Department of Plastic Surgery, Royal Marsden Hospital, The Royal Marsden Hospital NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, United Kingdom.
Imperial College Healthcare NHS Trust, Department of Breast Surgery, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, United Kingdom.
J Plast Reconstr Aesthet Surg. 2024 Sep;96:242-253. doi: 10.1016/j.bjps.2024.07.022. Epub 2024 Jul 15.
Pre-operative radiotherapy (PRT) and pre-operative chemoradiotherapy (PCRT) prior to mastectomy and immediate breast reconstruction for locally advanced breast cancer have the potential to reduce radiation late-effects and expedite oncologic treatment. Recent feasibility work indicates that PCRT is safe and technically possible. Here, we present a systematic review of currently available data on clinical, oncological, reconstructive and aesthetic outcomes.
A prospectively registered search of Medline (Ovid), EMBASE (Ovid), EMCARE (Ovid) and CINAHL (EBSCO) databases was performed in August 2023. Clinical, oncological, reconstructive and aesthetic outcomes were appraised with risk of bias (ROBINS-I) and methodological quality determined (STROBE checklist) for each study.
Twenty-two published articles (19 journal articles and 3 abstracts) were identified reporting the outcomes of 1258 patients with median follow-up between 19.0-212.4 months. Patients received neoadjuvant chemotherapy in 20 studies. Rates of locoregional recurrence and overall survival ranged between 0-21.7% and 82.0%-98.3% respectively. Rates of flap loss or necrosis ranged from 0-7.6%. Rates of revisional procedures ranged between 1.9-35.3%. Patient-reported outcomes were reported in 7 studies and were mostly 'good' or 'excellent'.
PRT and PCRT preceding mastectomy and breast reconstruction produce acceptable oncological outcomes with rates of surgical complication and reconstructive outcomes within normal limits, however, the majority of available studies are of low methodological quality and at high risk of bias. A pragmatic randomised trial comparing PRT versus PMRT in the setting of breast reconstruction is now urgently required to guide surgical practice.
术前放疗（PRT）和术前放化疗（PCRT）在局部晚期乳腺癌行乳房切除术和即刻乳房重建之前具有降低放射后效应和加快肿瘤治疗的潜力。最近的可行性研究表明，PCRT 是安全且在技术上可行的。在这里，我们对目前关于临床、肿瘤学、重建和美学结果的可用数据进行了系统回顾。
我们于 2023 年 8 月在 Medline（Ovid）、EMBASE（Ovid）、EMCARE（Ovid）和 CINAHL（EBSCO）数据库中进行了前瞻性注册搜索。对每个研究的临床、肿瘤学、重建和美学结果进行了风险评估（ROBINS-I）和方法学质量评估（STROBE 清单）。
确定了 22 篇已发表的文章（19 篇期刊文章和 3 篇摘要），报道了 1258 例患者的结果，中位随访时间为 19.0-212.4 个月。20 项研究中患者接受了新辅助化疗。局部区域复发和总生存率的发生率分别在 0-21.7%和 82.0%-98.3%之间。皮瓣坏死或坏死的发生率为 0-7.6%。再次手术的发生率在 1.9-35.3%之间。7 项研究报告了患者报告的结果，大多为“良好”或“优秀”。
PRT 和 PCRT 在前乳房切除术和乳房重建之前进行，产生了可接受的肿瘤学结果，手术并发症和重建结果的发生率在正常范围内，但大多数可用的研究方法质量较低，存在较高的偏倚风险。现在迫切需要进行一项比较 PRT 与 PMRT 在乳房重建背景下的实用性随机试验，以指导手术实践。
