Tallet Agnès V, Salem Naji, Moutardier Vincent, Ananian Pascal, Braud Anne-Chantal, Zalta Remy, Cowen Didier, Houvenaeghel Gilles
Department of Radiation Oncology, Institut Paoli-Calmettes, Marseille, France.
Int J Radiat Oncol Biol Phys. 2003 Sep 1;57(1):136-42. doi: 10.1016/s0360-3016(03)00526-1.
To report complications, failure rate, and esthetic results in patients undergoing immediate breast reconstruction with a tissue expander and implant, with or without adjuvant treatment.
We reviewed the records of the 77 patients who underwent immediate breast reconstruction with an expander/implant between January 1999 and December 2000. Complications were assessed using the Common Toxicity Criteria, version 2, scale. Esthetic results were assessed by the physician using five criteria.
Of the 77 patients, 55 had received adjuvant radiotherapy. The median follow-up was 25 months. Complications appeared to correlate with radiotherapy (14% for nonirradiated patients; 51% for irradiated patients; p = 0.006) and adjuvant chemotherapy (54% with chemotherapy [CHT] vs. 25% without CHT; p = 0.02). Breast reconstruction failed in 21% of patients (9% of nonirradiated patients and 24% of irradiated patients; p = 0.1), and chemotherapy was associated with a worse rate of failure (34% with CHT vs. 6% without CHT, p = 0.005). Adjuvant tamoxifen, however, correlated neither with complications (45% with tamoxifen vs. 39% without; p = 0.15) nor with failure (21% with tamoxifen and 23% without, p = 0.79). Esthetic results were acceptable in 60% of cases.
Immediate breast reconstruction with an expander/implant can be considered even for patients requiring adjuvant treatment. However, the complication and failure rates are three times higher after postexpander radiotherapy.
报告采用组织扩张器和植入物进行即刻乳房重建的患者（无论是否接受辅助治疗）的并发症、失败率和美学效果。
我们回顾了1999年1月至2000年12月间77例行扩张器/植入物即刻乳房重建患者的记录。使用第2版通用毒性标准量表评估并发症。医生使用五项标准评估美学效果。
77例患者中，55例接受了辅助放疗。中位随访时间为25个月。并发症似乎与放疗相关（未接受放疗患者为14%；接受放疗患者为51%；p = 0.006）以及辅助化疗相关（接受化疗者为54%，未接受化疗者为25%；p = 0.02）。21%的患者乳房重建失败（未接受放疗患者为9%，接受放疗患者为24%；p = 0.1），化疗与更高的失败率相关（接受化疗者为34%，未接受化疗者为6%，p = 0.005）。然而，辅助性他莫昔芬既与并发症无关（接受他莫昔芬者为45%，未接受者为39%；p = 0.15）也与失败无关（接受他莫昔芬者为21%，未接受者为23%，p = 0.79）。60%的病例美学效果可接受。
即使对于需要辅助治疗的患者，也可考虑采用扩张器/植入物进行即刻乳房重建。然而，扩张器后放疗后的并发症和失败率高出三倍。
