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Top Line: Considering how intensely all aspects of breast cancer treatment are studied, the available data for or against the role of post-mastectomy radiation (PMRT) scar boost is surprisingly underwhelming.
The Study: In particular, there is little data on the cosmetic effects of PMRT scar boost. Sure, there’s a benefit to chest wall and nodal irradiation, but at some point you gotta know where to stop. Here we have a large series of PMRT scar boost outcomes from MGH, which included all women who were treated with mastectomy, reconstruction, and radiation (usually in that order). The vast majority had an immediate post-mastectomy reconstruction procedure with 25% autologous, 36% single-stage implant, and 39% staged implant reconstruction. The most common PMRT regimen was 50.4 Gy in 28 fractions with every other day bolus +/- a 10 Gy 6-9 MeV electron boost to 2-3 cm margin around the scar with bolus. Administration of a boost was dealer’s choice without any strict guidelines, and ultimately about 50% were treated with scar boost. Scar boost increased the risk of both infection (6→ 13%) and skin necrosis (3→ 8%). In multivariate analysis, scar boost and two-stage implant reconstruction were associated with both necrosis and infection.
Bottom Line: Scar boost, especially in the setting of staged reconstruction, may increase the risk of complications in women receiving post-mastectomy radiation with no decipherable impact on local control. | Naoum, Int J Radiat Oncol Biol Phys 2019
The Study: In particular, there is little data on the cosmetic effects of PMRT scar boost. Sure, there’s a benefit to chest wall and nodal irradiation, but at some point you gotta know where to stop. Here we have a large series of PMRT scar boost outcomes from MGH, which included all women who were treated with mastectomy, reconstruction, and radiation (usually in that order). The vast majority had an immediate post-mastectomy reconstruction procedure with 25% autologous, 36% single-stage implant, and 39% staged implant reconstruction. The most common PMRT regimen was 50.4 Gy in 28 fractions with every other day bolus +/- a 10 Gy 6-9 MeV electron boost to 2-3 cm margin around the scar with bolus. Administration of a boost was dealer’s choice without any strict guidelines, and ultimately about 50% were treated with scar boost. Scar boost increased the risk of both infection (6→ 13%) and skin necrosis (3→ 8%). In multivariate analysis, scar boost and two-stage implant reconstruction were associated with both necrosis and infection.
Bottom Line: Scar boost, especially in the setting of staged reconstruction, may increase the risk of complications in women receiving post-mastectomy radiation with no decipherable impact on local control. | Naoum, Int J Radiat Oncol Biol Phys 2019
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