title: Comparison of Long-Term Outcomes of Postmastectomy Radiotherapy between Breast Cancer Patients with and without Immediate Flap Reconstruction.
abstract: OBJECTIVE
  To compare the long-term clinical outcomes of postmastectomy radiotherapy (PMRT) between breast cancer patients with and without immediate transverse rectus abdominis myocutaneous (TRAM) flap reconstruction.
  
  
  METHODS
  The study included 492 patients with stage II or III breast cancer who underwent modified radical mastectomy (MRM) and chemotherapy followed by PMRT between 1997 and 2011. Cox regression model and Kaplan-Meier curves were calculated, and the log-rank test was used to evaluate the differences between overall and disease-free survival rates in the 2 groups.
  
  
  RESULTS
  Among 492 patients, 213 patients had immediate TRAM flap reconstruction. The mean follow-up was 7.2 years (range, 11-191 months). The 5-year and 10-year disease free survival rates were 81% and 76% for the TRAM flap group and 78% and 73% for the non-flap group. The 5-year and 10-year overall survival rates were 89% and 73% for the TRAM flap group and 83% and 74% for the non-flap group.
  
  
  CONCLUSIONS
  There exists no statistically significant difference in the rates of local recurrence, distant metastasis, disease-free and overall survival when comparing immediate TRAM flap reconstruction with no reconstruction. Our results suggest that immediate TRAM flap reconstruction does not compromise long term clinical outcomes in breast cancer patients requiring PMRT.
authors: Division of Radiation Oncology, Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.|Department of Radiation Oncology, Antai Tian-Sheng Memorial Hospital, Pingtung, Taiwan.
authors: Hsin-Hua
authors: HH
authors: Lee
authors: Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.|Department of General Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.|National Sun Yat-Sen University-Kaohsiung Medical University Joint Research Center, Kaohsiung, Taiwan.
authors: Ming-Feng
authors: MF
authors: Hou
authors: Department of Internal Medicine, Kaohsiung Municipal United Hospital, Kaohsiung, Taiwan.|Yuh-Ing Junior College of Health Care & Management, Kaohsiung, Taiwan.
authors: Shu-Yi
authors: SY
authors: Wei
authors: Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.|Department of General Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.|National Sun Yat-Sen University-Kaohsiung Medical University Joint Research Center, Kaohsiung, Taiwan.
authors: Sin-Daw
authors: SD
authors: Lin
authors: Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors: Kuei-Hau
authors: KH
authors: Luo
authors: Division of Radiation Oncology, Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.|Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors: Ming-Yii
authors: MY
authors: Huang
authors: Department of General Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors: Fu
authors: F
authors: Ou-Yang
authors: Division of Radiation Oncology, Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.|Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors: Chih-Jen
authors: CJ
authors: Huang
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D011184:Postoperative Period; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D017568:Rectus Abdominis / Q000601:surgery*; D012044:Regression Analysis; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome