保乳治疗和缩野放疗在既往隆乳背景下的可行性。
Feasibility of Breast-Conservation Therapy and Hypofractionated Radiation in the Setting of Prior Breast Augmentation.
机构信息
Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
出版信息
Pract Radiat Oncol. 2020 Sep-Oct;10(5):e357-e362. doi: 10.1016/j.prro.2020.01.003. Epub 2020 Mar 20.
PURPOSE
Cosmetic outcomes and rate of implant loss are poorly characterized among patients with breast cancer with previous breast augmentation (BA) who undergo breast-conservation therapy (BCT). Here we determine capsular contracture and implant loss frequency after BCT among patients receiving contemporary whole-breast radiation therapy (RT).
METHODS AND MATERIALS
Patients with breast cancer with a history of BA presenting to our institution from January 2006 to January 2017 who elected for BCT were included. Seventy-one breast cancers in 70 patients with a history of BA electing for BCT were retrospectively identified. Clinicopathologic, treatment, and outcome variables were examined. Whole-breast RT included conventional and hypofractionated schedules with and without a boost. Rates of implant loss and cosmetic outcomes among patients who did and did not develop a new/worse contracture based on physician assessment were compared.
RESULTS
In the study, 54.9% of patients received radiation using hypofractionated whole-breast tangents; 81.7% received a boost. In addition, 18 out of 71 cases (25.4%) developed a new/worse contracture after BCT with a mean follow-up of 1.9 years. Furthermore, 9 out of 71 cases (12.7%) were referred to a plastic surgeon for revisional surgery. There were no implant-loss cases. On univariate analysis, implant location, time from implant placement to diagnosis, RT type, RT boost, body mass index, and tumor size were not associated with new/worse contracture. Of 12 patients with existing contracture, only 2 developed worsening contracture. Physician assessment of cosmetic outcome after BCT was noted to be excellent or good for 87.4% of patients.
CONCLUSIONS
BCT for breast cancer patients with prior history of BA has a low risk of implant loss. Hypofractionated RT does not adversely affect implant outcomes. Patients should be counseled regarding risk for capsular contracture, but the majority have good/excellent outcome; BA does not represent a contraindication to BCT.
目的
在接受保乳治疗（BCT）的既往接受过乳房隆乳术（BA）的乳腺癌患者中，对美容结果和植入物丢失率的描述很差。在这里，我们确定在接受当代全乳放射治疗（RT）的患者中，BCT 后包膜挛缩和植入物丢失的频率。
方法和材料
纳入 2006 年 1 月至 2017 年 1 月期间在我院就诊的既往有 BA 病史并选择 BCT 的乳腺癌患者。回顾性识别了 70 名既往有 BA 病史并选择 BCT 的患者的 71 例乳腺癌。检查了临床病理、治疗和结局变量。全乳 RT 包括常规和分次剂量 RT，并结合或不结合局部加量照射。比较了根据医生评估出现新/更严重挛缩的患者和未出现新/更严重挛缩的患者的植入物丢失率和美容结果。
结果
在这项研究中，54.9%的患者接受了全乳分次切线野的调强放射治疗；81.7%的患者接受了局部加量照射。此外，在 BCT 后 18 例（25.4%）出现新/更严重的挛缩，平均随访 1.9 年。此外，有 9 例（12.7%）患者因需要进行整形修复手术而转诊给整形外科医生。没有发生植入物丢失的病例。单因素分析显示，植入物位置、植入物放置至诊断的时间、RT 类型、RT 局部加量照射、体重指数和肿瘤大小与新/更严重的挛缩无关。在 12 例存在挛缩的患者中，只有 2 例出现挛缩加重。BCT 后医生评估美容效果为优秀或良好的患者比例为 87.4%。
结论
对于既往有 BA 病史的乳腺癌患者，BCT 具有较低的植入物丢失风险。调强放疗不会对植入物的结果产生不利影响。应告知患者发生包膜挛缩的风险，但大多数患者的结果都很好/优秀；BA 并不代表 BCT 的禁忌症。
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