TidalHealth Richard A. Henson Cancer Institute, MD; Rutgers Robert Wood Johnson Medical School Cancer Institute of New Jersey, New Brunswick, NJ.
Harvard Medical School, Dana-Farber/Brigham and Women's Cancer Center.
Semin Radiat Oncol. 2022 Jul;32(3):237-244. doi: 10.1016/j.semradonc.2022.01.009.
Postmastectomy radiation therapy (PMRT) is a mainstay of local therapy for many breast cancer patients. Patients undergoing mastectomy typically are offered options for breast reconstruction. For patients who are candidates for PMRT, there are ongoing challenges with combining optimal radiation technique to prioritize oncologic outcomes, against the goals of minimizing toxicity and achieving the best reconstruction outcomes. The process by which these decisions are made continues to evolve as surgical and radiation techniques have improved and expanded, and as more patients with different risk profiles for local recurrence are receiving PMRT. We review the considerations regarding the different types of reconstruction and timing with radiation treatment. We also review the technical radiation consideration such as dose-fractionation, use of bolus and scar boost, exploring the controversies associated with the nuanced decisions regarding radiation and reconstructive surgery which are influenced by variables that are under continued investigation.
术后放疗（PMRT）是许多乳腺癌患者局部治疗的主要方法。接受乳房切除术的患者通常有乳房重建的选择。对于适合 PMRT 的患者，如何将最佳的放射技术与优化肿瘤学结果相结合，同时又要尽量减少毒性并获得最佳的重建效果，这方面仍然存在挑战。随着手术和放射技术的改进和扩展，以及越来越多具有不同局部复发风险特征的患者接受 PMRT，这些决策的制定过程也在不断发展。我们回顾了不同类型重建和与放射治疗相关的时间的考虑因素。我们还回顾了技术放射方面的考虑，如剂量分割、使用填充物和疤痕增强，探讨了与放射和重建手术相关的争议，这些争议受到不断研究的变量的影响。
