Stuart Silvia Radwanski, Munhoz Alexandre Mendonça, Chaves Cristiane L G, Montag Eduardo, Cordeiro Thalita C S, Fuzisaki Tatiana Taba, Marta Gustavo N, Carvalho Heloisa A
Department of Radiology and Oncology - Radiotherapy, Instituto do Câncer do Estado de São Paulo (ICESP), Brasil.
Instituto de Radiologia (INRAD) - Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brasil.
Rep Pract Oncol Radiother. 2021 Sep 30;26(5):730-739. doi: 10.5603/RPOR.a2021.0087. eCollection 2021.
Breast reconstruction following mastectomy is a relevant element of breast cancer treatment. The purpose of this study was to evaluate the influence of radiotherapy (RT) on local complications in patients with breast cancer that had undergone breast reconstruction with alloplastic material.
Retrospective study of breast cancer patients submitted to mastectomy and breast reconstruction from 2009 to 2013. Clinical and treatment variables were correlated with early and late complications.
251 patients were included; mean age was 49.7 (25 to 78) years. Reconstruction was immediate in 94% of the patients, with 88% performed with a temporary tissue expander. Postoperative radiotherapy (RT) was delivered to 167 patients (66.5%). Early complications were present in 26.3% of the patients. Irradiated patients presented 5.4% incidence of late complications versus 2.4% for non-irradiated patients (p = 0.327). Diabetes (OR = 3.41 95% CI: 1.23-9.45, p = 0.018) and high body mass index (BMI) (OR = 2.65; 95% CI: 1.60-4.37, p < 0.0001) were the main risk factors. The overall incidence of late complications was 4.4%, with predominance of severe capsular contracture (8/11). Arterial hypertension (OR = 4.78; 95% CI: 1.97-11.63, p = 0.001), BMI (OR = 0.170; 95% CI: 0.048-0.607, p = 0.006) and implant placement (OR = 3.55; 95% CI: 1.26-9.99, p = 0.016) were related to late complications.
The overall rate of complications was low in this population. Radiotherapy delivery translated into a higher but not statistically significant risk of late complications when compared with the non-irradiated patients. Already well-known clinical risk factors for complications after breast reconstruction were identified.
乳房切除术后乳房重建是乳腺癌治疗的一个重要组成部分。本研究的目的是评估放疗（RT）对采用异体材料进行乳房重建的乳腺癌患者局部并发症的影响。
对2009年至2013年接受乳房切除及乳房重建的乳腺癌患者进行回顾性研究。将临床和治疗变量与早期及晚期并发症进行关联分析。
共纳入251例患者；平均年龄为49.7岁（25至78岁）。94%的患者进行了即刻重建，其中88%采用了临时组织扩张器。167例患者（66.5%）接受了术后放疗（RT）。26.3%的患者出现早期并发症。接受放疗的患者晚期并发症发生率为5.4%，未接受放疗的患者为2.4%（p = 0.327）。糖尿病（OR = 3.41，95% CI：1.23 - 9.45，p = 0.018）和高体重指数（BMI）（OR = 2.65；95% CI：1.60 - 4.37，p < 0.0001）是主要危险因素。晚期并发症的总体发生率为4.4%，以严重包膜挛缩为主（8/11）。动脉高血压（OR = 4.78；95% CI：1.97 - 11.63，p = 0.001）、BMI（OR = 0.170；95% CI：0.048 - 0.607，p = 0.006）和植入物放置（OR = 3.55；95% CI：1.26 - 9.99，p = 0.016）与晚期并发症有关。
该人群并发症的总体发生率较低。与未接受放疗的患者相比，放疗导致晚期并发症的风险更高，但无统计学意义。已确定了乳房重建术后并发症的一些众所周知的临床危险因素。
