TY - JOUR
T1 - Dosimetric analysis of radiation dose to latissimus dorsi myocutaneous flap in women undergoing adjuvant radiotherapy for early breast cancer-short report
T2 - Radiation dose to latissimus dorsi myocutaneous flap
AU - Albuquerque, Kevin
AU - Sieber, David
AU - Hiro, Matthew
AU - Saeed, Hajirah
AU - Surfield, Greg
AU - Shankaran, Vidya
AU - Cimino, Victor
N1 - Copyright:
Copyright 2010 Elsevier B.V., All rights reserved.
PY - 2010/10
Y1 - 2010/10
N2 - Breast reconstruction following mastectomy often involves the use of regional myocutaneous flaps such as the latissimus dorsi (LDM) and transverse rectus abdominus flaps. A history of previous radiation to the skin paddle of the myocutaneous flap planned for breast reconstruction may cause the plastic surgeon to consider using an alternative muscle flap which has not received radiation. To aid decision-making in the setting of previous radiation, we prospectively assessed the dose given to the latissimus myocutaneous flap of a small series of seven women who were to undergo adjuvant 3-D conformal radiation therapy after breast conservation surgery (four) or mastectomy (three). The skin paddles of this flap were marked using wires prior to the planning CT scan required for 3-D conformal therapy. Radiation dose to the skin paddles was minimal but the LD muscle dose averaged 888 cGy. The thoracodorsal artery received the highest doses of radiation averaging 2,750 cGy with 55.5% of the artery receiving at least 2,500 cGy and 25.3% of the artery receiving at least 4,500 cGy which was almost a prescription radiation dose to the whole breast. The clinical implications of this level of radiation dose to the arterial pedicle are likely minimal because it is a peripheral small blood vessel. The surgeon and the radiation oncologist should be aware of this as a potential factor and its possible effects on breast reconstruction outcome particularly in the midst of other predictors of poor vascularity such as smoking, diabetes, or peripheral vascular disease. We plan to study further the dose to LDM flap in a larger series of women. However, information about dose to planned myocutaneous flap in the setting of history of previous breast radiation can be easily obtained from the radiation plan and should be ascertained prior to breast reconstruction.
AB - Breast reconstruction following mastectomy often involves the use of regional myocutaneous flaps such as the latissimus dorsi (LDM) and transverse rectus abdominus flaps. A history of previous radiation to the skin paddle of the myocutaneous flap planned for breast reconstruction may cause the plastic surgeon to consider using an alternative muscle flap which has not received radiation. To aid decision-making in the setting of previous radiation, we prospectively assessed the dose given to the latissimus myocutaneous flap of a small series of seven women who were to undergo adjuvant 3-D conformal radiation therapy after breast conservation surgery (four) or mastectomy (three). The skin paddles of this flap were marked using wires prior to the planning CT scan required for 3-D conformal therapy. Radiation dose to the skin paddles was minimal but the LD muscle dose averaged 888 cGy. The thoracodorsal artery received the highest doses of radiation averaging 2,750 cGy with 55.5% of the artery receiving at least 2,500 cGy and 25.3% of the artery receiving at least 4,500 cGy which was almost a prescription radiation dose to the whole breast. The clinical implications of this level of radiation dose to the arterial pedicle are likely minimal because it is a peripheral small blood vessel. The surgeon and the radiation oncologist should be aware of this as a potential factor and its possible effects on breast reconstruction outcome particularly in the midst of other predictors of poor vascularity such as smoking, diabetes, or peripheral vascular disease. We plan to study further the dose to LDM flap in a larger series of women. However, information about dose to planned myocutaneous flap in the setting of history of previous breast radiation can be easily obtained from the radiation plan and should be ascertained prior to breast reconstruction.
KW - Breast cancer
KW - Breast reconstruction
KW - Myocutaneous flap
KW - Radiation dose
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U2 - 10.1007/s00238-010-0419-3
DO - 10.1007/s00238-010-0419-3
M3 - Article
AN - SCOPUS:77957281455
SN - 0930-343X
VL - 33
SP - 271
EP - 275
JO - European Journal of Plastic Surgery
JF - European Journal of Plastic Surgery
IS - 5
ER -