Department of Radiation Oncology, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.
Department of Radiology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyoku, Tokyo, 113-8655, Japan.
Breast Cancer. 2018 Mar;25(2):167-175. doi: 10.1007/s12282-017-0808-6. Epub 2017 Oct 19.
The use of post-mastectomy radiotherapy (PMRT) following immediate breast reconstruction has increased recently, and its safety is becoming a major concern. We aimed to evaluate the complication rates of PMRT to immediate tissue-expander/permanent implant (TE/PI)-based reconstructions for breast cancer and its association with radiotherapy timing (irradiation to TE or PI).
We retrospectively reviewed the cases of breast cancer patients who underwent mastectomy, immediate TE/PI reconstruction, and PMRT between January 2003 and December 2014. The rates of complications including reconstruction failure, re-operation, and infection were estimated by Kaplan-Meier analysis. The risk factors including radiotherapy timing were analyzed by log-rank test and multivariate Cox proportional hazard model.
A total of 81 patients were included. Median follow-up was 32 months (range 2-120 months). Radiotherapy consisted of 50 Gy to the reconstructed breast and supraclavicular region in most cases. Total reconstruction failure, re-operation, and infection rates were 12.3, 13.6, and 11.1%, and 5-year cumulative reconstruction failure, re-operation, and infection rates were 16.7, 16.6, and 12.2%, respectively. No significant differences were observed in complication rates with respect to radiotherapy timing. In multivariate analysis, age 55 years and older was a significant risk factor for complications (P < 0.05).
There were no significant differences in rates of reconstruction failure, re-operation, or infection with regard to radiotherapy timing. PMRT to reconstructed breasts of older patients aged 55 years or over can be expected to result in more complications than in younger patients.
近年来，乳腺癌患者接受即刻乳房重建后行乳房切除术放疗（PMRT）的比例有所增加，其安全性成为人们关注的主要问题。本研究旨在评估即刻组织扩张器/永久性植入物（TE/PI）为基础的乳房重建后行 PMRT 的并发症发生率及其与放疗时机（对 TE 或 PI 进行照射）的关系。
我们回顾性分析了 2003 年 1 月至 2014 年 12 月间接受乳房切除术、即刻 TE/PI 重建和 PMRT 的乳腺癌患者的病例。通过 Kaplan-Meier 分析估计并发症（包括重建失败、再次手术和感染）的发生率。采用对数秩检验和多因素 Cox 比例风险模型分析包括放疗时机在内的危险因素。
共纳入 81 例患者。中位随访时间为 32 个月（范围 2-120 个月）。大多数情况下，放疗包括 50Gy 照射重建乳房和锁骨上区域。总重建失败、再次手术和感染的发生率分别为 12.3%、13.6%和 11.1%，5 年累积重建失败、再次手术和感染的发生率分别为 16.7%、16.6%和 12.2%。放疗时机对并发症发生率无显著影响。多因素分析显示，年龄≥55 岁是并发症的显著危险因素（P＜0.05）。
放疗时机与重建失败、再次手术或感染的发生率之间无显著差异。对于年龄≥55 岁的老年患者，与年轻患者相比，PMRT 照射重建乳房可能会导致更多的并发症。
