McCormick Beryl, Wright Jean, Cordiero Peter
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
Cancer J. 2008 Jul-Aug;14(4):264-8. doi: 10.1097/PPO.0b013e31817fbe4b.
Mastectomy with immediate breast reconstruction is a surgical procedure that addresses both the need to perform a cancer operation, and the desire of the patient to emerge from anesthesia with a replacement breast. An increasing number of these women with invasive breast cancer will benefit from chest wall and regional nodal radiation, in terms of both a decreased risk in local-regional recurrence and an increased chance of overall survival at 10 years and beyond, based on the most recent 2005 Oxford Overview.Indications for recommending radiation are based primarily on the pathologic assessment of the primary tumor and the axillary lymph nodes. More than a decade ago, only women with 10 or more involved nodes were thought to benefit from this treatment; that recommendation shifted to women with 4 or more involved nodes with the publication of the American Society for Clinical Oncology (ASCO) guidelines in 2001 and more recently to considering postmastectomy radiation (PMRT) in women with 1 to 3 positive nodes.In some scenarios, the need for PMRT is recognized before the patient goes to surgery, and reconstruction can be planned with this in mind, as discussed elsewhere in this issue. In other scenarios, the need for radiation is not realized until the final pathology report is back in the surgeon's hands. If that patient has elected an immediate reconstruction, is the radiation feasible and is it effective? Our published experience at Memorial Sloan Kettering (MSK) Cancer Center suggests the answer to both questions is "yes." However, our results differ dramatically from that of other major centers. Both our experience and that of others is discussed in this article.
即刻乳房重建的乳房切除术是一种外科手术，它既能满足癌症手术的需要，又能满足患者在麻醉苏醒后拥有替代乳房的愿望。根据2005年最新的牛津综述，越来越多的这些浸润性乳腺癌女性将从胸壁和区域淋巴结放疗中获益，这既能降低局部区域复发风险，又能增加10年及以后的总体生存机会。推荐放疗的指征主要基于原发肿瘤和腋窝淋巴结的病理评估。十多年前，只有腋窝淋巴结转移10个或更多的女性被认为能从这种治疗中获益；随着2001年美国临床肿瘤学会（ASCO）指南的发布，这一推荐改为腋窝淋巴结转移4个或更多的女性，最近又改为考虑对腋窝淋巴结转移1至3个阳性的女性进行乳房切除术后放疗（PMRT）。在某些情况下，在患者手术前就认识到需要进行PMRT，可以考虑到这一点来规划重建手术，本刊其他地方有相关讨论。在其他情况下，直到最终病理报告回到外科医生手中才意识到需要放疗。如果该患者选择了即刻重建，放疗是否可行且有效？我们纪念斯隆凯特琳癌症中心（MSK）公布的经验表明，这两个问题的答案都是“是”。然而，我们的结果与其他主要中心有很大不同。本文将讨论我们的经验以及其他中心的经验。
