Impact of Breast Reconstruction on Biophysical Parameters of Mammary Skin in Patients Receiving Postmastectomy Radiotherapy for Breast Cancer

Radiation recall dermatitis induced by abemaciclib with successful rechallenge: a case series and literature review

PURPOSE

To raise awareness of radiation recall dermatitis (RRD) in the context of radiotherapy combined with abemaciclib, and to explore its potential mechanisms, characteristics, and treatment options.

METHODS

We conducted a case series study reporting the first instances of RRD induced by abemaciclib in two women with locally advanced luminal breast cancer. Both patients experienced skin reactions in previously irradiated areas following abemaciclib administration. Additionally, a comprehensive literature review was performed to analyze the potential mechanisms of RRD, characteristics of radiotherapy, triggering drugs, and available treatments.

RESULTS

The case series demonstrated that abemaciclib can induce RRD in patients who have undergone radiotherapy. Both patients experienced significant skin reactions, which were successfully managed and resolved upon rechallenge with abemaciclib. The literature review highlighted the importance of recognizing RRD as a potential adverse effect of cyclin-dependent kinase 4/6 inhibitors (CDK4/6is), emphasizing the need for careful monitoring and appropriate management strategies.

CONCLUSION

Radiation recall dermatitis is a potential adverse effect of abemaciclib in patients receiving radiotherapy for breast cancer. Our findings underscore the importance of awareness and vigilance in managing patients on CDK4/6is.

Integrating Radioprotective Agents into Post-Mastectomy Radiotherapy: Optimization of Reconstructive Outcomes in Breast Cancer

Surgical intervention utilizing various approaches is a cornerstone in the management of breast cancer. The surgical approaches include lumpectomy, mastectomy, axillary lymph node dissection, and primary or delayed reconstruction. Post-mastectomy radiotherapy is frequently recommended in cases of advanced tumors and extensive lymph node involvement. However, there are several adverse effects of radiotherapy. In this article, we critically reviewed the various complications. Additionally, we discussed the biological basis of radiation-induced tissue damage, the impact of implant-based and autologous tissue reconstruction, and the functional and aesthetic results of the reconstruction. Indeed, several radioprotective agents can attenuate the adverse effects of post-mastectomy radiotherapy while sustaining oncologic efficacy. Radioprotective agents, including free radical scavengers and antioxidants, offer promising strategies to protect tissues from the oxidative stress and inflammation induced by radiotherapy. The role of several radioprotective agents, including amifostine, N-acetylcysteine, tempol, manganese superoxide dismutase (MnSOD) plasmid liposomes, vitamin E, and beta-carotene has been analyzed with a focus on their logistical applications in breast reconstruction. Despite several challenges, the integration of radioprotective agents into post-mastectomy radiotherapy protocols offers significant potential to improve reconstructive outcomes. Development of novel radioprotective agents with improved selectivity and fewer side effects and large-scale clinical trials in diverse group of patients are warranted to determine long-term safety and efficacy.

Breast reconstruction during the COVID-19 pandemic in resource-limited settings

The coronavirus disease 2019 (COVID-19) is a novel, rapidly changing pandemic. It has affected specialized medical services in unprecedented ways. Surgical decision making, always the most important aspect of care has taken on an added layer of complexity in the face of the COVID-19 pandemic. Therefore, recommendations for breast reconstruction during COVID-19 remain challenging and unclear. This article reviews the impact of the COVID-19 pandemic and suggests potential approaches that could be considered in the absence of validated strategies in breast reconstruction.