Hunt K K, Baldwin B J, Strom E A, Ames F C, McNeese M D, Kroll S S, Singletary S E
Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
Ann Surg Oncol. 1997 Jul-Aug;4(5):377-84. doi: 10.1007/BF02305549.
Postoperative radiotherapy (PORT) has been shown to decrease locoregional failure rates in high-risk breast cancer patients following modified radical mastectomy. However, there had not been a study evaluating the effect of PORT in patients after transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction. Therefore, we evaluated flap viability, cosmetic results, and locoregional recurrence in patients who underwent TRAM flap reconstruction and PORT.
The charts of patients who had undergone modified radical mastectomy with TRAM flap reconstruction and PORT at our institution were reviewed. Patients were examined in the clinic and interviewed by telephone to evaluate their perceptions of the cosmetic result.
PORT was delivered to 19 patients with TRAM flaps (3 pedicled and 16 free flaps) between 1988 and 1994. There were no TRAM flap losses as a result of either surgical or radiotherapy complications. Two patients developed fat necrosis, one with a pedicled and one with a free TRAM flap. Patients with pedicled TRAM flaps noted more volume loss in the breast after radiation therapy. Eighty-four percent of patients felt their overall cosmetic result was excellent or good; only one patient reported a poor cosmetic result. Local control was achieved in three of the four patients who received PORT for local recurrence. There was only one local recurrence among the 14 patients who received PORT because they were at high risk of local recurrence.
These results suggest that PORT can be given safely to high-risk patients following TRAM flap breast reconstruction with excellent cosmetic results and good locoregional control.
术后放疗（PORT）已被证明可降低高危乳腺癌患者改良根治术后的局部区域复发率。然而，此前尚无研究评估PORT对横行腹直肌肌皮瓣（TRAM瓣）乳房重建术后患者的影响。因此，我们评估了接受TRAM瓣重建和PORT的患者的皮瓣存活情况、美容效果及局部区域复发情况。
回顾了在我们机构接受改良根治术加TRAM瓣重建及PORT的患者病历。在门诊对患者进行检查，并通过电话访谈评估他们对美容效果的看法。
1988年至1994年间，对19例接受TRAM瓣（3例带蒂瓣和16例游离瓣）的患者进行了PORT治疗。未因手术或放疗并发症导致TRAM瓣丢失。2例患者出现脂肪坏死，1例为带蒂TRAM瓣，1例为游离TRAM瓣。带蒂TRAM瓣的患者放疗后乳房体积缩小更明显。84%的患者认为其整体美容效果为优或良；只有1例患者报告美容效果差。接受PORT治疗局部复发的4例患者中有3例实现了局部控制。在因局部复发风险高而接受PORT治疗的14例患者中，仅出现1例局部复发。
这些结果表明PORT可安全应用于TRAM瓣乳房重建后的高危患者，美容效果良好，局部区域控制佳。
