Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia and Perugia General Hospital, Italy.
Oncology Institute, Rambam Medical Center, Haifa, Israel.
Eur J Surg Oncol. 2018 Apr;44(4):436-443. doi: 10.1016/j.ejso.2018.01.010. Epub 2018 Jan 12.
To describe the current European practise on post-mastectomy radiation therapy (PMRT) in relation to breast reconstruction.
A 21-item questionnaire was distributed online via Survey Monkey. Items referred to 1. general topics (country, centre, years of experience in breast cancer); 2. clinical decision making; 3. RT techniques and dosimetry; 4. dose fractionation.
283 responses were received from 19 countries. Most responders worked in public health services and in academic institutions and had 5-20 years experience. Although many indicated they were consulted about the timing and type of breast reconstructive surgery, final decisions were most often made by surgeons. Immediate reconstruction with expander followed by RT and subsequently permanent reconstruction with prosthesis was recommended by 61.6% of responders. Most (48.4%) adviced a boost only when margins were close or involved with an another 17.7% recommending it in the presence of high-risk features (T3-T4, lympho-vascular involvement). Intensity modulated RT was rarely used by about two-thirds of responders, except when with 3D technique the dose constraints were not achieved or when regional lymph nodes were included. Almost 60% of responders did not use bolus/tissue equivalent material (TEM). The main indication for bolus/TEM use was skin involvement. The majority of responders used 1.8-2 Gy per fraction.
The present survey highlighted controversial areas in clinical practise, confirming the uncertainties about the scheduling of PMRT and breast reconstruction.
描述与乳房重建相关的欧洲当前乳房切除术放疗（PMRT）的实践情况。
通过 Survey Monkey 在线分发了 21 项问卷。这些项目涉及 1. 一般主题（国家、中心、乳腺癌经验年限）；2. 临床决策；3. RT 技术和剂量学；4. 剂量分割。
从 19 个国家收到了 283 份回复。大多数应答者在公共卫生服务机构和学术机构工作，经验在 5-20 年之间。尽管许多人表示他们咨询过乳房重建手术的时间和类型，但最终决定通常由外科医生做出。61.6%的应答者建议在扩张器即刻重建后进行 RT，随后用假体进行永久性重建。大多数（48.4%）建议在边缘接近或涉及另一个时仅进行局部放疗，17.7%的人建议在存在高危特征（T3-T4、淋巴管血管侵犯）时进行。约三分之二的应答者很少使用调强放疗，除非 3D 技术无法达到剂量限制，或者包括区域淋巴结。近 60%的应答者不使用纱布/组织等效材料（TEM）。使用纱布/TEM 的主要指征是皮肤受累。大多数应答者使用 1.8-2 Gy/次分割。
本调查突出了临床实践中的争议领域，证实了对 PMRT 和乳房重建时间安排的不确定性。
