Interplay of Oncoplastic Reconstruction and Adjuvant Radiation Therapy in Breast Cancer.
Interplay of Oncoplastic Reconstruction and Adjuvant Radiation Therapy in Breast Cancer.
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乳腺癌肿瘤整形重建与辅助放射治疗的相互作用。
DOI：
10.1016/j.adro.2023.101403
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发表时间：
2024
影响因子：
2.3
通讯作者：
Mitchell,MelissaP
中科院分区：
文献类型：
--
作者：
Morse,RyanT;Moreno,Matthew;Butterworth,JamesA;Mitchell,MelissaP
目的乳房肿瘤整形手术（OBS）是在保乳手术的同时将乳腺癌肿瘤切除与整形手术的美容效果结合起来的一种手术。OBS的潜在优势包括肿瘤床周围更宽的手术边缘，同时比标准的乳房肿瘤切除术更能保持乳房的自然形状和外观。然而，关于辅助放射治疗计划的潜在影响的信息有限。材料与方法回顾性分析2014 - 2019年行乳房肿瘤切除术并立即行OBS和辅助放射治疗的局限性乳腺癌患者。采用体积置换技术进行OBS，患者接受全乳三维适形放射治疗。结果术中切除的同侧乳腺组织体积为21 ~ 2086 cm3（中位数为304 cm3）， 29%的患者切除的组织为50 ~ 500 cm3。12.5%的手术边缘呈阳性，不受切除乳腺组织体积的影响（445对439 cm3）。使用手术夹的患者更常接受乳房肿瘤切除术床上的提升（75.9% vs 50.0%），有夹子的患者平均提升量为157 cm3，而没有夹子的患者平均提升量为205 cm3。切除bbb500 cm3的患者的平均V105与切除>1000 cm3的患者相当，而切除>26 cm的患者的绝对体积更高（58.0 cm3vs 102.7 cm3；P= .07）。对于>6 cm后分离、>500 cm3乳腺组织切除或>1000 cm3乳腺体积的患者，Dmax或辐射覆盖率（95%的体积接受95%的处方剂量）无显著差异。结论肿瘤整形手术患者的放射剂量计划是可接受的，切除较多组织的患者没有明显的放射或手术优势。我们的研究强调外科医生和放射肿瘤学家之间关于充分标记乳房肿瘤切除腔的明确沟通的重要性，采用尽量减少重新切除的需要和尽量减少重排过程中乳房肿瘤切除腔的破坏的做法。
PurposeOncoplastic breast surgery (OBS) combines breast cancer tumor removal with the cosmetic benefits of plastic surgery at the time of breast-conserving surgery. Potential advantages of OBS include wider surgical margins around the tumor bed, while the natural shape and appearance of the breast are maintained more than standard lumpectomy procedures. However, limited information is available regarding the potential effect on adjuvant radiation treatment planning.Materials and MethodsWomen with localized breast cancer undergoing lumpectomy with immediate OBS and adjuvant radiation therapy between 2014 and 2019 were reviewed. OBS was performed using volume displacement techniques and patients received whole-breast irradiation with 3-dimensional conformal radiation therapy.ResultsVolume of additional ipsilateral breast tissue removed during OBS ranged from 21 to 2086 cm3(median, 304 cm3), 29% of patients had >500 cm3of tissue removed. Surgical margins were positive in 12.5% and were not affected by volume of breast tissue removed (445 vs 439 cm3). Patients with surgical clips more often received a lumpectomy bed boost (75.9% vs 50.0%), boost volumes were on average 157 cm3with clips versus 205 cm3without clips. Mean V105 was comparable in patients with >500 cm3tissue removed and irradiated breast volume >1000 cm3, while higher absolute volumes were found in patients with >26 cm posterior separation (58.0 cm3vs 102.7 cm3;P= .07). No meaningful difference was observed in Dmax or radiation coverage (95% of the volume receiving 95% of the prescription dose) for patients with >26 cm posterior separation, >500 cm3of breast tissue removed, or irradiated breast volume >1000 cm3.ConclusionsRadiation dosimetry plans for patients undergoing oncoplastic surgery were acceptable and no significant radiation or surgical advantage was gained in patients with more tissue removed. Our study stresses the importance of clear communication between surgeons and radiation oncologists about sufficient marking of the lumpectomy cavity, using practices that minimize the need for re-excisions and minimize lumpectomy cavity disruption during rearrangement.