O' Halloran Niamh, McVeigh Terri, Martin Joseph, Keane Maccon, Lowery Aoife, Kerin Michael
Discipline of Surgery, Lambe Institute, NUI Galway, Galway, Ireland.
Department of Radiation Oncology, Galway University Hospital, Galway, Ireland.
Ir J Med Sci. 2019 Feb;188(1):75-83. doi: 10.1007/s11845-018-1846-6. Epub 2018 Jun 14.
Immediate breast reconstruction (IBR) improves psychosocial and quality of life outcomes. Post-mastectomy radiation therapy is indicated for patients with a high risk of locoregional recurrence including locally advanced tumours (≥ 5 cm) or greater than or equal to four axillary nodes positive for breast cancer and can be a relative contraindication to IBR. Administration of radiation therapy pre-operatively, analogous to neoadjuvant chemotherapy, may reduce time to completion of treatment and facilitate better access to IBR.
This is a prospective pilot study in a tertiary referral breast cancer unit, comparing surgical, pathological response and oncological outcomes and time to completion of therapy for a prospective group of patients who received neoadjuvant radiotherapy with a cohort of age- and stage-matched patients requiring post-mastectomy (± reconstruction) radiation between 2010 and 2016.
Sixteen patients with locally advanced breast cancer underwent neoadjuvant radiation and were age- and stage-matched to 32 patients who received post-mastectomy radiation therapy (PMRT) between 2010 and 2016. Neoadjuvant radiotherapy resulted in shorter time between diagnosis and treatment completion (245.6 ± 44.2 days in the neoadjuvant group, 291.2 ± 36.7 days in the adjuvant group, p = 0.001). A higher proportion of patients undergoing neoadjuvant chemoradiation therapy underwent breast reconstruction (14/16 patients in the neoadjuvant group, 15/32 patients in the adjuvant group, p = 0.007) without an increase in complication rate (p = 0.117). There was a trend towards improved pathological complete response and survival in the neoadjuvant group.
This pilot study confirms that neoadjuvant chemoradiation is a feasible way of delivering breast cancer treatment and may facilitate improved access to IBR.
即刻乳房重建（IBR）可改善心理社会状况及生活质量。乳房切除术后放疗适用于局部区域复发风险高的患者，包括局部晚期肿瘤（≥5厘米）或乳腺癌腋窝淋巴结阳性数大于或等于4个，且可能是IBR的相对禁忌证。术前放疗，类似于新辅助化疗，可能会缩短治疗完成时间，并有助于更好地进行IBR。
这是一项在三级转诊乳腺癌治疗中心开展的前瞻性试点研究，比较了2010年至2016年间接受新辅助放疗的一组前瞻性患者与年龄和分期匹配的一组需要乳房切除术后（±重建）放疗的患者的手术、病理反应、肿瘤学结局及治疗完成时间。
16例局部晚期乳腺癌患者接受了新辅助放疗，年龄和分期与2010年至2016年间接受乳房切除术后放疗（PMRT）的32例患者相匹配。新辅助放疗使诊断至治疗完成的时间缩短（新辅助组为245.6±44.2天，辅助组为291.2±36.7天，p = 0.001）。接受新辅助放化疗的患者进行乳房重建的比例更高（新辅助组14/16例患者，辅助组15/32例患者，p = 0.007），且并发症发生率未增加（p = 0.117）。新辅助组在病理完全缓解和生存率方面有改善趋势。
这项试点研究证实新辅助放化疗是一种可行的乳腺癌治疗方式，可能有助于更好地进行IBR。
