title: The impact of skin-sparing mastectomy with immediate reconstruction in patients with Stage III breast cancer treated with neoadjuvant chemotherapy and postmastectomy radiation.
abstract: OBJECTIVE
  The safety and efficacy of skin-sparing mastectomy (SSM) with immediate reconstruction (IR) in patients with locally advanced breast cancer are unclear. The purpose of this study is to compare the outcomes of women with noninflammatory Stage III SSM with IR vs. non-SSM-treated women who underwent neoadjuvant chemotherapy and adjuvant radiation therapy (XRT).
  
  
  METHODS
  Between October 1997 and March 2010, 100 consecutive patients (40 SSM with IR vs. 60 non-SSM) with Stage III breast cancer received anthracycline- and/or taxane-based neoadjuvant chemotherapy, mastectomy, and adjuvant XRT. Clinical stage (SSM with IR vs. for non-SSM) was IIIA (75% vs. 67%), IIIB (8% vs. 18%), and IIIC (8% vs. 8%). Tumors greater than 5 cm were found in 74% vs. 69%; 97% of patients in both groups were clinically node positive; and 8% vs. 18% had T4b disease.
  
  
  RESULTS
  The time from initial biopsy to XRT was prolonged for SSM-IR patients (274 vs. 254 days, p = 0.04), and there was a trend toward XRT delay of more than 8 weeks (52% vs. 31%, p = 0.07) after surgery. The rate of complications requiring surgical intervention was higher in the SSM-IR group (37.5% vs. 5%, p < 0.001). The 2-year actuarial locoregional control, breast cancer-specific survival, and overall survival rates for SSM with IR vs. non-SSM were 94.7% vs. 97.4%, 91.5% vs. 86.3%, and 87.4% vs. 84.8%, respectively (p = not significant).
  
  
  CONCLUSIONS
  In our small study with limited follow-up, SSM with IR prolonged overall cancer treatment time and trended toward delaying XRT but did not impair oncologic outcomes. Complication rates were significantly higher in this group. Longer follow-up is needed.
authors.affiliation: Department of Radiation Oncology, Emory University, Atlanta, GA 30322, USA.
authors.forename: Roshan
authors.initials: R
authors.lastname: Prabhu
authors.forename: Karen
authors.initials: K
authors.lastname: Godette
authors.forename: Grant
authors.initials: G
authors.lastname: Carlson
authors.forename: Albert
authors.initials: A
authors.lastname: Losken
authors.forename: Sheryl
authors.initials: S
authors.lastname: Gabram
authors.forename: Carolina
authors.initials: C
authors.lastname: Fasola
authors.forename: Ruth
authors.initials: R
authors.lastname: O'Regan
authors.forename: Amelia
authors.initials: A
authors.lastname: Zelnak
authors.forename: Mylin
authors.initials: M
authors.lastname: Torres
mesh_terms: D000328:Adult; D000368:Aged; D018943:Anthracyclines / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D001952:Bridged-Ring Compounds / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant / Q000379:methods; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D016462:Mammaplasty; D008408:Mastectomy / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D015996:Survival Rate; D043823:Taxoids / Q000008:administration & dosage; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden / Q000187:drug effects / Q000528:radiation effects
chemical_list: D018943:Anthracyclines; D001952:Bridged-Ring Compounds; D043823:Taxoids; C080625:taxane; D004317:Doxorubicin