title: Fibrotic changes after postmastectomy radiotherapy and reconstructive surgery in breast cancer. A retrospective analysis in 109 patients.
abstract: OBJECTIVE
  The purpose of this study was to analyze the probability and time course of fibrotic changes in breast reconstruction before or after postmastectomy radiotherapy (PMRT).
  
  
  METHODS
  Between 1995 and 2004, 109 patients were treated with PMRT at Tübingen University and underwent heterologous (HL) or autologous (AL) breast reconstruction prior or subsequent to radiation therapy. Fibrosis of the reconstructed breast after radiotherapy was assessed using the Baker score for HL reconstructions and the Common Terminology Criteria for Adverse Events (CTCAE) for all patients. Actuarial rates of fibrosis were calculated for the maximum degree acquired during follow- up and at the last follow-up visit documented.
  
  
  RESULTS
  Median time to follow-up was 34 months (3-227 months). Radiotherapy was applied with a median total dose of 50.4 Gy. A total of 44 patients (40.4%) received a boost treatment with a median dose of 10 Gy. Breast reconstruction was performed with AL, HL, or combined techniques in 20, 82, and 7 patients, respectively. The 3-year incidence of ≥ grade III maximum fibrosis was 20% and 43% for Baker and CTCAE scores, respectively. The corresponding figures for fibrosis at last follow-up visit were 18% and 2%. The 3-year rate of surgical correction of the contralateral breast was 30%. Initially unplanned surgery of the reconstructed breast was performed in 39 patients (35.8%). Boost treatment and type of cosmetic surgery (HL vs. AL) were not significantly associated with the incidence of fibrosis.
  
  
  CONCLUSIONS
  We found severe fibrosis to be a frequent complication after PMRT radiotherapy and breast reconstruction. However, surgical intervention can ameliorate the majority of high grade fibrotic events leading to acceptable long-term results. No treatment parameters associated with the rate of fibrosis could be identified.
authors.affiliation: Department of Radiation Oncology, Tübingen University, Tübingen, Germany. johannes.classen@vincentius-ka.de
authors.forename: Johannes
authors.initials: J
authors.lastname: Classen
authors.forename: Sibille
authors.initials: S
authors.lastname: Nitzsche
authors.forename: Diethelm
authors.initials: D
authors.lastname: Wallwiener
authors.forename: Peter
authors.initials: P
authors.lastname: Kristen
authors.forename: Rainer
authors.initials: R
authors.lastname: Souchon
authors.forename: Michael
authors.initials: M
authors.lastname: Bamberg
authors.forename: Sara
authors.initials: S
authors.lastname: Brucker
mesh_terms: D000206:Actuarial Analysis; D000328:Adult; D000368:Aged; D001940:Breast / Q000528:radiation effects*; D001941:Breast Diseases / Q000209:etiology* / Q000601:surgery; D001943:Breast Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015182:Lymphatic Irradiation; D016462:Mammaplasty; D008408:Mastectomy; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery; D011336:Probability; D017564:Radiation Pneumonitis / Q000209:etiology* / Q000601:surgery; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012086:Reoperation