Near-Surface Dose Correlates With Moist Desquamation and Unplanned Reconstructive Surgery in Patients With Implant-Based Reconstruction Receiving Postmastectomy Radiation Therapy

Ronald Levitin; Kamran Salari; Bryan S Squires; Allison J Hazy; Michael J Maywood; Patrick Thrasher; Anthony P Delise; Muayad F Almahariq; Nayana Dekhne; Lauren Oliver; Peter Y Chen; Kailee J Walters; Diane Dudley; Joshua T Dilworth

doi:10.1016/j.adro.2023.101283

Near-Surface Dose Correlates With Moist Desquamation and Unplanned Reconstructive Surgery in Patients With Implant-Based Reconstruction Receiving Postmastectomy Radiation Therapy

Adv Radiat Oncol. 2023 Jun 5;8(6):101283. doi: 10.1016/j.adro.2023.101283. eCollection 2023 Nov-Dec.

Affiliations

¹ Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan.
² Radiation oncology, Huron River Radiation Oncology Specialists, Ypsilanti, Michigan.
³ Department of Ophthalmology, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan.
⁴ Oakland University William Beaumont School of Medicine, Rochester, Michigan.
⁵ Department of Family Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan.
⁶ Department of Radiation Oncology, Corewell Health Dearborn Hospital, Dearborn, Michigan.
⁷ Department of Breast Surgery, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan.
⁸ Department of Plastic Surgery, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan.

Abstract

Purpose: Postmastectomy radiation therapy (PMRT) reduces disease recurrence in appropriately selected patients but may compromise implant-based reconstruction. We investigated whether near-surface dose correlates with radiation-related toxic effects in these patients.

Methods and materials: Patients receiving PMRT at a single institution from 2016 to 2019 were retrospectively reviewed. Patient demographics and treatment information were collected. Three near-surface structures were retrospectively generated, bound by the chest wall tangent beam as well as the skin surface and the skin-3 mm contour (SR3), skin surface and skin-5 mm contour (SR5), or skin-5 and skin-10 mm contours. Dosimetric analysis of these near-surface contours was performed in 2 Gy intervals. Univariate and multivariate analyses were used to identify predictors of moist desquamation, grade 2+ chest wall pain, use of opiate pain medication, unplanned reconstructive surgery, and implant failure. Logistic regression for each outcome and near-surface contour was performed for receiver-operator area under the curve (AUC) analysis and the Youden J Statistic was used to determine the optimal threshold for each dosimetric parameter.

Results: Of 126 patients reviewed, 109 met the study's eligibility criteria. Median follow-up was 2.3 years. Twenty-five patients (23%) underwent unplanned reconstructive surgery, and 10 (9.2%) experienced implant failure. Among clinical variables, low body mass index and history of smoking predicted unplanned surgery on univariate and multivariate analyses, and moist desquamation predicted grade 2+ chest wall pain. The top dosimetric parameters by AUC for moist desquamation, grade 2+ chest wall pain, use of opiates, unplanned reconstructive surgery, and implant failure were SR5 D10 cc (AUC = 0.701, optimal threshold 57.8 Gy, P < .001), SR3 D10 cc (AUC = 0.600, optimal threshold 56.8 Gy, P = .079), SR5 D10 cc (AUC = 0.642, optimal threshold 57.3 Gy, P = .041), SR3 V44 Gy (AUC = 0.711, optimal threshold 81%, P = .001), and SR3 V44 Gy (AUC = 0.688, optimal threshold 82%, P = .052), respectively.

Conclusions: Near-surface dose correlates with moist desquamation and unplanned reconstructive surgery after PMRT. Further evaluation of prospective optimization of dosimetric parameters related to SR3 and SR5 should be considered.