Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada.
Department of Oncology, London Regional Cancer Program, London, ON N6A 5W9, Canada.
Curr Oncol. 2023 Feb 14;30(2):2271-2276. doi: 10.3390/curroncol30020175.
Following mastectomy for breast cancer, women may choose implant-based reconstruction for many reasons, such as cosmesis, self-identity, and the ability to wear particular items of clothing. However, postmastectomy radiation therapy (PMRT) can compromise these cosmetic goals, including as much as a 40% loss of implant rate. To minimize the risk of radiation toxicity, it is important to consider how clinical target volumes (CTVs) can be optimized in PMRT to preserve the implant and reduce complications. Typically, guidelines from organizations such as the Radiation Oncology Group are used, which include regions previously encompassed by tangential fields. This includes all structures below the pectoralis muscle, such as the chest wall, where the risk of recurrence is negligible; this technique often requires incidental inclusion of portions of the lung and heart plus circumferential radiation of the implant. We present the preliminary single institution case series of a technique of complication avoidance of reconstruction implant radiation therapy, called CARIT, where the chest wall, and a large proportion of the implant, is not irradiated. In a retrospective review of 30 cases in which CARIT has been attempted, it was found that 24% of patients treated required a second surgery due to Baker grade III/IV capsular contracture. Using the Modified Harvard Harris Cosmetic Scale, 66.5% of patients had cosmetic outcomes rated as "good" or "excellent". CARIT could offer a technique to reduce complications in postmastectomy implant-based reconstruction patients, with our next steps focusing on improving dosimetry, and formally comparing the cosmesis and tumor control aspects with commonly used techniques.
在因乳腺癌进行乳房切除术之后，出于美容、自我认同和能够穿某些特定衣物等诸多原因，许多女性会选择基于植入物的重建。然而，乳房切除术后续放疗（PMRT）可能会影响这些美容目标，包括高达 40%的植入物丧失率。为了最大限度降低辐射毒性风险，重要的是要考虑如何在 PMRT 中优化临床靶区（CTV），以保留植入物并减少并发症。通常，会使用放射肿瘤学组等组织的指南，其中包括以前包括切线野的区域。这包括胸肌下方的所有结构，如复发风险可以忽略不计的胸壁；这种技术通常需要意外地包括部分肺和心脏，并对植入物进行环形放射治疗。我们提出了一种名为 CARIT 的重建植入物放射治疗并发症避免技术的初步单机构病例系列，该技术不照射胸壁和大部分植入物。在对 30 例尝试使用 CARIT 的病例进行回顾性研究后，发现 24%的接受治疗的患者因贝克分级 III/IV 包膜挛缩需要进行第二次手术。使用改良哈佛哈里斯美容量表，66.5%的患者的美容效果被评为“好”或“优秀”。CARIT 可为乳房切除术后续基于植入物的重建患者提供一种降低并发症的技术，我们的下一步重点是改善剂量学，并与常用技术正式比较美容和肿瘤控制方面。
