Jackson W B, Goldson A L, Staud C
Department of Radiation Oncology, Howard University Hospital, Washington, DC 20060.
J Natl Med Assoc. 1994 Jul;86(7):538-42.
Ten consecutive patients at Howard University Hospital underwent modified radical mastectomy with immediate breast reconstruction using a temporary tissue expander. Postoperative irradiation was delivered to the breast mound encompassing the tissue expander. The effects of expansion on the delivery of postoperative irradiation was assessed. Dosimetric measurements with thermoluminescent dosimeters revealed that the saline-filled expander attenuated the photon beam 3% less than tissue-equivalent material of equal volume. This dose variation was negligible, so no adjustments were made. Postoperative treatment consisted of 5040 cGy to 5220 cGy delivered in 5 to 10 weeks using 4 mV photon tangentials. Cosmesis was assessed over a 2-year period. Six patients completed reconstruction and irradiation without complications. Cosmesis was good in five and fair in one. One patient developed a moist reaction secondary to postoperative irradiation; however, final cosmesis was good. Three patients developed complications leading to the loss of the reconstructed breast. Successful final reconstruction can be achieved with careful patient selection and close follow-up by the plastic surgeon and radiation oncologist.
霍华德大学医院的连续10例患者接受了改良根治性乳房切除术，并使用临时组织扩张器立即进行乳房重建。术后放疗针对包含组织扩张器的乳房隆起部位进行。评估了扩张对术后放疗的影响。使用热释光剂量计进行的剂量测量显示，充满盐水的扩张器对光子束的衰减比等体积的组织等效材料少3%。这种剂量变化可以忽略不计，因此未进行调整。术后治疗采用4兆伏光子切线野，在5至10周内给予5040厘戈瑞至5220厘戈瑞的剂量。在两年时间内对美容效果进行了评估。6例患者完成了重建和放疗，无并发症。5例患者的美容效果良好，1例一般。1例患者术后放疗继发出现湿性反应；然而，最终美容效果良好。3例患者出现并发症，导致重建乳房丢失。通过仔细选择患者并由整形外科医生和放射肿瘤学家密切随访，可以实现成功的最终重建。
