title: Amifostine reduces radiation-induced complications in a murine model of expander-based breast reconstruction.
abstract: BACKGROUND
  Immediate expander-based breast reconstruction after mastectomy is a prevalent option for many women with breast cancer. When coupled with adjuvant radiation therapy, however, radiation-induced skin and soft-tissue injury diminish the success of this reconstructive technique. The authors hypothesize that prophylactic administration of the cytoprotectant amifostine will reduce soft-tissue complications from irradiation, aiding expander-based reconstruction.
  
  
  METHODS
  Sprague-Dawley rats were divided into two groups: operative expander placement (expander group) and operative sham (sham group). Expander specimens received a sublatissimus tissue expander with a 15-cc fill volume; shams underwent identical procedures without expanders. Experimental groups were further divided into control specimens receiving no further intervention, radiation therapy-only specimens receiving human-equivalent irradiation, and amifostine plus radiation therapy specimens receiving both amifostine and human-equivalent irradiation. After a 45-day recovery period, animals were evaluated grossly and with ImageJ analysis for skin and soft-tissue complications.
  
  
  RESULTS
  None of the control, radiation therapy-alone, or amifostine plus radiation therapy sham specimens showed skin and soft-tissue complications. For expander animals, significantly fewer amifostine plus radiation therapy specimens [four of 13 (30 percent)] demonstrated skin and soft-tissue complications compared with radiation therapy-alone specimens [nine of 13 (69 percent); p = 0.041]. ImageJ evaluation of expander specimens demonstrated a significant increase in skin and soft-tissue necrosis for radiation therapy-alone specimens (12.94 percent) compared with animals receiving amifostine plus radiation therapy (6.96 percent) (p = 0.019).
  
  
  CONCLUSIONS
  Amifostine pretreatment significantly reduced skin and soft-tissue complications. These findings demonstrate that amifostine prophylaxis provides protection against radiation-induced skin and soft-tissue injury in a murine model of expander-based breast reconstruction.
authors.affiliation: Ann Arbor, Mich.; and Columbia, S.C. From the Craniofacial Research Laboratory, Plastic Surgery Section, University of Michigan; and the Department of General Surgery, University of South Carolina School of Medicine.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Felice
authors.forename: Noah S
authors.initials: NS
authors.lastname: Nelson
authors.forename: Erin E
authors.initials: EE
authors.lastname: Page
authors.forename: Sagar S
authors.initials: SS
authors.lastname: Deshpande
authors.forename: Alexis
authors.initials: A
authors.lastname: Donneys
authors.forename: José
authors.initials: J
authors.lastname: Rodriguez
authors.forename: Steven R
authors.initials: SR
authors.lastname: Buchman
mesh_terms: D004999:Amifostine / Q000627:therapeutic use*; D000818:Animals; D008297:Male; D016462:Mammaplasty / Q000379:methods*; D023421:Models, Animal; D011832:Radiation Injuries / Q000517:prevention & control*; D011837:Radiation-Protective Agents / Q000627:therapeutic use*; D051381:Rats; D017207:Rats, Sprague-Dawley; D015626:Tissue Expansion
chemical_list: D011837:Radiation-Protective Agents; D004999:Amifostine