cancer.

Materials and Methods: We identified the practice patterns and inter-hospital variations from a multi-center cohort of women with breast cancer who underwent post-mastectomy RT (PMRT) to the reconstructed breast at 16 institutions between 2015 and 2016. The institutions were requested to contour the target volume and produce RT plans for one representative case with five different clinical scenarios and answer questionnaires which elicited infrastructural information. We assessed the inter-institutional variations in RT in terms of the target, normal organ delineation, and dose-volume histograms.

Results: Three hundred fourteen patients were included; 99% of them underwent immediate reconstruction. The most irradiated material was tissue expander (36.9%) followed by transverse rectus abdominis musculocutaneous flap (23.9%) and silicone implant (12.1%). In prosthetic-based reconstruction with tissue expander, most patients received PMRT following partial deflation. Conventional fractionation and hypofractionation RT were used in 66.6% and 33.4% patients, respectively (commonest: 40.05 Gy in 15 fractions [17.5%]). Furthermore, 15.6% of the patients received boost RT and 53.5% were treated with bolus. Overall, 15 physicians responded to the questionnaires and six submitted their contours and RT plans. There was a significant variability in target delineations and RT plans between physicians, and between clinical scenarios.

Conclusion: Adjuvant RT following post-mastectomy reconstruction has become a common practice in Korea. The details vary significantly between institutions, which highlights an urgent need for standard protocol in this clinical setting.

키워드

Radiotherapy; Mammaplasty; Breast neoplasm

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