title: Acute effects of postmastectomy radiotherapy after immediate TRAM flap reconstruction in breast cancer patients.
abstract: OBJECTIVE
  To study the acute effects of radiotherapy after mastectomy and immediate transverse rectus abdominis myocutaneous (TRAM) flap reconstruction in breast cancer patients treated at Ramathibodi Hospital.
  
  
  METHODS
  Between January 2004 and March 2005, ten breast cancer patients (age 32-51 years) were treated with postoperative radiotherapy after mastectomy and immediate TRAM flap reconstruction. Medical records of these patients were retrospectively reviewed. Radiotherapy was delivered to the chest wall and reconstructed TRAM flap using 6-MV x-ray or Cobalt-60. The total dose was 45 to 50.4 Gy delivered in 25 to 28 fractions. Patients were evaluated weekly during the course of radiation and then at 1 and 2 months after treatment completion to determine acute effects or toxicities of radiation.
  
  
  RESULTS
  During radiation, 3 patients developed erythema or mild hyperpigmentation of the skin, and 4 developed moderate hyperpigmentation. Three patients who were treated with Cobalt-60 and/or bolus to the chest wall developed skin desquamation (1 dry desquamation, 2 moist desquamation). No patient required a treatment break because of acute side effects. One patient who received chemotherapy after radiation developed recalled moist desquamation.
  
  
  CONCLUSIONS
  Radiotherapy after mastectomy and immediate TRAM flap reconstruction is well tolerated and is not associated with increased acute complication or radiation interruption. The authors have noticed that chemotherapy given after radiation was related to severe skin reaction, so it should be used with caution.
authors.affiliation: Radiation Oncology Division, Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand. racsi@mahidol.ac.th
authors.forename: Chomporn
authors.initials: C
authors.lastname: Sitathanee
authors.forename: Putipun
authors.initials: P
authors.lastname: Puataweepong
authors.forename: Thiti
authors.initials: T
authors.lastname: Swangsilpa
authors.forename: Ladawan
authors.initials: L
authors.lastname: Narkwong
authors.forename: Youwanush
authors.initials: Y
authors.lastname: Kongdan
authors.forename: Ronnarat
authors.initials: R
authors.lastname: Suvikapakornkul
mesh_terms: D000208:Acute Disease; D000328:Adult; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006801:Humans; D016462:Mammaplasty; D008408:Mastectomy; D008875:Middle Aged; D011855:Radiodermatitis / Q000209:etiology / Q000473:pathology*; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012867:Skin / Q000528:radiation effects; D013524:Surgical Flaps