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Multicenter Study
. 2023 Oct 1;109(10):2896-2905.
doi: 10.1097/JS9.0000000000000063.

Surgical outcomes following breast reconstruction in patients with and without a history of chest radiotherapy for Hodgkin lymphoma: a multicentre, matched cohort study

J Xavier Harmeling  1 , Leonie A E Woerdeman  1 , Ezgi Ozdemir  1 , Michael Schaapveld  2 , Hester S A Oldenburg  3 , Cécile P M Janus  4 , Nicola S Russell  5 , Linetta B Koppert  6 , Inge M Krul  2 , Flora E van Leeuwen  2 , Marc A M Mureau  1
Affiliations
Multicenter Study

Surgical outcomes following breast reconstruction in patients with and without a history of chest radiotherapy for Hodgkin lymphoma: a multicentre, matched cohort study

J Xavier Harmeling et al. Int J Surg. .

Abstract

Background: Breast cancer is the most common treatment-related second malignancy among women with previous chest radiotherapy for Hodgkin lymphoma (HL). Little is known about the effects of this kind of radiotherapy on the outcomes of postmastectomy breast reconstruction (BR). This study compared adverse outcomes of BR after HL-related chest radiotherapy to matched controls.

Methods: The authors conducted a retrospective, matched cohort study in two expert cancer centres in the Netherlands. BRs after therapeutic or prophylactic mastectomy in HL survivors who received chest radiotherapy were matched with BRs in nonirradiated patients without HL on age at mastectomy date, date of BR, and type of BR. The primary outcome was complication-related BR failure or conversion and secondary outcomes were complication-related re-operation, capsular contracture, major donor-site complications, and complication-related ICU admission. The authors analyzed all outcomes univariably using Fisher's exact tests and the authors assessed reconstruction failure, complication-related re-operation, and capsular contracture with multivariable Cox regression analysis adjusting for confounding and data clustering.

Results: Seventy BRs in 41 patients who received chest radiotherapy for HL were matched to 121 BRs in 110 nonirradiated patients. Reconstruction failure did not differ between HL survivors (12.9%) and controls (12.4%). The comparison groups showed no differences in number of reoperations, major donor-site complications, or capsular contractures. BR in HL survivors more often let to ICU admission due to complications compared with controls ( P =0.048).

Conclusions: We observed no increased risk of adverse outcomes following BR after previous chest radiotherapy for HL. This is important information for counselling these patients and may improve shared decision-making.

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Conflict of interest statement

The Department of Plastic & Reconstructive Surgery of the Erasmus MC received funding from POLYTECH Health & Aesthetics GmbH in the form of financial support for personnel costs for one PhD candidate (no grant number available) from July 2018 until July 2021. No funding was received for this article. None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript.

Figures

Figure 1
Figure 1
Schematic representation of target area for mantle field irradiation.
Figure 2
Figure 2
Univariable survival curve (Kaplan–Meier) for survival until failure or conversion of breast reconstruction due to a complication (unadjusted for clustering/confounding). HL, Hodgkin lymphoma.
Figure 3
Figure 3
Univariable survival curve (Kaplan–Meier) for reoperation due to a complication after breast reconstruction (unadjusted for clustering/confounding). HL, Hodgkin lymphoma.
Figure 4
Figure 4
Univariable survival curve (Kaplan–Meier) for survival until capsular contracture for all breast reconstructions involving an implant (unadjusted for clustering/confounding). HL, Hodgkin lymphoma.
See this image and copyright information in PMC

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