Department of Radiation Oncology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea.
Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
Radiother Oncol. 2022 May;170:111-117. doi: 10.1016/j.radonc.2022.02.028. Epub 2022 Mar 1.
The European Society for Radiotherapy and Oncology (ESTRO) recently defined delineation guidelines for the clinical target volume for postmastectomy radiation therapy (PMRT) after immediate implant-based reconstruction for early-stage breast cancer. We analyzed the three-dimensional location and pattern of local recurrence in accordance with the reconstruction type and ESTRO-target volume.
This retrospective study involved patients who had undergone mastectomy with implant reconstruction between 2010 and 2019 and who had local recurrence as the first event. For mapping analysis, one subpectoral and one prepectoral implant patient were selected. All recurrence lesions were contoured and mapped in a representative case.
A total of 1327 patients with breast cancer who underwent mastectomy and implant-based breast reconstruction were identified; 51 were enrolled with a total of 65 lesions. In subpectoral implant patients, 93% of recurrences were located in the ESTRO-target volume. No recurrence occurred in the implant pocket, but 7% of the recurrent tumors developed in the pectoralis major and deep thoracic muscle. In prepectoral implant patients, all recurrent tumors occurred within the ESTRO-target volume.
The ESTRO-target volume in PMRT after reconstruction encompassed most local recurrences in patients who underwent mastectomy with immediate implant reconstruction. Our results support the application of the ESTRO Advisory Committee for Radiation Oncology Practice consensus guideline for target volume of PMRT after immediate implant-based reconstruction for early-stage breast cancer.
欧洲放射肿瘤学会（ESTRO）最近为早期乳腺癌即刻乳房植入重建术后的乳房切除术放疗（PMRT）制定了临床靶区勾画指南。我们根据重建类型和 ESTRO 靶区分析了局部复发的三维位置和模式。
本回顾性研究纳入了 2010 年至 2019 年间接受乳房切除术和植入物重建且以局部复发为首发事件的患者。为了进行映射分析，选择了一名胸肌下植入物患者和一名胸肌前植入物患者。在一个有代表性的病例中，对所有复发病灶进行了轮廓勾画和映射。
共确定了 1327 名接受乳房切除术和基于植入物的乳房重建的乳腺癌患者，其中 51 名患者共 65 个病灶被纳入研究。在胸肌下植入物患者中，93%的复发位于 ESTRO 靶区内。植入物袋内未发生复发，但 7%的复发性肿瘤发生在胸大肌和深部胸肌。在胸肌前植入物患者中，所有复发性肿瘤均位于 ESTRO 靶区内。
即刻乳房植入重建术后 PMRT 的 ESTRO 靶区涵盖了接受即刻乳房植入重建的乳房切除术患者中大多数的局部复发。我们的研究结果支持将 ESTRO 放射肿瘤学实践咨询委员会的早期乳腺癌即刻乳房植入重建术后 PMRT 靶区的共识指南应用于临床。
