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ORIGINAL RESEARCH article

Front. Oncol.
Sec. Breast Cancer
Volume 14 - 2024 | doi: 10.3389/fonc.2024.1373434
This article is part of the Research Topic Radioresistance in Breast Cancer View all 6 articles

The Impact of the New ESTRO-ACROP Target Volume Delineation Guidelines for Postmastectomy Radiotherapy after Implant-Based Breast Reconstruction on Breast Complications

Provisionally accepted
Jung Bin Park Jung Bin Park 1Bum-Sup Jang Bum-Sup Jang 1Ji Hyun Chang Ji Hyun Chang 1Jin Ho Kim Jin Ho Kim 1Chang Heon Choi Chang Heon Choi 1Ki Yong Hong Ki Yong Hong 2Ung Sik Jin Ung Sik Jin 2Hak Chang Hak Chang 2Yujin Myung Yujin Myung 3Jae Hoon Jeong Jae Hoon Jeong 3Chan Yeong Heo Chan Yeong Heo 3In Ah Kim In Ah Kim 4KyungHwan Shin KyungHwan Shin 1,5,6*
  • 1 Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
  • 2 Departments of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul, Republic of Korea
  • 3 Departments of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
  • 4 Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
  • 5 Department of Radiation Oncology, College of Medicine, Seoul National University, Seoul, Republic of Korea
  • 6 Cancer Research Institute, College of Medicine, Seoul National University, Seoul, Republic of Korea

The final, formatted version of the article will be published soon.

    The European Society for Radiotherapy and Oncology Advisory Committee in Radiation Oncology Practice (ESTRO-ACROP) updated a new target volume delineation guideline for postmastectomy radiotherapy (PMRT) after implant-based reconstruction. This study aimed to evaluate the impact on breast complications with the new guideline compared to the conventional guidelines. In total, 308 patients who underwent PMRT after tissue expander or permanent implant insertion from 2016 to 2021 were included; 184 received RT by the new ESTRO-ACROP target delineation (ESTRO-T), and 124 by conventional target delineation (CONV-T). The endpoints were major breast complications (infection, necrosis, capsular contracture, and deformity) requiring re-operation or re-hospitalization and any grade ≥2 breast complications. With a median follow-up of 36.4 months, the cumulative incidence rates of major breast complications at 1, 2, and 3 years were 6.6%, 10.3%, and 12.6% in the ESTRO-T group, and 9.7%, 15.4%, and 16.3% in the CONV-T group; it did not show a significant difference between the groups (p = 0.56). In multivariable analyses, target delineation is not associated with the major complications (sHR = 0.87; p = 0.77). There was no significant difference in any breast complications (3-year incidence, 18.9% vs. 23.3%, respectively; p = 0.56). Symptomatic RT-induced pneumonitis was developed in 6 (3.2%) and 3 (2.4%) patients, respectively. One local recurrence occurred in the ESTRO-T group, which was within the ESTRO-target volume. The new ESTRO-ACROP target volume guideline did not demonstrate significant differences in major or any breast complications, although it showed a tendency of reduced complication risks. As the dosimetric benefits of normal organs and comparable oncologic outcomes have been reported, further analyses with long-term follow-up are necessary to evaluate whether it could be connected to better clinical outcomes.

    Keywords: Breast cancer1, Breast implant2, Breast reconstruction3, radiotherapy4, Target delineation5, Implant complcation6, Radiotherapy adverse effects7

    Received: 19 Jan 2024; Accepted: 29 Apr 2024.

    Copyright: © 2024 Park, Jang, Chang, Kim, Choi, Hong, Jin, Chang, Myung, Jeong, Heo, Kim and Shin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: KyungHwan Shin, Department of Radiation Oncology, Seoul National University Hospital, Seoul, 03080, Republic of Korea

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