Kellogg College, Nuffield Department of Surgery, University of Oxford, Oxford, UK.
Department of Surgery and Cancer, Imperial College London, London, UK.
BJS Open. 2020 Apr;4(2):182-196. doi: 10.1002/bjs5.50245. Epub 2019 Dec 29.
Effects of postmastectomy radiotherapy (PMRT) on autologous breast reconstruction (BRR) are controversial regarding surgical complications, cosmetic appearance and quality of life (QOL). This systematic review evaluated these outcomes after abdominal free flap reconstruction in patients undergoing postoperative adjuvant radiotherapy (PMRT), preoperative radiotherapy (neoadjuvant radiotherapy) and no radiotherapy, aiming to establish evidence-based optimal timings for radiotherapy and BRR to guide contemporary management.
The study was registered on PROSPERO (CRD42017077945). Embase, MEDLINE, Google Scholar, CENTRAL, Science Citation Index and ClinicalTrials.gov were searched (January 2000 to August 2018). Study quality and risk of bias were assessed using GRADE and Cochrane's ROBINS-I respectively.
Some 12 studies were identified, involving 1756 patients (350 PMRT, 683 no radiotherapy and 723 neoadjuvant radiotherapy), with a mean follow-up of 27·1 (range 12·0-54·0) months for those having PMRT, 16·8 (1·0-50·3) months for neoadjuvant radiotherapy, and 18·3 (1·0-48·7) months for no radiotherapy. Three prospective and nine retrospective cohorts were included. There were no randomized studies. Five comparative radiotherapy studies evaluated PMRT and four assessed neoadjuvant radiotherapy. Studies were of low quality, with moderate to serious risk of bias. Severe complications were similar between the groups: PMRT versus no radiotherapy (92 versus 141 patients respectively; odds ratio (OR) 2·35, 95 per cent c.i. 0·63 to 8·81, P = 0·200); neoadjuvant radiotherapy versus no radiotherapy (180 versus 392 patients; OR 1·24, 0·76 to 2·04, P = 0·390); and combined PMRT plus neoadjuvant radiotherapy versus no radiotherapy (272 versus 453 patients; OR 1·38, 0·83 to 2·32, P = 0·220). QOL and cosmetic studies used inconsistent methodologies.
Evidence is conflicting and study quality was poor, limiting recommendations for the timing of autologous BRR and radiotherapy. The impact of PMRT and neoadjuvant radiotherapy appeared to be similar.
关于术后辅助放疗（PMRT）对自体乳房重建（BRR）的影响，手术并发症、美容效果和生活质量（QOL）存在争议。本系统评价评估了腹部游离皮瓣重建后患者接受术后辅助放疗（PMRT）、术前放疗（新辅助放疗）和无放疗的这些结局，旨在为放疗和 BRR 的最佳时机建立循证依据，以指导当代管理。
该研究在 PROSPERO（CRD42017077945）上进行了注册。检索了 Embase、MEDLINE、Google Scholar、CENTRAL、科学引文索引和 ClinicalTrials.gov（2000 年 1 月至 2018 年 8 月）。使用 GRADE 和 Cochrane 的 ROBINS-I 分别评估研究质量和偏倚风险。
共确定了 12 项研究，涉及 1756 名患者（350 名 PMRT、683 名无放疗和 723 名新辅助放疗），PMRT 组平均随访 27.1 个月（范围 12.0-54.0），新辅助放疗组 16.8 个月（1.0-50.3），无放疗组 18.3 个月（1.0-48.7）。纳入了三项前瞻性队列研究和九项回顾性队列研究。没有随机研究。五项比较放疗的研究评估了 PMRT，四项评估了新辅助放疗。研究质量低，偏倚风险为中度至严重。各组严重并发症相似：PMRT 与无放疗（分别为 92 例和 141 例；比值比（OR）2.35，95%置信区间（CI）0.63 至 8.81，P=0.200）；新辅助放疗与无放疗（180 例和 392 例；OR 1.24，0.76 至 2.04，P=0.390）；PMRT 加新辅助放疗与无放疗（272 例和 453 例；OR 1.38，0.83 至 2.32，P=0.220）。QOL 和美容研究使用了不一致的方法。
证据存在争议，研究质量较差，限制了对自体 BRR 和放疗时机的建议。PMRT 和新辅助放疗的影响似乎相似。
