Yu Stephanie Wing Yin, Ho Chiu Ming, Kwok Carol, Soong Inda, Li Lawrence Pui Ki, Choi Peter Ho Keung, Yau Chun Chung, Kwan Wing Hong, Cheung Polly Suk Yee
Department of Surgery, Queen Mary Hospital, 102 Pokfulam Road, Pok Fu Lam, Hong Kong Special Administrative Region.
Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong Special Administrative Region.
Eur J Surg Oncol. 2025 Aug;51(8):110110. doi: 10.1016/j.ejso.2025.110110. Epub 2025 Apr 29.
Radiotherapy (RT) is typically administered as adjuvant therapy for breast cancer patients with high risk of locoregional recurrence. However, for patients receiving mastectomy and autologous tissue immediate breast reconstruction (IBR), RT to the neobreast is associated with higher complication rates and poorer esthetics. Administering preoperative RT before mastectomy and autologous tissue reconstruction may be an alternative therapeutic sequence to improve patient outcomes.
Patients with invasive breast carcinoma treated with therapeutic-dose RT before receiving mastectomy and autologous tissue IBR (pedicled transverse rectus abdominis myocutaneous flap or latissimus dorsi flap) were identified from a single high-volume breast clinic in Hong Kong. Propensity score matching was done to select an equal number of patients who received RT after mastectomy and autologous tissue IBR. Clinical records of each patient were then retrospectively reviewed.
50 patients (25 in the preoperative RT arm, and 25 in the postoperative RT arm) were included in this study. Minor complications occurred in similar frequencies between patients who received preoperative RT and postoperative RT. However, pigmentation occurred significantly more frequently in patients who received post-autologous reconstruction RT. There were no instances of flap failure in either arm. Rates of disease recurrence (p = 0.48) and death (p = 0.30) between the two arms were not significantly different.
Preoperative RT before mastectomy and autologous tissue IBR is safe and feasible, and has the potential to reduce RT-related complications on autologous flaps without compromising oncological safety in a select group of patients.
放射治疗（RT）通常作为局部区域复发风险高的乳腺癌患者的辅助治疗。然而，对于接受乳房切除术和自体组织即刻乳房重建（IBR）的患者，对新乳房进行放疗会导致更高的并发症发生率和更差的美学效果。在乳房切除术和自体组织重建前进行术前放疗可能是一种改善患者预后的替代治疗顺序。
从香港一家大型乳房诊所中识别出在接受乳房切除术和自体组织IBR（带蒂腹直肌肌皮瓣或背阔肌皮瓣）之前接受治疗剂量放疗的浸润性乳腺癌患者。进行倾向评分匹配以选择相同数量的在乳房切除术和自体组织IBR后接受放疗的患者。然后对每位患者的临床记录进行回顾性审查。
本研究纳入了50名患者（术前放疗组25名，术后放疗组25名）。术前放疗组和术后放疗组患者出现轻微并发症的频率相似。然而，自体组织重建后放疗的患者色素沉着明显更频繁。两组均未出现皮瓣坏死情况。两组之间的疾病复发率（p = 0.48）和死亡率（p = 0.30）无显著差异。
乳房切除术和自体组织IBR前的术前放疗是安全可行的，并且有可能在不影响特定患者群体肿瘤学安全性的情况下减少自体皮瓣相关的放疗并发症。
