Neoadjuvant radiotherapy and immediate breast reconstruction: A systematic review of literature of the last decade.

Summary

Across 21 studies (1,199 patients), neoadjuvant radiotherapy followed by immediate breast reconstruction yielded generally excellent-to-good cosmetic outcomes and acceptable complication rates, with low implant loss and no complete flap failures. Oncologic outcomes, including pCR (12–53%) and locoregional recurrence (3–10%), were within expected ranges, supporting feasibility while calling for randomized confirmation.

Key Findings

• Included 21 studies (1,199 patients) with mean follow-up 35 months; six studies compared NART vs adjuvant RT.
• Patient-reported cosmetic outcomes were excellent-to-good; one comparative study favored NART over adjuvant RT.
• Complications: no complete flap failures, low implant loss; unplanned reoperation mean 11% (2–21%); grade 3 skin toxicity 1–17% with no grade 4–5 events; mastectomy skin necrosis 3–17%.
• Oncologic outcomes: pCR 12–53% after NARCT; locoregional recurrence 3–10%.

Clinical Implications

In centers with NART capability, considering NART followed by immediate reconstruction may improve patient satisfaction and streamline treatment timelines, with careful patient selection and multidisciplinary planning.

Limitations

• Predominance of non-randomised designs and inclusion of conference abstracts
• Heterogeneity in regimens (e.g., high use of neoadjuvant chemoradiotherapy) and outcomes reporting

Future Directions

Randomised head-to-head trials of NART vs adjuvant RT with standardised cosmetic and complication endpoints, and longer oncologic follow-up.