Evidence map›Paper›PMID 34113723›Full record

ArticleClinical and translational radiation oncology2021

Redefining postmastectomy radiation contouring in the era of immediate breast reconstruction: An accurate assessment of local recurrence risk.

Nicholas Lao, Muriel Brackstone, Silvia C Formenti, Christopher Doherty, Francisco Perera, Ronald Chow, Tanya DeLyzer, Aaron Grant, Gabriel Boldt, Michael Lock

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Clinical and translational radiation oncology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
1.0field-weighted citation impact, top 24% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 6 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 5 institutions in 2 countries.

Nicholas LaoDept. Oncology, London Regional Cancer Program, London, ON, Canada.
Muriel BrackstoneDept. Oncology, London Regional Cancer Program, London, ON, Canada.
Silvia C FormentiDept Radiation Oncology, Weill-Cornell Medicine, New York, NY, USA.
Christopher DohertyDiv Plastic & Reconstructive Surgery, Vancouver General Hospital, Vancouver, BC, Canada.
Francisco PereraDept. Oncology, London Regional Cancer Program, London, ON, Canada.
Ronald ChowYale School of Public Health, Yale University, New Haven, CT, USA.
Tanya DeLyzerDiv Plastic & Reconstructive Surgery, London Health Sciences Centre, London, ON, Canada.
Aaron GrantDiv Plastic & Reconstructive Surgery, London Health Sciences Centre, London, ON, Canada.
Gabriel BoldtDept. Oncology, London Regional Cancer Program, London, ON, Canada.
Michael LockDept. Oncology, London Regional Cancer Program, London, ON, Canada.
Cancer Care Ontario · CALondon Health Sciences Centre · CACornell University · USVancouver General Hospital · CAYale University · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionMost studies report post-mastectomy local recurrences as chest wall recurrences without clarifying whether the recurrence is in the subcutaneous tissue, muscle or underlying rib. Post-mastectomy chest wall radiation is recommended in patients at increased risk of locoregional recurrence. Chest wall radiation-related fibrosis has become an important clinical consideration in the era of immediate implant-based breast reconstruction. In patients with commonly performed subpectoral implant-based reconstruction, the pectoralis major becomes relocated anterior to the implant and just deep to skin, therefore raising the question of value in radiating deep chest wall structures. This study assessed the rate of recurrence in each anatomical region of chest wall in post-mastectomy patients.

methodsA comprehensive breast cancer database of 4287 patients at a single regional cancer center from 2006 to 2018 was retrospectively analyzed to identify 1571 mastectomy patients. Recurrences were classified as local skin/subcutaneous, pectoralis muscle (pectoralis major), deep chest wall (pectoralis minor, intercostal muscle or rib) or regional axillary recurrence.

resultsA total of 26 patients with locoregional recurrence were identified. Most recurrences were in the skin/subcutaneous level. Of 1571 mastectomy patients, only one patient developed a local recurrence posterior to pectoralis major. Our literature search and meta-analysis revealed that local recurrences post-mastectomy are much more likely to be in subcutaneous tissues/pectoralis major versus deeper chest wall.

conclusionA reduced clinical target volume which encompasses skin/subcutaneous and pectoralis muscle layers without treating deep chest wall may be more appropriate to reduce radiation-associated toxicity since avoiding circumferential radiation of an implant may prevent capsular contracture without compromising treatment benefit.

Indexed as

Breast cancerBreast implantChest wallContractureImmediate breast reconstructionLocal recurrenceMastectomyPost-mastectomy radiationRadiation therapy

Identifiers

PMID34113723
PMCPMC8170417
OpenAlexW3158846198

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.