Ben David Merav A, Evron Ella, Rasco Adi F, Shai Ayelet, Corn Benjamin W
Assuta Medical Center, Tel Aviv 6971028, Israel.
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 84105, Israel.
Cancers (Basel). 2021 May 30;13(11):2694. doi: 10.3390/cancers13112694.
Risk-reducing mastectomy (RRM) is often advocated for BRCA1/2 mutation carriers who face a heightened lifetime risk of breast cancer. However, many carrier patients seek alternative risk-reducing measures. In a phase II nonrandomized trial, we previously reported that prophylactic irradiation to the contralateral breast among BRCA carriers undergoing breast-conserving treatment significantly reduced subsequent contralateral breast cancer. Herein, we report the outcome of salvage mastectomy and reconstruction in 11 patients that suffered reoccurrences of breast cancer in either the ipsilateral or contralateral breast or elected to have the procedure for risk reduction during the eight-year follow-up period. Patients' satisfaction with the procedure and physicians' assessment of the cosmetic outcome were not inferior for previously irradiated compared to non-irradiated breasts. Although the numbers are small, the results are encouraging and sustain hope in a challenging population. Our findings support continuing research as well as a discussion of risk-reduction alternatives besides mastectomy, including prophylactic breast irradiation, in BRCA1/2 mutation carriers.
对于面临乳腺癌终生风险增加的BRCA1/2基因突变携带者，常提倡进行降低风险的乳房切除术（RRM）。然而，许多携带基因突变的患者寻求其他降低风险的措施。在一项II期非随机试验中，我们之前报告称，接受保乳治疗的BRCA基因携带者对侧乳房的预防性放疗显著降低了随后对侧乳腺癌的发病率。在此，我们报告了11例患者在八年随访期内同侧或对侧乳房出现乳腺癌复发或选择进行该手术以降低风险后，进行挽救性乳房切除术和重建的结果。与未接受放疗的乳房相比，患者对手术的满意度以及医生对美容效果的评估在先前接受过放疗的乳房中并不逊色。尽管数量较少，但结果令人鼓舞，并给这个具有挑战性的人群带来了希望。我们的研究结果支持继续开展研究，并支持在BRCA1/2基因突变携带者中讨论除乳房切除术之外的降低风险的替代方法，包括预防性乳房放疗。
