Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachussetts; Current Affiliation: Department of Radiation Oncology, Northwestern University Memorial Hospital, Chicago, Illinois.
Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachussetts.
Pract Radiat Oncol. 2022 Nov-Dec;12(6):475-486. doi: 10.1016/j.prro.2022.05.017. Epub 2022 Jun 27.
Our purpose is to explore the effect of postmastectomy radiation therapy (PMRT) modality and timing on complication rates in breast cancer patients receiving immediate 2-stages expander/implant.
We reviewed the charts of 661 patients who underwent immediate 2-stages expander/implant with/without PMRT at our institution from 2000 to 2019. Patients were divided into 3 cohorts: no radiation, PMRT to expanders (RTE), and PMRT to implants after expander exchange (RTI). PMRT was delivered either with 3-dimensional conformal photon with or without chest wall boost (CWB) or proton therapy. Reconstruction complications were defined as infection/necrosis requiring debridement, capsular-contracture requiring capsulotomy, and reconstruction failure requiring prothesis removal. Logistic regression and Cox models were used to assess the effect of different radiation therapy modalities on complication rates and local control.
Among 661 patients, 309 (46.7%) received PMRT, 220 of the 309 (71.2%) received RTE before exchange, and 89 (28.8%) received RTI after exchange. Seventeen out of 309 (5.5%) patients received proton therapy. The complications among RTE versus RTI cohorts were 22.7% versus 15.7% for infection/necrosis, 13.6% versus 19.1% for capsular-contracture, and 39.5% versus 31.5% for overall reconstruction failure, respectively. Among proton patients, 8/17 (47%) developed capsular contracture compared with 16.4% (24/146) and 10.3% (15/146) in CWB and non-CWB groups, respectively. Adjusted multivariable analysis showed no significant difference between RTI and RTE in terms of infection/necrosis and capsular contracture. Yet, RTE significantly increased overall reconstruction failure compared with RTI (39.5% vs 31.5%; odds ratio [OR], 2.11; P = .02). Protons significantly increased capsular contracture compared with both CWB and non-CWB groups (OR, 5.4; P = .01 and OR, 10.9; P < .001, respectively). Moreover, proton significantly increased overall reconstruction failure. The 5-year local control rates were 95.3% and 97.7% for RTE and RTI, respectively (hazard ratio, 1.2; P = .7).
Early radiation to the expander before the exchange to implant significantly increased overall reconstruction failure without improving local control. Protons significantly increased capsular contracture rates and overall reconstruction failure leading to more revision surgeries.
本研究旨在探讨乳腺癌患者接受即刻 2 期扩张器/植入物治疗时，乳房切除术（PMRT）方式和时机对并发症发生率的影响。
我们回顾了 2000 年至 2019 年在我院接受即刻 2 期扩张器/植入物治疗的 661 例患者的病历。患者被分为 3 组：无放疗组、PMRT 至扩张器组（RTE）和 PMRT 至扩张器更换后植入物组（RTI）。PMRT 采用三维适形光子放疗，或联合或不联合胸壁加量放疗（CWB），或质子治疗。重建并发症定义为需要清创的感染/坏死、需要切开松解的包膜挛缩和需要去除假体的重建失败。采用 logistic 回归和 Cox 模型评估不同放疗方式对并发症发生率和局部控制的影响。
在 661 例患者中，309 例（46.7%）接受了 PMRT，其中 220 例（71.2%）在交换前接受了 RTE，89 例（28.8%）在交换后接受了 RTI。309 例患者中有 17 例（5.5%）接受了质子治疗。RTE 组与 RTI 组的并发症发生率分别为感染/坏死 22.7%比 15.7%，包膜挛缩 13.6%比 19.1%，整体重建失败 39.5%比 31.5%。在质子治疗患者中，8/17（47%）发生包膜挛缩，而 CWB 组和非 CWB 组分别为 16.4%（24/146）和 10.3%（15/146）。多变量调整分析显示，RTI 与 RTE 在感染/坏死和包膜挛缩方面无显著差异。然而，RTE 与 RTI 相比，整体重建失败显著增加（39.5%比 31.5%；比值比[OR]，2.11；P=0.02）。与 CWB 和非 CWB 组相比，质子治疗显著增加了包膜挛缩（OR，5.4；P=0.01 和 OR，10.9；P<0.001）。此外，质子治疗还显著增加了整体重建失败。RTE 和 RTI 的 5 年局部控制率分别为 95.3%和 97.7%（风险比，1.2；P=0.7）。
在更换为植入物之前，早期对扩张器进行放疗显著增加了整体重建失败的风险，而没有改善局部控制。质子治疗显著增加了包膜挛缩的发生率和整体重建失败的风险，导致更多的修复手术。
