EDU 18 - Integrating Postmastectomy Radiotherapy (PMRT) with Breast Reconstruction: Insights from Plastic Reconstructive Surgery and the Role of the Radiation Oncologist
MODERATOR(S)
Kimberly Gergelis, MD - University of Rochester Medical Center
session DESCRIPTION
The integration of postmastectomy radiation therapy (PMRT) with the full spectrum of breast reconstruction techniques remains one of the most complex and heterogeneous areas in breast cancer care. Despite advances in surgical innovation and radiation delivery, substantial variation persists in clinical practice, evidence interpretation and institutional standards. These gaps are reflected in comparative effectiveness studies and highlighted in the 2025 ASTRO PMRT consensus and NCCN guidelines, underscoring the lack of unified high-level data to guide standardization across reconstruction scenarios. This multidisciplinary session will synthesize perspectives from plastic surgery, radiation oncology and quality of life research to clarify current evidence, define persistent uncertainties and identify priorities for future study. 1) A plastic/reconstructive surgery speaker will review autologous, direct-to-implant, two-stage expander/implant, and hybrid reconstruction approaches, emphasizing complication profiles in the PMRT setting and advances such as novel types of surgical mesh, prepectoral versus subpectoral implant positioning, and timing of PMRT relative to reconstruction. 2)The first radiation oncology speaker will critically appraise PMRT techniques across reconstruction types, including planning considerations, boost and bolus use, IMRT/VMAT, proton therapy, and skin-dose implications, highlighting how endpoint inconsistency and publications heterogeneity affect interpretation. 3) A second radiation oncologist will address hypofractionation trials (FABREC, RT-CHARM), recent ASTRO guidelines, patient-reported outcomes, equity-focused trial design, disparities in access, financial toxicity, and real-world insurance and logistical constraints. The session will equip attendees with multidisciplinary frameworks for patient counseling, aligned practice, and evidence-based decision making while recognizing current limitations and the need for coordinated prospective research.
learning objectives
- Compare reconstruction outcomes across different surgical approaches such as prepectoral versus subpectoral implants, tissue expander/implant, direct-to-implant, and autologous approaches in patients receiving PMRT, and assess how PMRT techniques (fractionation, boost/bolus use, skin dose, and photon vs. proton modalities) influence reconstruction success and complications.
- Apply multidisciplinary, coordinated workflows to optimize PMRT timing relative to reconstruction, minimize unwarranted practice variation, and incorporate disparities, financial toxicity, and patient access considerations into individualized treatment planning and patient counseling.
- Identify key evidence gaps and evolving data from ongoing and recent trials (e.g., FABREC, RT-CHARM) to inform future multidisciplinary practice and guideline development in PMRT and breast reconstruction.
Credits
| AMA PRA Category 1 Credits: | 1.00 |
Presentations
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10:45am - 10:47am ETSpeaker: Kimberly Gergelis, MD - University of Rochester Medical Center, Rochester
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10:47am - 11:07am ETSpeaker: Amy Colwell, MD - Massachusetts General Hospital, Boston
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11:07am - 11:27am ETSpeaker: George Naoum, MD, MS - Memorial Sloan Kettering Cancer Center, New York
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11:27am - 11:47am ET
Evolving PMRT Practice After FABREC and RT-CHARM: Hypofractionation, ASTRO Guidelines, Quality of Life, Equity, and Future Directions
Speaker: Jean Wright, MD, FASTRO - University of North Carolina, Chapel Hill -
11:47am - 12:00pm ETSpeaker: Kimberly Gergelis, MD - University of Rochester Medical Center, Rochester