Godden Amy R, Micha Aikaterini, O'Connell Rachel L, Mohammed Kabir, Kirby Anna M, Thiruchelvam Paul T R, Leff Daniel R, MacNeill Fiona A, Rusby Jennifer E
The Royal Marsden NHS Foundation Trust, United Kingdom; Institute of Cancer Research, United Kingdom.
The Royal Marsden NHS Foundation Trust, United Kingdom.
J Plast Reconstr Aesthet Surg. 2023 Mar;78:19-28. doi: 10.1016/j.bjps.2022.11.040. Epub 2023 Jan 20.
The optimal combination of radiotherapy and breast reconstruction has not yet been defined. Post-mastectomy radiotherapy (PMRT) has deleterious effects on breast reconstruction, leading to caution amongst surgeons. Pre-operative radiotherapy (PRT) is a growing area of interest, is demonstrated to be safe, and spares autologous flaps from radiotherapy. This study evaluates the aesthetic outcome of PRT and deep inferior epigastric artery perforator (DIEP) flap reconstruction within the Pre-operative Radiotherapy And Deep Inferior Epigastric artery Perforator (DIEP) flAp (PRADA) cohort.
PRADA was an observational cohort study designed to evaluate the feasibility and safety of PRT for women undergoing neoadjuvant chemotherapy and DIEP reconstruction. Panel evaluation of 3D surface images (3D-SIs) and patient-reported outcome measures (BREAST-Q) for a subset of women in the study were compared with those of a DIEP-PMRT cohort who had undergone DIEP reconstruction and PMRT.
Seventeen out of 33 women from the PRADA study participated in this planned substudy. Twenty-eight women formed the DIEP-PMRT cohort (median follow-up 23 months). The median (inter-quartile range [IQR]) 'satisfaction with breasts' score at 12 months for the PRADA cohort was significantly better than the DIEP-PMRT cohort (77 [72-87] versus 64 [54-71], respectively), p=0.01). Median [IQR] panel evaluation (5-point scale) was also significantly better for the PRADA cohort than for the DIEP-PMRT cohort (4.3 [3.9-4.6] versus 3.6 [2.8-4] p=0.003).
Aesthetic outcome for the PRADA cohort was reported to be 'good' or 'excellent' in 93% of cases using a bespoke panel assessment with robust methodology. Patient satisfaction at one year is encouraging and superior to DIEP-PMRT at 23 months. Switching surgery-radiotherapy sequencing leads to similar breast aesthetic outcomes and warrants further large-scale, multi-centre evaluation in a randomised trial.
放射治疗与乳房重建的最佳组合尚未确定。乳房切除术后放疗（PMRT）对乳房重建有不良影响，这使得外科医生对此持谨慎态度。术前放疗（PRT）是一个日益受到关注的领域，已被证明是安全的，并且可使自体皮瓣免受放疗。本研究在术前放疗与腹壁下动脉穿支（DIEP）皮瓣（PRADA）队列中评估PRT联合DIEP皮瓣重建的美学效果。
PRADA是一项观察性队列研究，旨在评估PRT用于接受新辅助化疗及DIEP重建的女性的可行性和安全性。对该研究中部分女性的3D表面图像（3D-SIs）进行小组评估，并将患者报告结局量表（BREAST-Q）与接受DIEP重建及PMRT的DIEP-PMRT队列的评估结果进行比较。
PRADA研究的33名女性中有17名参与了这项计划中的子研究。28名女性组成了DIEP-PMRT队列（中位随访时间23个月）。PRADA队列在12个月时“对乳房的满意度”评分中位数（四分位间距[IQR]）显著高于DIEP-PMRT队列（分别为77[72 - 87]和64[54 - 71]），p = 0.01）。PRADA队列的小组评估中位数（IQR）（5分制）也显著优于DIEP-PMRT队列（4.3[3.9 - 4.6]对3.6[2.8 - 4]，p = 0.003）。
使用定制的小组评估方法且方法可靠，PRADA队列93%的病例美学效果报告为“良好”或“优秀”。一年时的患者满意度令人鼓舞，且优于DIEP-PMRT队列23个月时的满意度。改变手术-放疗顺序可带来相似的乳房美学效果，值得在随机试验中进行进一步的大规模、多中心评估。
