Park Jung Bin, Jang Bum-Sup, Chang Ji Hyun, Kim Jin Ho, Choi Chang Heon, Hong Ki Young, Jin Ung Sik, Chang Hak, Myung Yujin, Jeong Jae Hoon, Heo Chan Yeong, Kim In Ah, Shin Kyung Hwan
Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea.
Front Oncol. 2024 May 23;14:1373434. doi: 10.3389/fonc.2024.1373434. eCollection 2024.
The European Society for Radiotherapy and Oncology-Advisory Committee in Radiation Oncology Practice (ESTRO-ACROP) updated a new target volume delineation guideline for postmastectomy radiotherapy (PMRT) after implant-based reconstruction. This study aimed to evaluate the impact on breast complications with the new guideline compared to the conventional guidelines. In total, 308 patients who underwent PMRT after tissue expander or permanent implant insertion from 2016 to 2021 were included; 184 received PMRT by the new ESTRO-ACROP target delineation (ESTRO-T), and 124 by conventional target delineation (CONV-T). The endpoints were major breast complications (infection, necrosis, dehiscence, capsular contracture, animation deformity, and rupture) requiring re-operation or re-hospitalization and any grade ≥2 breast complications. With a median follow-up of 36.4 months, the cumulative incidence rates of major breast complications at 1, 2, and 3 years were 6.6%, 10.3%, and 12.6% in the ESTRO-T group, and 9.7%, 15.4%, and 16.3% in the CONV-T group; it did not show a significant difference between the groups (p = 0.56). In multivariable analyses, target delineation is not associated with the major complications (sHR = 0.87; p = 0.77). There was no significant difference in any breast complications (3-year incidence, 18.9% vs. 23.3%, respectively; p = 0.56). Symptomatic RT-induced pneumonitis was developed in six (3.2%) and three (2.4%) patients, respectively. One local recurrence occurred in the ESTRO-T group, which was within the ESTRO-target volume. The new ESTRO-ACROP target volume guideline did not demonstrate significant differences in major or any breast complications, although it showed a tendency of reduced complication risks. As the dosimetric benefits of normal organs and comparable oncologic outcomes have been reported, further analyses with long-term follow-up are necessary to evaluate whether it could be connected to better clinical outcomes.
欧洲放射治疗与肿瘤学会放射肿瘤学实践咨询委员会（ESTRO - ACROP）更新了基于植入物重建后乳房切除术后放疗（PMRT）的新靶区勾画指南。本研究旨在评估与传统指南相比，新指南对乳房并发症的影响。总共纳入了2016年至2021年间在组织扩张器或永久性植入物植入后接受PMRT的308例患者；184例采用新的ESTRO - ACROP靶区勾画（ESTRO - T）接受PMRT，124例采用传统靶区勾画（CONV - T）接受PMRT。终点指标为需要再次手术或再次住院的严重乳房并发症（感染、坏死、裂开、包膜挛缩、动态畸形和破裂）以及任何≥2级的乳房并发症。中位随访36.4个月，ESTRO - T组1年、2年和3年严重乳房并发症的累积发生率分别为6.6%、10.3%和12.6%，CONV - T组分别为9.7%、15.4%和16.3%；两组之间未显示出显著差异（p = 0.56）。在多变量分析中，靶区勾画与严重并发症无关（标准化风险比[sHR]=0.87；p = 0.77）。任何乳房并发症均无显著差异（3年发生率分别为18.9%和23.3%；p = 0.56）。分别有6例（3.2%）和3例（2.4%）患者发生了有症状的放疗诱发肺炎。ESTRO - T组发生1例局部复发，位于ESTRO靶区内。新的ESTRO - ACROP靶区指南在严重或任何乳房并发症方面未显示出显著差异，尽管其显示出并发症风险降低的趋势。由于已报道了对正常器官的剂量学益处和相当的肿瘤学结局，因此有必要进行长期随访的进一步分析，以评估其是否能带来更好的临床结局。
