Salmon Remi, Garbey Marc, Moore Linda W, Bass Barbara L
Department of Computer Science, University of Houston, Houston, TX, USA.
Department of Biology and Biochemistry, University of Houston, Houston, TX, USA; Methodist Institute for Technology, Innovation and Education, Houston, TX, USA.
PLoS One. 2015 Apr 23;10(4):e0125006. doi: 10.1371/journal.pone.0125006. eCollection 2015.
Most women with early stage breast cancer do not require removal of the entire breast to treat their cancer; instead, up to 70% of women can be effectively and safely treated by breast conserving therapy (BCT) with surgical removal of the tumor only (lumpectomy) followed by radiation treatment of the remaining breast tissue. Unfortunately, the final contour and cosmesis of the treated breast is suboptimal in approximately 30% of patients. The ability to accurately predict breast contour after BCT for breast cancer could significantly improve patient decision-making regarding the choice of surgery for breast cancer. Our overall hypothesis is that the complex interplay among mechanical forces due to gravity, breast tissue constitutive law distribution, inflammation induced by radiotherapy and internal stress generated by the healing process play a dominant role in determining the success or failure of lumpectomy in preserving the breast contour and cosmesis. We have shown here from a first patient study that even in the idealistic situation of excellent cosmetic outcome this problem requires multiscale modeling. We propose a method to decide which component of the model works best for each phase of healing and what parameters should be considered dominant and patient specific. This patient study is part of a clinical trial registered on ClinicalTrial.gov, identifier NCT02310711.
大多数早期乳腺癌女性患者并不需要切除整个乳房来治疗癌症；相反，高达70%的女性患者可通过保乳治疗（BCT）得到有效且安全的治疗，即仅通过手术切除肿瘤（肿块切除术），随后对剩余乳腺组织进行放射治疗。不幸的是，在大约30%的患者中，接受治疗后的乳房最终外形和美容效果并不理想。准确预测乳腺癌保乳治疗后的乳房外形，能够显著改善患者在乳腺癌手术方式选择上的决策。我们总的假设是，重力引起的机械力、乳腺组织本构规律分布、放疗引发的炎症以及愈合过程产生的内应力之间的复杂相互作用，在决定肿块切除术能否成功保留乳房外形和美容效果方面起着主导作用。我们在此通过首个患者研究表明，即便在美容效果极佳这种理想情况下，这个问题仍需要多尺度建模。我们提出一种方法，以确定模型的哪个组成部分在愈合的每个阶段效果最佳，以及哪些参数应被视为主要参数且因患者而异。该患者研究是在ClinicalTrial.gov上注册的一项临床试验的一部分，标识符为NCT02310711。
