ABSTRACT
In autologous breast reconstruction, a sufficient flap volume is fundamental to restore breast shape and ensure an aesthetic outcome. After mastectomy, postoperative irradiation is regularly indicated in the oncological treatment algorithm. When administering radiation therapy after autologous reconstruction, the tissue transferred is inherently irradiated. Although there is evidence that points to a reduction in flap volume after adjuvant radiotherapy, the data have been contradicting and inconclusive. To address this anecdotal evidence, we performed a scoping review of the current literature that addresses the effect of radiotherapy on breast flap volume. Six two-armed studies, comprising a total of 462 patients, reported on the effect of adjuvant radiotherapy on free flap volume changes. Of those, two studies found a significant negative impact of radiotherapy on free flap volume, while the other four studies did not. Reported flap volume changes ranged from no change to a reduction of 26.2%, measured up to two years postoperatively. The selected studies contain varying patient numbers, follow-up timepoints, types of flaps, and measuring methods, contributing to a relatively high heterogeneity. While we present some evidence suggesting a significant impact of adjuvant radiotherapy on breast flap volume, future studies are needed to further investigate this potential correlation.
ABSTRACT
Smarter Medicine in Radiation Oncology - current and proven treatment concepts offering the greatest possible benefit to cancer patients in clinical practice Abstract. Modern procedures in radiation therapy with respect to indication, therapy planning and implementation of shorter treatment regimens result in high local tumor control and excellent quality of life in frequent and clinically relevant disease entities including breast and prostate cancer as well as bone metastases. In the adjuvant therapy for early breast cancer, a careful comparative analysis of the use of endocrine adjuvant treatment over five years versus postoperative radiation therapy over less than four weeks may result in omission of radiation treatment in a selected patient population. Partial breast irradiation, while treating the tumor bed only in low risk situations, and hypofractionated whole breast radiotherapy for patients with a higher risk profile for local recurrence, halved treatment time compared to 10 years ago, making adjuvant radiotherapy for patients with breast cancer more convenient. In patients with localized prostate cancer, the introduction of hypofractionated treatment regimens halved the number of daily fractions and current developments point towards a one-week outpatient therapy for locally limited disease using high precision stereotactic techniques and accurate therapy planning based on multifunctional imaging. Patients with bone metastases are more and more treated with a single fraction, high precision stereotactic radiotherapy (radiosurgery) with high analgesic potential and achieving long lasting local tumor control. These modern, often significantly shorter, radiotherapy treatment regimens not only result in an excellent treatment response and better quality of life for patients, but also include a better utilization of radiotherapy resources needing less treatment machines and thus helping to reduce costs in the Swiss healthcare system.
Subject(s)
Breast Neoplasms , Radiation Oncology , Breast Neoplasms/radiotherapy , Female , Humans , Neoplasm Recurrence, Local , Quality of Life , Radiotherapy, AdjuvantABSTRACT
SMARCA4-deficient thoracic sarcoma is a newly described entity of thoracic sarcomas with a poor prognosis, defined by poorly differentiated epithelioid to rhabdoid histomorphology and SMARCA4 gene inactivation. We present a case of a SMARCA4-deficient thoracic sarcoma in a 41-year-old male with a smoking history who presented with an upper anterior mediastinal mass, after seeking medical evaluation for increasing thoracic pain, odynophagia, and dizziness. The biopsy confirmed a large cell tumor with an epithelioid to rhabdoid histomorphology, positive for EMA, CD99, vimentin, TLE1, INI1, PAS-positive cytoplasmic granules, and PD-L1 (100% of tumor cells). High TMB and HRD scores were displayed in the tumor. The histology and immunophenotype of the mass were in line with the diagnosis of SMARCA4-deficient thoracic sarcoma. In the course of his treatment, the patient showcased a partial response to pembrolizumab and the combination of pembrolizumab and ipilimumab. This case report highlights the importance of recognizing SMARCA4-deficient thoracic sarcoma as an individual entity and supports the importance of checkpoint inhibition therapy for SMARCA4-deficient thoracic sarcomas, particularly in cases with a high TMB and PD-L1 expression.
