Post-mastectomy radiotherapy negatively impacts short-term patient-reported outcomes in patients with and without immediate breast reconstruction – a retrospective cohort study

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INTRODUCTION: Despite prior demonstration of a detrimental effect of post-mastectomy radiotherapy (PMRT) on patient reported outcomes (PROs) in patients with breast cancer (BC) undergoing breast reconstruction, the impact of PMRT on patients without reconstruction remains less clear. The objective of this study was to assess the association between PMRT and patient-reported outcomes (PROs). MATERIALS AND METHODS: Patients with stage 0-III BC who underwent mastectomy (including total mastectomy, nipple-sparing mastectomy, and skin-sparing mastectomy) at a Swiss university hospital between 01/2013-12/2023, who completed at least one postoperative BREAST-Q questionnaire, were identified from a prospectively maintained institutional database. Outcomes included the identification of differences in PROs relative to receipt of PMRT. RESULTS: Of 243 eligible patients, 30.9 % (75/243) underwent PMRT. The median time to last PRO assessment was 30.4 months, without differences between the groups (p = 0.100). The frequency and type of breast reconstruction were comparable between the groups, with 41.2 % of patients not undergoing breast reconstruction. Physical well-being and psychosocial well-being were reduced following PMRT. In the multivariate analysis, PMRT was identified as a predictor of worse short-term (0-2 years postoperatively) physical well-being (estimated difference [ED] -7.9, 95 %CI -15.4 to -0.4) and showed a trend towards worse psychosocial well-being (ED -9.1, 95 %CI -18.3 - 0.1) irrespective of breast reconstruction. CONCLUSION: In conclusion, PMRT negatively impacts short-term PROs, regardless of whether breast reconstruction is performed or not.

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