title: Mastectomy with immediate expander-implant reconstruction, adjuvant chemotherapy, and radiation for stage II-III breast cancer: treatment intervals and clinical outcomes.
abstract: OBJECTIVE
  To determine intervals between surgery and adjuvant chemotherapy and radiation in patients treated with mastectomy with immediate expander-implant reconstruction, and to evaluate locoregional and distant control and overall survival in these patients.
  
  
  METHODS
  Between May 1996 and March 2004, 104 patients with Stage II-III breast cancer were routinely treated at our institution under the following algorithm: (1) definitive mastectomy with axillary lymph node dissection and immediate tissue expander placement, (2) tissue expansion during chemotherapy, (3) exchange of tissue expander for permanent implant, (4) radiation. Patient, disease, and treatment characteristics and clinical outcomes were retrospectively evaluated.
  
  
  RESULTS
  Median age was 45 years. Twenty-six percent of patients were Stage II and 74% Stage III. All received adjuvant chemotherapy. Estrogen receptor staining was positive in 77%, and 78% received hormone therapy. Radiation was delivered to the chest wall with daily 0.5-cm bolus and to the supraclavicular fossa. Median dose was 5,040 cGy. Median interval from surgery to chemotherapy was 5 weeks, from completion of chemotherapy to exchange 4 weeks, and from exchange to radiation 4 weeks. Median interval from completion of chemotherapy to start of radiation was 8 weeks. Median follow-up was 64 months from date of mastectomy. The 5-year rate for locoregional disease control was 100%, for distant metastasis-free survival 90%, and for overall survival 96%.
  
  
  CONCLUSIONS
  Mastectomy with immediate expander-implant reconstruction, adjuvant chemotherapy, and radiation results in a median interval of 8 weeks from completion of chemotherapy to initiation of radiation and seems to be associated with acceptable 5-year locoregional control, distant metastasis-free survival, and overall survival.
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
authors.forename: Jean L
authors.initials: JL
authors.lastname: Wright
authors.forename: Peter G
authors.initials: PG
authors.lastname: Cordeiro
authors.forename: Leah
authors.initials: L
authors.lastname: Ben-Porat
authors.forename: Kimberly J
authors.initials: KJ
authors.lastname: Van Zee
authors.forename: Clifford
authors.initials: C
authors.lastname: Hudis
authors.forename: Kathryn
authors.initials: K
authors.lastname: Beal
authors.forename: Beryl
authors.initials: B
authors.lastname: McCormick
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D000704:Analysis of Variance; D000971:Antineoplastic Combined Chemotherapy Protocols; D018427:Breast Implants; D001943:Breast Neoplasms / Q000737:chemistry / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D016462:Mammaplasty / Q000295:instrumentation / Q000379:methods*; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D011960:Receptors, Estrogen / Q000032:analysis; D012189:Retrospective Studies; D013524:Surgical Flaps; D016019:Survival Analysis; D013997:Time Factors; D015626:Tissue Expansion / Q000379:methods; D016896:Treatment Outcome
chemical_list: D011960:Receptors, Estrogen