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2008 Annual Meeting Abstracts

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How Does Reconstructive Surgery Impact the Timing of Chemotherapy for Breast Cancer? Results from the National Comprehensive Cancer Network
Amy K. Alderman, MD, MPH1, E. Dale Collins, MD, MS2, Anne Schott, MD1, Melissa Hughes, MSc3, Rebecca Ottesen, MS3, Richard Theriault, DO, MBA4, Yu-Ning Wong, MD5, Jane C. Weeks, MD3, Joyce C. Niland, PhD6, Steve Edge, MD7.
1University of Michigan, Ann Arbor, MI, USA, 2Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA, 3Harvard, Boston, MA, USA, 4MD Anderson, Houston, TX, USA, 5Fox Chase Cancer Center, Philadelphia, PA, USA, 6City of Hope, Los Angeles, CA, USA, 7Roswell Park Cancer Institute, Buffalo, NY, USA.

PURPOSE: Performing breast reconstruction at the time of mastectomy may have aesthetic, psychological and economic advantages. However, the impact of immediate breast reconstruction on the initiation of adjuvant chemotherapy is poorly understood. Previous studies have been limited by small sample sizes, and medical oncologists continue to have concern regarding the interference of reconstruction with chemotherapy delivery. We examined whether reconstructive surgery affected the timing of chemotherapy among women with Stage I-III breast cancer at NCCN institutions.

METHODS: Our study population of 3,966 patients included all Stage I-III unilateral breast cancer treated at eight NCCN institutions between July 1997 to December 2003 who received both their definitive surgery and adjuvant chemotherapy at the NCCN center. Type of definitive surgery was categorized as lumpectomy, mastectomy alone, mastectomy with immediate reconstruction, or mastectomy with delayed reconstruction. A multinomial logistic regression analysis, controlling for disease severity and other disease and demographic characteristics, was used to evaluate effect of surgery type on time to start of chemotherapy, categorized as <8 weeks, >8-12 weeks, and >12 weeks.

RESULTS: By multivariable analysis, patients receiving mastectomy with immediate reconstruction were more likely to have a delay in initiation of chemotherapy (either >8-12 weeks or >12 weeks v. within 8 weeks) compared to those who received lumpectomy: at >8-12 weeks, Odds Ratio (OR)= 1.98 (1.47-2.66); and at >12 weeks, OR= 2.93 (1.61-5.34), p<.0001. Among all surgery groups, only 63 patients (1.5%) initiated chemotherapy more than12 weeks after surgery. However, the proportion was somewhat higher among patients who underwent mastectomy with immediate reconstruction (2.9%).
CONCLUSION: Our results suggest that immediate reconstruction is associated with a modest but statistically significant delay in the initiation of adjuvant chemotherapy for breast cancer. However, delays exceeding 3 months occurred in less than 3% of patients treated in NCCN centers. The findings suggest that for the vast majority of patients, benefits of immediate reconstruction can be obtained without meaningfully compromising cancer control.
Median Time from Surgery to Initiation of Chemotherapy (n=3966)
Type of Definitive SurgeryMedian Time to Chemotherapy in Weeks
Lumpectomy (n=2185)5.14
Mastectomy only (n=887)5.14
Mastectomy/immediate reconstruction (n=767)6.00
Mastectomy/delayed reconstruction (n=127)4.86


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