title: Neoadjuvant radiotherapy followed by mastectomy and immediate breast reconstruction : An alternative treatment option for locally advanced breast cancer.
abstract: BACKGROUND
  The optimal sequence of mastectomy with immediate breast reconstruction (IBR) and radiotherapy (RT) for the treatment of locally advanced breast cancer (LABC) is still under debate. Increased rates of postoperative complications are described following postmastectomy RT. Neoadjuvant RT aims to improve the aesthetic results and simplify the reconstructive pathway.
  
  
  METHODS
  A total of 22 patients diagnosed with LABC and treated with neoadjuvant RT followed by mastectomy and IBR between 04/2012 and 03/2015 were retrospectively analyzed. RT consisted of external beam RT to the breast and the regional lymphatics, if indicated. Both implant-based and autologous tissue-transfer reconstruction techniques were used.
  
  
  RESULTS
  At the time of RT, 10 patients had no prior surgery and 12 patients had previously undergone breast-conserving surgery (BCS) with positive resection margins without the possibility to perform a second BCS. Additional neoadjuvant chemotherapy was administered in 18 patients prior to RT. A complete pathological response was achieved in 55.0% of patients. The 2‑year overall survival rate was 89.3%, the 2‑year disease-free-survival 79.8% and the local-recurrence-free survival was 95.2%. The cosmetic result was excellent or good in 66% of the patients treated with upfront mastectomy and 37% of the patients who had previously undergone BCS. Among patients who received implant-based IBR, 4 patients developed serious wound-healing problems with implant loss. The most satisfactory results were achieved with autologous tissue reconstruction.
  
  
  CONCLUSIONS
  A sequential neoadjuvant chemo-/radiotherapy to allow IBR following mastectomy in selected cases of LABC seems feasible and can be safely attempted. Careful patient selection, close monitoring, and continuous patient support is mandatory to ensure compliance in this treatment strategy.
authors.affiliation: Department of Radiation Oncology, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Pazos
authors.affiliation: Department of Radiation Oncology, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany. stefanie.corradini@med.uni-muenchen.de.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Corradini
authors.affiliation: Mednord Munich Clinic, Heidemannstraße 5b, 80939, Munich, Germany.
authors.forename: Darius
authors.initials: D
authors.lastname: Dian
authors.affiliation: Breast Center, Department of Obstetrics and Gynecology, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
authors.forename: Vera
authors.initials: V
authors.lastname: von Bodungen
authors.affiliation: Breast Center, Department of Obstetrics and Gynecology, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
authors.forename: Nina
authors.initials: N
authors.lastname: Ditsch
authors.affiliation: Breast Center, Department of Obstetrics and Gynecology, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
authors.forename: Rachel
authors.initials: R
authors.lastname: Wuerstlein
authors.affiliation: Department of Radiation Oncology, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Schönecker
authors.affiliation: Breast Center, Department of Obstetrics and Gynecology, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
authors.forename: Nadia
authors.initials: N
authors.lastname: Harbeck
authors.affiliation: Department of Radiation Oncology, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
authors.forename: Heike
authors.initials: H
authors.lastname: Scheithauer
authors.affiliation: Department of Radiation Oncology, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Belka
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D003131:Combined Modality Therapy / Q000379:methods; D019091:Critical Pathways / Q000458:organization & administration; D016462:Mammaplasty / Q000379:methods / Q000523:psychology; D008408:Mastectomy / Q000379:methods / Q000523:psychology; D017060:Patient Satisfaction; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant / Q000379:methods / Q000523:psychology; D020266:Radiotherapy, Conformal / Q000379:methods / Q000523:psychology; D016896:Treatment Outcome; D012189:Retrospective Studies
keywords: Breast neoplasms; Mammaplasty; Premastectomy; Radiotherapy; Wound healing