TY - JOUR
T1 - Breast reconstruction and radiation therapy
T2 - An Italian expert Delphi consensus statements and critical review
AU - Meattini, Icro
AU - Becherini, Carlotta
AU - Bernini, Marco
AU - Bonzano, Elisabetta
AU - Criscitiello, Carmen
AU - De Rose, Fiorenza
AU - De Santis, Maria Carmen
AU - Fontana, Antonella
AU - Franco, Pierfrancesco
AU - Gentilini, Oreste Davide
AU - Livi, Lorenzo
AU - Meduri, Bruno
AU - Parisi, Silvana
AU - Pasinetti, Nadia
AU - Prisco, Agnese
AU - Rocco, Nicola
N1 - Funding Information:
We would like to acknowledge the Group for Reconstructive and Therapeutic Advancements (G.RE.T.A.) and the Clinical Oncology Breast Cancer Group (COBCG) for the endorsement. We would like to acknowledge the Scientific and General Board of the Italian Association of Radiotherapy and Clinical Oncology (AIRO) for the endorsement. We would like to acknowledge the AIRO Breast Cancer Group Investigators and Expert Panel of the Consensus Statements (Table S2). Preliminary work was presented as selected poster at San Gallen Breast Cancer Conference 2021 (Breast reconstruction and radiation therapy: consensus statements of the Italian association of radiotherapy and clinical oncology (AIRO) breast cancer group. April 2021, The Breast 56:S47; DOI: 10.1016/S0960-9776(21)00160-0).
Funding Information:
Icro Meattini reports occasional advisory boards supported by Eli Lilly, Novartis, Pfizer, and Roche, outside the submitted work. None other disclosed by the Authors.
Publisher Copyright:
© 2021 Elsevier Ltd
PY - 2021/9
Y1 - 2021/9
N2 - Breast conserving surgery (BCS) plus radiation therapy (RT) or mastectomy have shown comparable oncological outcomes in early-stage breast cancer and are considered standard of care treatments. Postmastectomy radiation therapy (PMRT) targeted to both the chest wall and regional lymph nodes is recommended in high-risk patients. Oncoplastic breast conserving surgery (OBCS) represents a significant recent improvement in breast surgery. Nevertheless, it represents a challenge for radiation oncologists as it triggers different decision-making strategies related to treatment volume definition and target delineation. Hence, the choice of the best combination and timing when offering RT to breast cancer patients who underwent or are planned to undergo reconstruction procedures should be carefully evaluated and based on individual considerations. We present an Italian expert Delphi Consensus statements and critical review, led by a core group of all the professional profiles involved in the management of breast cancer patients undergoing reconstructive procedures and RT. The report was structured as to consider the main recommendations on breast reconstruction and RT and analyse the current open issues deserving investigation and consensus. We used a three key-phases and a Delphi process. The final expert panel of 40 colleagues selected key topics as identified by the core group of the project. A final consensus on 26 key statements on RT and breast reconstruction after three rounds of the Delphi voting process and harmonisation was reached. An accompanying critical review of available literature was summarized. A clear communication and cooperation between surgeon and radiation oncologist is of paramount relevance both in the setting of breast reconstruction following mastectomy when PMRT is planned and when extensive glandular rearrangements as OBCS is performed. A shared-decision making, relying on outcome-based and patient-centred considerations, is essential, while waiting for higher level-of-evidence data.
AB - Breast conserving surgery (BCS) plus radiation therapy (RT) or mastectomy have shown comparable oncological outcomes in early-stage breast cancer and are considered standard of care treatments. Postmastectomy radiation therapy (PMRT) targeted to both the chest wall and regional lymph nodes is recommended in high-risk patients. Oncoplastic breast conserving surgery (OBCS) represents a significant recent improvement in breast surgery. Nevertheless, it represents a challenge for radiation oncologists as it triggers different decision-making strategies related to treatment volume definition and target delineation. Hence, the choice of the best combination and timing when offering RT to breast cancer patients who underwent or are planned to undergo reconstruction procedures should be carefully evaluated and based on individual considerations. We present an Italian expert Delphi Consensus statements and critical review, led by a core group of all the professional profiles involved in the management of breast cancer patients undergoing reconstructive procedures and RT. The report was structured as to consider the main recommendations on breast reconstruction and RT and analyse the current open issues deserving investigation and consensus. We used a three key-phases and a Delphi process. The final expert panel of 40 colleagues selected key topics as identified by the core group of the project. A final consensus on 26 key statements on RT and breast reconstruction after three rounds of the Delphi voting process and harmonisation was reached. An accompanying critical review of available literature was summarized. A clear communication and cooperation between surgeon and radiation oncologist is of paramount relevance both in the setting of breast reconstruction following mastectomy when PMRT is planned and when extensive glandular rearrangements as OBCS is performed. A shared-decision making, relying on outcome-based and patient-centred considerations, is essential, while waiting for higher level-of-evidence data.
KW - Breast cancer
KW - Breast reconstruction
KW - Consensus statements
KW - Radiation therapy
KW - Review
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U2 - 10.1016/j.ctrv.2021.102236
DO - 10.1016/j.ctrv.2021.102236
M3 - Review article
AN - SCOPUS:85107631180
VL - 99
JO - Cancer Treatment Reviews
JF - Cancer Treatment Reviews
SN - 0305-7372
M1 - 102236
ER -