Postmastectomy radiation therapy using VMAT technique for breast cancer patients with expander reconstruction

Fiorenza De Rose, Antonella Fogliata, Davide Franceschini, Salvatore Cozzi, Cristina Iftode, Antonella Stravato, Stefano Tomatis, Giovanna Masci, Rosalba Torrisi, Alberto Testori, Corrado Tinterri, Andrea V E Lisa, Luca Maione, Valeriano Vinci, Marco Klinger, Armando Santoro, Marta Scorsetti

Research output: Contribution to journalArticlepeer-review


Postmastectomy radiotherapy (PMRT) following immediate breast reconstruction is increasingly adopted in the management of breast cancer patients. We retrospectively evaluate the complication rates of PMRT using VMAT technique to immediate tissue expander-based reconstructions and the possible impact of tissue expander volume on radiotherapy planning. We reviewed the data of patients who underwent immediate expander breast reconstruction and received PMRT with VMAT (50 Gy in 25 fractions) on the reconstructed breast and axillary levels III-IV. Neoadjuvant or adjuvant systemic therapy was administered in most of the patients. Autologous fat grafting was routinely performed at the time of second-stage reconstruction. Between 2015 and 2017, PMRT was delivered to 46 consecutive patients (median age 50 years) with expander reconstruction. Median follow-up was 27 months (range 10-41). Two patients (4.3%) had a reconstruction failure, as expander rupture and infection, following the first- and the second-stage reconstruction, respectively. In most cases expanders were completely inflated before PMRT (65.2%). Median expander volume before PMRT was 425 cm3 (range 150-700 cm3). The amount of expander inflation did not significantly affect dosimetry, except for skin dose, with a surface receiving more than 30 Gy of 36.6 ± 0.9 cm2 and 47.0 ± 2.5 cm2 for a volume expander below or above the median, respectively. However, this variable was not predictor for complications. Disease progression was recorded in 15.2% of patients. PMRT using VMAT technique for breast cancer patients with expander reconstruction is associated with a very low complication rate. The expander volume before PMRT does not significantly compromise radiotherapy dose distribution.

Original languageEnglish
Pages (from-to)48
JournalMedical oncology (Northwood, London, England)
Issue number6
Publication statusPublished - Apr 25 2019


  • Adult
  • Aged
  • Breast Implants
  • Breast Neoplasms/pathology
  • Combined Modality Therapy
  • Dose Fractionation, Radiation
  • Female
  • Humans
  • Mammaplasty/adverse effects
  • Mastectomy
  • Middle Aged
  • Postoperative Complications
  • Radiotherapy Planning, Computer-Assisted
  • Radiotherapy, Adjuvant/adverse effects
  • Retrospective Studies
  • Tissue Expansion Devices
  • Treatment Outcome


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