Zinzindohoué Cécile, Bertrand Pierre, Michel Aude, Monrigal Emilie, Miramand Bernard, Sterckers Nicolas, Faure Christelle, Charitansky Hélène, Gutowski Marian, Cohen Monique, Houvenaeghel Gilles, Trentini Frederic, Raro Pedro, Daures Jean-Pierre, Lacombe Sandy
Montpellier Institut du Sein, Clinique Clémentville, Montpellier, France.
Epsylon EA 4556 Laboratory "Dynamics of Human Abilities & Health Behaviors", University Paul Valéry Montpellier 3, Montpellier, France.
Ann Surg Oncol. 2016 Jul;23(7):2350-6. doi: 10.1245/s10434-016-5146-y. Epub 2016 Mar 8.
Skin-sparing mastectomy (SSM) with immediate breast reconstruction (IBR) is increasingly used in invasive breast cancer. However, adjuvant chemotherapy (CT) and radiotherapy (RT) can increase the rate of local complications.
The aim of this study was to assess the morbidity of SSM-IBR after neoadjuvant CT and RT.
A French prospective pilot study of women aged 18-75 years with invasive breast cancer requiring mastectomy after CT and RT. Reconstruction was performed using autologous latissimus dorsi flap with or without prosthesis. The primary endpoint was the skin necrosis rate within 6 months, while secondary endpoints included pathological complete response rate (pCR) and global morbidity.
Among 94 patients included in this study, 83 were analyzed (mean age 45.2 ± 9.5 years, T1 23.6 %, T2 55.6 %, T3 18.1 %). All but one patient received anthracyclines and taxanes, and all patients received RT (49.3 ± 5.2 Gy) before SSM-IBR. Prostheses were used for IBR in 32 patients (mean volume 256 ± 73 mm(3)). Five patients had necrosis (≤2 cm(2), 2-10 cm(2) and >10 cm(2), in three, one, and one cases, respectively), and they all recovered without revision surgery. Among 50 patients who underwent upfront mastectomy, 36 % achieved pCR.
SSM-IBR performed after CT and RT is safe, with an acceptable local morbidity rate. Long-term data are needed to evaluate recurrence rates.
保乳皮肤切除术（SSM）联合即刻乳房重建术（IBR）在浸润性乳腺癌中的应用日益广泛。然而，辅助化疗（CT）和放疗（RT）会增加局部并发症的发生率。
本研究旨在评估新辅助CT和RT后SSM-IBR的发病率。
一项针对18-75岁浸润性乳腺癌患者的法国前瞻性试点研究，这些患者在CT和RT后需要进行乳房切除术。采用带或不带假体的自体背阔肌皮瓣进行重建。主要终点是6个月内的皮肤坏死率，次要终点包括病理完全缓解率（pCR）和总体发病率。
本研究纳入的94例患者中，83例进行了分析（平均年龄45.2±9.5岁，T1期占23.6%，T2期占55.6%，T3期占18.1%）。除1例患者外，所有患者均接受了蒽环类药物和紫杉烷类药物治疗，所有患者在SSM-IBR前均接受了放疗（49.3±5.2 Gy）。32例患者在IBR中使用了假体（平均体积256±73 mm³）。5例患者出现坏死（≤2 cm²、2-10 cm²和>10 cm²，分别为3例、1例和1例），且均未进行翻修手术而康复。在50例接受 upfront乳房切除术的患者中，36%达到了pCR。
CT和RT后进行的SSM-IBR是安全的，局部发病率可接受。需要长期数据来评估复发率。
