Berlin Eva, Yegya-Raman Nikhil, Hollawell Casey, Haertter Allison, Fosnot Joshua, Rhodes Sylvia, Seol Seung Won, Gentile Michelle, Li Taoran, Freedman Gary M, Taunk Neil K
Department of Radiation Oncology.
Division of Plastic Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Adv Radiat Oncol. 2023 Oct 14;9(3):101385. doi: 10.1016/j.adro.2023.101385. eCollection 2024 Mar.
Our purpose was to report complications requiring surgical intervention among patients treated with postmastectomy proton radiation therapy (PMPRT) for breast cancer in the setting of breast reconstruction (BR).
Patients enrolled on a prospective proton registry who underwent BR with immediate autologous flap, tissue expander (TE), or implant in place during PMPRT (50/50.4 Gy +/- chest wall boost) were eligible. Major reconstruction complication (MRC) was defined as a complication requiring surgical intervention. Absolute reconstruction failure was an MRC requiring surgical removal of BR. A routine revision (RR) was a plastic surgery refining cosmesis of the BR. Kaplan-Meier method was used to assess disease outcomes and MRC. Cox regression was used to assess predictors of MRC.
Seventy-three courses of PMPRT were delivered to 68 women with BR between 2013 and 2021. Median follow-up was 42.1 months. Median age was 47 years. Fifty-six (76.7%) courses used pencil beam scanning PMPRT. Of 73 BR, 29 were flaps (39.7%), 30 implants (41.1%), and 14 TE (19.2%) at time of irradiation. There were 20 (27.4%) RR. There were 9 (12.3%) MRC among 5 implants, 2 flaps, and 2 TE, occurring a median of 29 months from PMPRT start. Three-year freedom from MRC was 86.9%. Three (4.1%) of the MRC were absolute reconstruction failure. Complications leading to MRC included capsular contracture in 5, fat necrosis in 2, and infection in 2. On univariable analysis, BR type, boost, proton technique, age, and smoking status were not associated with MRC, whereas higher body mass index trended toward significance (hazard ratio, 1.07; 95% CI, 0.99-1.16; = .10).
Patients undergoing PMPRT to BR had a 12.3% incidence of major complications leading to surgical intervention, and total loss of BR was rare. MRC rates were similar among reconstruction types. Minor surgery for RR is common in our practice.
我们的目的是报告在乳房重建（BR）背景下接受乳腺癌乳房切除术后质子放疗（PMPRT）的患者中需要手术干预的并发症。
符合条件的患者纳入前瞻性质子登记处，这些患者在PMPRT（50/50.4 Gy±胸壁加量）期间接受了即刻自体皮瓣、组织扩张器（TE）或植入物的BR。主要重建并发症（MRC）定义为需要手术干预的并发症。绝对重建失败是指需要手术切除BR的MRC。常规修复（RR）是指对BR进行美容改善的整形手术。采用Kaplan-Meier方法评估疾病结局和MRC。采用Cox回归评估MRC的预测因素。
2013年至2021年期间，对68例接受BR的女性进行了73疗程的PMPRT。中位随访时间为42.1个月。中位年龄为47岁。56个（76.7%）疗程采用笔形束扫描PMPRT。在接受照射时，73例BR中，29例为皮瓣（39.7%），30例为植入物（41.1%），14例为TE（19.2%）。有20例（27.4%）RR。在5例植入物、2例皮瓣和2例TE中有9例（12.3%）发生MRC，从PMPRT开始中位发生时间为29个月。三年无MRC发生率为86.9%。其中3例（4.1%）MRC为绝对重建失败。导致MRC的并发症包括5例包膜挛缩、2例脂肪坏死和2例感染。单因素分析显示，BR类型、加量、质子技术、年龄和吸烟状况与MRC无关，而较高的体重指数有显著趋势（风险比，1.07；95%CI，0.99-1.16；P = 0.10）。
接受PMPRT的BR患者中，导致手术干预的主要并发症发生率为12.3%，BR完全丧失的情况罕见。不同重建类型的MRC发生率相似。在我们的实践中，RR的小手术很常见。
