Acute Effects of Postmastectomy Radiotherapy after Immediate TRAM Flap Reconstruction in Breast Cancer Patients
Chomporn Sitathanee MD*, Putipun Puataweepong MD*, Thiti Swangsilpa MD*, Ladawan Narkwong MD*, Youwanush Kongdan MD**, Ronnarat Suvikapakornkul MD**
Affiliation : * Radiation Oncology Division, Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University ** Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University
Objectives : To study the acute effects of radiotherapy after mastectomy and immediate transverse rectus
abdominis myocutaneous (TRAM) flap reconstruction in breast cancer patients treated at Ramathibodi
Hospital.
Materials and Methods : Between January 2004 and March 2005, ten breast cancer patients (age 32-51 years)
were treated with postoperative radiotherapy after mastectomy and immediate TRAM flap reconstruction.
Medical records of these patients were retrospectively reviewed. Radiotherapy was delivered to the chest wall
and reconstructed TRAM flap using 6-MV x-ray or Cobalt-60. The total dose was 45 to 50.4 Gy delivered in 25
to 28 fractions. Patients were evaluated weekly during the course of radiation and then at 1 and 2 months after
treatment completion to determine acute effects or toxicities of radiation.
Results : During radiation, 3 patients developed erythema or mild hyperpigmentation of the skin, and 4
developed moderate hyperpigmentation. Three patients who were treated with Cobalt-60 and/or bolus to the
chest wall developed skin desquamation (1 dry desquamation, 2 moist desquamation). No patient required
a treatment break because of acute side effects. One patient who received chemotherapy after radiation
developed recalled moist desquamation.
Conclusion : Radiotherapy after mastectomy and immediate TRAM flap reconstruction is well tolerated and is
not associated with increased acute complication or radiation interruption. The authors have noticed that
chemotherapy given after radiation was related to severe skin reaction, so it should be used with caution.
Keywords : TRAM flap, Reconstruction, Radiotherapy, Acute effect, Breast cancer
