Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Icahn School of Medicine, Mount Sinai Health System, New York, NY, USA.
Lancet Oncol. 2017 Dec;18(12):e742-e753. doi: 10.1016/S1470-2045(17)30617-4.
As the use of breast reconstruction and postmastectomy radiotherapy (PMRT) has increased over the past decade, the typical approach to integrating radiotherapy with breast reconstruction has provoked intense controversy in the management of breast cancer. PMRT can lead to an increased frequency of complications in the reconstructed breast. Conversely, the reconstructed breast can increase the complexity of radiotherapy delivery. How to minimise the frequency of complications without compromising oncological or cosmetic outcomes of the reconstructed breast is an important shared multidisciplinary goal for oncologists and their patients. Several questions remain, however, regarding the type of reconstruction that should be used with PMRT, when reconstruction should be done relative to PMRT and whether radiotherapy treatment should be directed towards the tissue expander or the implant for women who opt for a two-stage expander-implant reconstruction. Following advances in the planning of radiotherapy treatment, new questions about the application of these technologies in the setting of breast reconstruction have arisen. In this Review, we address these questions by reviewing contemporary evidence on the optimal integration of radiotherapy and breast reconstruction in the management of breast cancer.
在过去十年中，随着乳房重建和乳腺癌术后放疗（PMRT）的应用增加，在乳腺癌的管理中，将放疗与乳房重建相结合的典型方法引发了激烈的争议。PMRT 可导致重建乳房并发症的发生率增加。相反，重建的乳房会增加放疗实施的复杂性。如何在不影响重建乳房的肿瘤学或美容结果的情况下，最大限度地减少并发症的发生频率，是肿瘤学家及其患者的一个重要的共同多学科目标。然而，关于应在 PMRT 中使用哪种类型的重建、何时相对于 PMRT 进行重建以及对于选择两阶段扩张器-植入物重建的女性，放疗治疗是否应针对组织扩张器或植入物，仍存在一些问题。在放疗治疗计划取得进展后，在乳房重建中应用这些技术的新问题也随之出现。在这篇综述中，我们通过回顾有关在乳腺癌管理中放疗和乳房重建最佳整合的当代证据来解决这些问题。
