Can radiotherapy be delivered in fewer sessions after mastectomy with immediate reconstruction?

Having immediate breast reconstruction does not necessarily mean radiotherapy must involve a longer course.

What did the researchers examine?

Researchers combined evidence from 11 studies including 3,611 patients, three of which were randomised trials. They compared hypofractionated radiotherapy — a somewhat higher dose per session over fewer visits — with conventional schedules after mastectomy and immediate breast reconstruction. Gustavo Nader Marta was a co-author of this European Journal of Cancer review.

What were the findings?

There was no statistically significant difference in major complications between the schedules studied. Among studies with comparable data, infections, wound separation and haematomas were also not significantly different. Shorter treatment was associated with a possible reduction in capsular contracture, or hardening of scar tissue around an implant, but this finding remains uncertain.

What could this mean for patients?

When radiotherapy is recommended after mastectomy, a shorter schedule may be an option for selected patients who have had immediate reconstruction. Fewer treatment sessions can reduce travel and time spent receiving treatment. The safest choice depends on the reconstruction type, whether regional lymph nodes need treatment and the individual radiotherapy plan.

What are the limitations?

Similar complication rates in the available studies do not guarantee freedom from complications or establish exact equivalence for every patient. The studies differed in reconstruction types, radiotherapy methods and quality; patient-reported quality of life was seldom assessed. Decisions should be made jointly with the radiotherapy and surgical teams.

For education only. Research findings do not replace individual clinical advice.