Piroth M D, Krug D, Baumann R, Strnad V, Borm K, Combs S, Corradini S, Duma M N, Dunst J, Fastner G, Feyer P, Fietkau R, Harms W, Hehr T, Hörner-Rieber J, Matuschek C, Schmeel C, Budach W
Department of Radiation Oncology, HELIOS University Hospital Wuppertal, Witten/Herdecke University, Heusnerstraße 40, 42283, Wuppertal, Germany.
Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Strahlenther Onkol. 2025 Apr;201(4):353-367. doi: 10.1007/s00066-024-02334-3. Epub 2025 Jan 9.
The aim of this review is to give an overview of the results of prospective and retrospective studies using allogenic reconstruction and postmastectomy radiotherapy (PMRT) in breast cancer and to make recommendations regarding this interdisciplinary approach.
A PubMed search was conducted to extract relevant articles from 2000 to 2024. The search was performed using the following terms: (breast cancer) AND (reconstruction OR implant OR expander) AND (radiotherapy OR radiation). Data from the literature on allogenic breast reconstruction and radiation are presented and discussed in relation to toxicity and cosmesis.
Breast reconstruction is also feasible if PMRT is necessary. Patients need to be informed about the relevant risk of capsular fibrosis and implant failure. A planned reconstruction is no reason to forgo PMRT nor is an indication for PMRT a reason to forego implant-based breast reconstruction if desired by the patient. It is important to provide detailed information here to enable shared decision-making. There is still no clear consensus regarding implant-based reconstruction (IBR) and PMRT. However, in clinical practice, both a one-stage (immediate "implant-direct" IBR) procedure with PMRT up to the final implant and a two-stage (immediate-delayed IBR) procedure with PMRT up to the tissue expander (TE) and later exchange of the TE are used; both approaches have their specific advantages and disadvantages. Depending on patient-specific factors and the surgeon's experience and estimates, both IBR procedures are also possible in combination with PMRT. When using a TE/implant approach, completing skin stretching by adequately filling the expander before PMRT may be favorable. This approach is particularly practical when adjuvant chemotherapy is planned but may lead to postponement of radiotherapy when primary systemic therapy is given. According to the latest data, moderate hypofractionation also appears to be safe in the context of the IBR approach. It is important to have a closely coordinated interdisciplinary approach and to fully inform patients about the increased rate of potential side effects.
本综述旨在概述乳腺癌中使用同种异体乳房重建和乳房切除术后放疗（PMRT）的前瞻性和回顾性研究结果，并就这种多学科方法提出建议。
进行PubMed检索，以提取2000年至2024年的相关文章。检索使用以下术语：（乳腺癌）AND（重建或植入物或扩张器）AND（放疗或放射）。呈现并讨论了文献中关于同种异体乳房重建和放疗的数据，涉及毒性和美容效果。
如果有必要进行PMRT，乳房重建也是可行的。需要告知患者包膜纤维化和植入物失败的相关风险。计划性重建并非放弃PMRT的理由，若患者希望进行基于植入物的乳房重建，PMRT的指征也不是放弃该重建的理由。在此提供详细信息以实现共同决策很重要。关于基于植入物的重建（IBR）和PMRT仍未达成明确共识。然而，在临床实践中，既使用在最终植入物之前进行PMRT的一期（即刻“植入物直接”IBR）手术，也使用在组织扩张器（TE）之前进行PMRT并随后更换TE的二期（即刻 - 延迟IBR）手术；两种方法都有其特定的优缺点。根据患者的具体因素以及外科医生的经验和评估，两种IBR手术也都可以与PMRT联合使用。当使用TE/植入物方法时，在PMRT之前通过充分填充扩张器来完成皮肤拉伸可能是有利的。当计划进行辅助化疗时，这种方法特别实用，但在进行一线全身治疗时可能会导致放疗推迟。根据最新数据，在IBR方法的背景下，适度的低分割放疗似乎也是安全的。密切协调的多学科方法很重要，并且要让患者充分了解潜在副作用增加的情况。
