Chidley Phoebe, Foroudi Farshad, Tacey Mark, Khor Richard, Yeh Janice, Bevington Elaine, Hyett Anthony, Loh Su Wen, Chew Grace, McCracken James, Neoh Derek, Yeo Belinda, Baker Caroline, Jassal Sunil, Law Michael, Zantuck Natalie, Cokelek Margaret, Guerrieri Mario, Brown Belinda, Stoney David, Ng Michael, Chao Michael
Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia.
University of Melbourne, Melbourne, Victoria, Australia.
J Med Imaging Radiat Oncol. 2021 Jun;65(3):345-353. doi: 10.1111/1754-9485.13180. Epub 2021 Apr 5.
Neoadjuvant radiotherapy (NART) as part of a multi-modality approach for locally advanced breast cancer (LABC) requires further investigation. Importantly, this approach may allow for a single-staged surgical procedure, with mastectomy and immediate autologous reconstruction. Multiple other potential benefits of NART include improved pathological downstaging of breast disease, reduced overall treatment time, elimination of time period with breast tissue deficit and improved patient satisfaction.
This is a retrospective multi-institutional review of patients with LABC and high-risk breast disease undergoing NART. Eligible patients sequentially underwent neoadjuvant chemotherapy (NACT) with or without HER2-targeted therapy, NART, followed by mastectomy with immediate autologous breast reconstruction (BR) 4- to 6 weeks post-completion of radiotherapy. Patient and tumour characteristics were analysed using descriptive statistics. Surgical complications were assessed using the Clavien-Dindo Classification (Ann Surg 2004; 240: 205).
From 3/2013 to 9/2019, 153 patients were treated with NART. The median age was 47 years (IQR 42-52), with median body mass index of 27. Eighteen patients experienced Grade 3 acute surgical complications. This included 13 Grade 3B breast-site events and 9 Grade 3B donor-site events, where further surgical intervention was required for management of wound infection, wound dehiscence, flap or mastectomy skin necrosis, haematoma and internal mammary venous anastomotic thrombosis. No autologous flap loss was observed.
Neoadjuvant radiotherapy facilitates a single-stage surgical procedure with mastectomy and immediate autologous BR, eliminating the delay to reconstructive surgery and thus shortening a woman's breast cancer journey. The findings of this review support the use of NART, with comparable rates of surgical complications to standard sequencing.
新辅助放疗（NART）作为局部晚期乳腺癌（LABC）多模式治疗方法的一部分，仍需进一步研究。重要的是，这种方法可能允许进行单阶段手术，即乳房切除术和即刻自体乳房重建。NART的其他多个潜在益处包括改善乳腺疾病的病理降期、缩短总体治疗时间、消除乳腺组织缺损期以及提高患者满意度。
这是一项对接受NART的LABC和高危乳腺疾病患者进行的多机构回顾性研究。符合条件的患者依次接受新辅助化疗（NACT），可联合或不联合HER2靶向治疗，然后进行NART，放疗结束后4至6周进行乳房切除术并即刻自体乳房重建（BR）。使用描述性统计分析患者和肿瘤特征。使用Clavien-Dindo分类法（《外科学年鉴》2004年；240卷：205页）评估手术并发症。
从2013年3月至2019年9月，153例患者接受了NART治疗。中位年龄为47岁（四分位间距42 - 52岁），中位体重指数为27。18例患者发生3级急性手术并发症。其中包括13例3B级乳房部位事件和9例3B级供区事件，这些事件需要进一步手术干预来处理伤口感染、伤口裂开、皮瓣或乳房切除皮肤坏死、血肿以及胸廓内静脉吻合口血栓形成。未观察到自体皮瓣丢失。
新辅助放疗有助于进行乳房切除术和即刻自体乳房重建的单阶段手术，消除了重建手术的延迟，从而缩短了女性乳腺癌的治疗进程。本综述结果支持使用NART，其手术并发症发生率与标准治疗顺序相当。
