Switching Breast Cancer Treatment Order, to Include Fewer Surgeries, Found to Be Safe in New Study

Generally, breast cancer patients have a mastectomy before radiation, followed by reconstructive surgery months later. A new study wanted to see if switching up the order was practical and safe. The findings show it may be, and it may also improve patients’ quality of life.

Researchers at the University of Texas MD Anderson Cancer Center recently investigated the impacts of administering radiation to breast cancer patients first, followed by one operation that included both a mastectomy and reconstruction. The goal of the study was to see if it was safe to start off with radiation, as doing it after a mastectomy can lead to quality of life issues and medical complications because of the months required to wait for a reconstructive surgery.

The findings, published in JAMA Network Open, showed that, of the patients in a Phase II trial who did so, there were no serious complications, no complete flap losses, and no recurrence at a median follow-up period of 2.5 years. This suggests that it’s a safe alternative, one that means fewer surgeries and better quality of life.

Dr. Mark Schaverien, lead author and associate professor of plastic surgery, says, “Our trial represents a pioneering achievement in the U.S., demonstrating the safety and effectiveness of this paradigm-shifting treatment sequence for patients with breast cancer. This sequence not only enhances surgical outcomes but also eliminates the need for patients to defer breast reconstruction surgery, significantly enhancing their quality of life.”

The study involved 49 patients with a median age of 48 who underwent radiation followed by mastectomy and immediate reconstruction. Half of the participants had short course and half had standard course radiation therapy. The surgery was performed a median of 23 days after this treatment wrapped.

The researchers found that, in addition to no complete flap losses and no recurrences at a median follow up period of 2.5 years, the complication rate was about the same as that of standard reconstruction surgery. All those who had tissue-based reconstruction had successful surgeries and no serious complications.

The researchers say this approach can minimize some of the issues with the standard order of mastectomy, then radiation, and then a reconstruction 6-12 months later to avoid having radiation impact the final reconstructive product. In that waiting period, there can be quality of life issues, along with complications from a tissue expander that’s typically inserted after the mastectomy. The current study shows that switching the order up can avoid these issues, which may improve patient satisfaction and limit treatment delays, while reducing the number of needed surgeries.

Dr. Benjamin Smith, co-author and professor of radiation oncology and health services research, says, “For many patients, this approach represents a significant breakthrough. It allows women to swiftly resume their lives following breast cancer treatment, feeling and looking confident, without the need for prolonged delays before undergoing reconstructive surgery.”

A larger randomized trial has now begun to compare the outcomes of administering a standard amount of radiation versus a smaller dose before surgery.