Maguire Patrick D, Adams Ashley, Nichols Michael A
*Coastal Carolina Radiation Oncology †South East Area Health Education Center, Wilmington, NC.
Am J Clin Oncol. 2015 Aug;38(4):353-7. doi: 10.1097/COC.0b013e31829d1ef0.
To analyze a multidisciplinary community experience with oncoplastic breast surgery (OBS) and postoperative radiation therapy (RT).
The records of 79 patients with localized breast cancer who underwent OBS+RT were reviewed. OBS included immediate reconstruction and contralateral mammoreduction. All patients had negative surgical margins. Whole-breast RT was delivered without boost. A subset of 44 patients agreed to complete a validated quality of life survey pre-RT, post-RT, 6 months after RT, and at final follow-up assessing cosmesis and treatment satisfaction.
Sixty-seven patients (85%) were white. Median age was 62 years. Median interval between OBS and RT start was 9.6 weeks. Median RT dose was 46 Gy. Fourteen patients (18%) developed surgical toxicities before RT. Five patients (6%) developed RT toxicities. Physician rating of cosmesis post-RT was: 3% excellent, 94% good, and 4% fair. Cosmesis was rated as excellent or good by 87% of patients pre-RT, 82% post-RT, 75% at 6 months, and 88% at the final follow-up. Treatment satisfaction was rated as "total" or "somewhat" by 97% of patients pre-RT, 93% post-RT, 75% at 6 months, and 96% at final follow-up. No significant relation was found between patient or treatment-related factors and toxicity. Local control is 100% at median follow-up of 2.9 years.
OBS followed by RT resulted in acceptable toxicity and favorable physician-rated cosmesis in this large community series. Patients' ratings of cosmesis and treatment satisfaction were initially high, decreasing at 6 months, returning near baseline at final follow-up.
分析多学科社区开展肿瘤整形乳房手术（OBS）及术后放射治疗（RT）的经验。
回顾了79例行OBS+RT的局限性乳腺癌患者的病历。OBS包括即刻重建和对侧乳房缩小术。所有患者手术切缘均为阴性。全乳放疗未加量。44例患者同意在放疗前、放疗后、放疗后6个月及最终随访时完成一项经过验证的生活质量调查，评估美容效果和治疗满意度。
67例患者（85%）为白人。中位年龄为62岁。OBS与放疗开始之间的中位间隔时间为9.6周。中位放疗剂量为46 Gy。14例患者（18%）在放疗前出现手术相关毒性反应。5例患者（6%）出现放疗相关毒性反应。放疗后医生对美容效果的评价为：3%优秀，94%良好，4%一般。放疗前87%的患者、放疗后82%的患者、6个月时75%的患者以及最终随访时88%的患者将美容效果评为优秀或良好。放疗前97%的患者、放疗后93%的患者、6个月时75%的患者以及最终随访时96%的患者将治疗满意度评为“完全”或“有些”。未发现患者或治疗相关因素与毒性反应之间存在显著关联。中位随访2.9年时局部控制率为100%。
在这个大型社区系列研究中，OBS后行RT导致了可接受的毒性反应和医生评价良好的美容效果。患者对美容效果和治疗满意度的评分最初较高，在6个月时下降，在最终随访时接近基线水平。
