Levitin Ronald, Salari Kamran, Squires Bryan S, Hazy Allison J, Maywood Michael J, Thrasher Patrick, Delise Anthony P, Almahariq Muayad F, Dekhne Nayana, Oliver Lauren, Chen Peter Y, Walters Kailee J, Dudley Diane, Dilworth Joshua T
Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan.
Radiation oncology, Huron River Radiation Oncology Specialists, Ypsilanti, Michigan.
Adv Radiat Oncol. 2023 Jun 5;8(6):101283. doi: 10.1016/j.adro.2023.101283. eCollection 2023 Nov-Dec.
Postmastectomy radiation therapy (PMRT) reduces disease recurrence in appropriately selected patients but may compromise implant-based reconstruction. We investigated whether near-surface dose correlates with radiation-related toxic effects in these patients.
Patients receiving PMRT at a single institution from 2016 to 2019 were retrospectively reviewed. Patient demographics and treatment information were collected. Three near-surface structures were retrospectively generated, bound by the chest wall tangent beam as well as the skin surface and the skin-3 mm contour (SR3), skin surface and skin-5 mm contour (SR5), or skin-5 and skin-10 mm contours. Dosimetric analysis of these near-surface contours was performed in 2 Gy intervals. Univariate and multivariate analyses were used to identify predictors of moist desquamation, grade 2+ chest wall pain, use of opiate pain medication, unplanned reconstructive surgery, and implant failure. Logistic regression for each outcome and near-surface contour was performed for receiver-operator area under the curve (AUC) analysis and the Youden J Statistic was used to determine the optimal threshold for each dosimetric parameter.
Of 126 patients reviewed, 109 met the study's eligibility criteria. Median follow-up was 2.3 years. Twenty-five patients (23%) underwent unplanned reconstructive surgery, and 10 (9.2%) experienced implant failure. Among clinical variables, low body mass index and history of smoking predicted unplanned surgery on univariate and multivariate analyses, and moist desquamation predicted grade 2+ chest wall pain. The top dosimetric parameters by AUC for moist desquamation, grade 2+ chest wall pain, use of opiates, unplanned reconstructive surgery, and implant failure were SR5 D10 cc (AUC = 0.701, optimal threshold 57.8 Gy, < .001), SR3 D10 cc (AUC = 0.600, optimal threshold 56.8 Gy, = .079), SR5 D10 cc (AUC = 0.642, optimal threshold 57.3 Gy, = .041), SR3 V44 Gy (AUC = 0.711, optimal threshold 81%, = .001), and SR3 V44 Gy (AUC = 0.688, optimal threshold 82%, = .052), respectively.
Near-surface dose correlates with moist desquamation and unplanned reconstructive surgery after PMRT. Further evaluation of prospective optimization of dosimetric parameters related to SR3 and SR5 should be considered.
乳房切除术后放射治疗（PMRT）可降低经适当选择的患者的疾病复发率，但可能会影响基于植入物的乳房重建。我们研究了这些患者的近表面剂量是否与放射相关毒性效应相关。
对2016年至2019年在单一机构接受PMRT的患者进行回顾性研究。收集患者的人口统计学和治疗信息。回顾性生成三个近表面结构，分别由胸壁切线野以及皮肤表面与皮肤-3毫米轮廓（SR3）、皮肤表面与皮肤-5毫米轮廓（SR5）或皮肤-5毫米与皮肤-10毫米轮廓界定。对这些近表面轮廓进行剂量分析，间隔为2 Gy。采用单因素和多因素分析来确定湿性脱皮、2级及以上胸壁疼痛、使用阿片类止痛药物、计划外重建手术和植入物失败的预测因素。对每个结局和近表面轮廓进行逻辑回归分析，以绘制曲线下面积（AUC），并使用尤登J统计量来确定每个剂量学参数的最佳阈值。
在126例接受评估的患者中，109例符合研究纳入标准。中位随访时间为2.3年。25例患者（23%）接受了计划外重建手术，10例（9.2%）出现植入物失败。在临床变量中，低体重指数和吸烟史在单因素和多因素分析中均预测了计划外手术，湿性脱皮预测了2级及以上胸壁疼痛。对于湿性脱皮、2级及以上胸壁疼痛、使用阿片类药物、计划外重建手术和植入物失败，按AUC计算排名靠前的剂量学参数分别为SR5 D10 cc（AUC = 0.701，最佳阈值57.8 Gy，P <.001）、SR3 D10 cc（AUC = 0.600，最佳阈值56.8 Gy，P =.079）、SR5 D10 cc（AUC = 0.642，最佳阈值57.3 Gy，P =.041）、SR3 V44 Gy（AUC = 0.711，最佳阈值81%，P <.001）和SR3 V44 Gy（AUC = 0.688，最佳阈值82%，P =.052）。
近表面剂量与PMRT后的湿性脱皮和计划外重建手术相关。应考虑进一步前瞻性评估与SR3和SR5相关的剂量学参数优化。
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