Postmastectomy radiotherapy has been assessed in Sweden

In Sweden, the County Councils are grouped into six healthcare regions to facilitate cooperation and to maintain a high level of advanced medical care. One of them is Västra Götaland County Council with its Health Technology Assessment (HTA) Center, which aimed to work for continuous development of knowledge-based care in the region and ensure that healthcare is supported by science and evaluation. Also, it should follow up on the development of evidence-based healthcare nationally and internationally.

In June 2019, Västra Götaland HTA-Centre has published an HTA report for the impact of postmastectomy radiotherapy (PMRT) on complications and results of immediate breast reconstruction. The following conclusions were provided:

• PMRT compared with no radiotherapy (RT) may result in a small decrease in patient satisfaction in breast cancer patients undergoing immediate breast reconstruction (IBR) (low certainty of the evidence)
• PMRT compared with no RT probably results in a clinically significant increase of implant or tissue expander loss in breast cancer patients undergoing IBR (moderate certainty of the evidence)
• PMRT compared with no RT may result in a substantial increase of re-operations in breast cancer patients undergoing IBR (low certainty of the evidence)
• PMRT compared with no RT may result in a significantly increased capsular contracture rate in breast cancer patients undergoing IBR (low certainty of the evidence)

These findings are important when informing and advising mastectomy patients when discussing the method of reconstruction, especially when it is already known that the patient will undergo PMRT. Furthermore, these results suggest that IBR has to be used with caution when PMRT is anticipated. There is still a lack of high-quality studies that evaluate the impact of PMRT compared with no RT on the breast-related outcome of the immediate implant or tissue expander-based breast reconstruction after mastectomy.

See the full report in Swedish and English here.

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