Clinical outcomes following immediate reconstruction and post-mastectomy radiation therapy

10560 Background: Post-mastectomy radiation therapy (PMRT) is an important component of the treatment for locally advanced breast cancer. Some patients opt for immediate breast reconstruction (IR) to cope with the aesthetic consequences of mastectomy. A small number of series have reported mixed results with IR using a tissue expander/implant (TE/I) followed by PMRT. We sought to determine the outcome of patients receiving PMRT after IR with either TE/I or autologous tissue reconstruction (ATR), with respect to both complications and cosmesis. Methods: We retrospectively reviewed the charts of 47 women who underwent PMRT in our practice after IR. All follow-up information was obtained by reexamination or by telephone interview. Contracture/fibrosis results were scored on a scale as follows: 0- no complaints, 1- mild discomfort, not affecting activities of daily life (ADLs), 2- moderate discomfort, affecting ADLs, or biopsy-proven fat necrosis, 3- complications requiring surgical revision, 4- reconstruction failure, requiring removal. For cosmesis, results were recorded as: 1- acceptable, 2- unacceptable. Results: A total of 47 patients were identified as having undergone PMRT after IR. 35 underwent TE/I and 12 underwent ATR, most commonly transverse rectus abdominus muscle flap reconstruction. Median follow-up was 36 months (range: 26 - 96 months). All patients were treated with 50.4 Gy in 25 fractions to the chest wall, and seven patients received an additional electron boost to high risk areas. All patients received 45 Gy in 25 fractions to a supraclavicular field. Of the patients who underwent TE/I and PRMT, twenty-one of 35 (60%) described unacceptable cosmesis, as opposed to two of 12 ATR patients (17%) (p = .02). Similarly, 13 patients in the TE/I (37%) group required either surgical revision (n = 3) or complete removal of their implant (n = 10), as compared to none of the patients in the ATR group (p = .02). Conclusion: Immediate TE/I reconstruction with PMRT was associated with high rates of complications and poor cosmetic results in our experience. ATR resulted in significantly higher rates of functional and cosmetic success. Thus, if IR is planned in the setting of PMRT, ATR should be recommended. No significant financial relationships to disclose. </jats:p

From sewer to saviour-targeting the lymphatic system to promote drug exposure and activity

The lymphatic system serves an integral role in fluid homeostasis, lipid metabolism and immune control. In cancer, the lymph nodes that drain solid tumours are a primary site of metastasis, and recent studies have suggested intrinsic links between lymphatic function, lipid deposition, obesity and atherosclerosis. Advances in the current understanding of the role of the lymphatics in pathological change and immunity have driven the recognition that lymph-targeted delivery has the potential to transform disease treatment and vaccination. In addition, the design of lymphatic delivery systems has progressed from simple systems that rely on passive lymphatic access to sophisticated structures that use nanotechnology to mimic endogenous macromolecules and lipid conjugates that 'hitchhike' onto lipid transport processes. Here, we briefly summarize the lymphatic system in health and disease and the varying mechanisms of lymphatic entry and transport, as well as discussing examples of lymphatic delivery that have enhanced therapeutic utility. We also outline future challenges to effective lymph-directed therapy