Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
Department of Biostatistics and Bioinformatics, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
Pract Radiat Oncol. 2023 Mar-Apr;13(2):122-131. doi: 10.1016/j.prro.2022.09.005. Epub 2022 Nov 1.
Postmastectomy radiation therapy is known to increase risk of complications in the reconstruction setting. We aim to identify the variables associated with reconstruction failure and other major complications.
A prospectively collected institutional database was queried for patients with up to stage IIIC breast cancer treated from 2000 to 2017, undergoing mastectomy, immediate implant or autologous tissue reconstruction, and radiation to the reconstructed breast within 1 year of surgery. Reconstruction failure was defined as complication requiring surgical revision or implant removal. Additional major complications were defined as any infection, contracture, necrosis, or fibrosis. Covariates of interest included age, body mass index, smoking status, stage, hormone receptor and HER2 status, systemic therapy timing, radiation technique, nodal irradiation, and interval between surgery and start of postmastectomy radiation therapy. Differences in complication rates were assessed with χ² or Fisher exact tests. Competing risk regression was used to estimate hazard ratios; covariates were included one at a time to avoid over adjustment.
A total of 206 reconstructed breasts in 202 patients resulted from our initial query, with 139 treated with intensity-modulated radiation therapy (IMRT) and 67 treated with conventional radiation therapy (CRT). Median follow-up was 45 months (range, 4-210 months); patient cohorts were generally similar. Eight patients were excluded from toxicity analysis for insufficient follow-up (<2 years). Overall, reconstruction failure and major complication rates were significantly lower in the IMRT group. Reconstruction failure rates were 3.0% for IMRT versus 16.4% for CRT (P = .002), and major complication rates were 6.8% for IMRT versus 24.6% for CRT (P < .001). On univariate analysis, CRT was significantly predictive of implant failure (hazard ratio, 5.54; P = .003) and increased complication rates (hazard ratio, 3.83; P = .001). Significance persisted on multivariable analysis. Survival outcomes were similar, with no difference in 2 year overall survival (P = .12) and local recurrence (P = .41).
Using IMRT may improve reconstruction outcomes over CRT, with significantly lower reconstruction failure and complication rates without compromising local control or survival.
乳腺癌根治术后放疗会增加重建时发生并发症的风险。本研究旨在确定与重建失败和其他重大并发症相关的变量。
我们对 2000 年至 2017 年期间接受过乳腺癌根治术、即刻植入物或自体组织重建且术后 1 年内接受过重建乳房放疗的 IIIC 期及以下乳腺癌患者的前瞻性收集的机构数据库进行了查询。重建失败的定义为需要手术修正或植入物移除的并发症。其他主要并发症定义为任何感染、挛缩、坏死或纤维化。感兴趣的协变量包括年龄、体重指数、吸烟状况、分期、激素受体和 HER2 状态、全身治疗时机、放疗技术、淋巴结照射和手术与乳腺癌根治术后放疗开始之间的时间间隔。采用 χ²检验或 Fisher 确切检验评估并发症发生率的差异。采用竞争风险回归估计风险比；逐个纳入协变量以避免过度调整。
我们最初的查询共涉及 202 例患者的 206 个重建乳房，其中 139 例接受了调强放疗（IMRT），67 例接受了常规放疗（CRT）。中位随访时间为 45 个月（范围：4-210 个月）；患者队列总体相似。由于随访时间不足（<2 年），有 8 例患者被排除在毒性分析之外。总体而言，IMRT 组的重建失败和重大并发症发生率明显较低。IMRT 组的重建失败率为 3.0%，而 CRT 组为 16.4%（P=0.002），IMRT 组的重大并发症发生率为 6.8%，而 CRT 组为 24.6%（P<0.001）。单因素分析显示，CRT 显著预测了植入物失败（风险比，5.54；P=0.003）和并发症发生率增加（风险比，3.83；P=0.001）。多变量分析仍有统计学意义。生存结果相似，2 年总生存率（P=0.12）和局部复发率（P=0.41）无差异。
与 CRT 相比，使用 IMRT 可能会改善重建结果，重建失败和并发症发生率显著降低，而不会影响局部控制或生存。
