硅胶假体隆乳后乳腺癌保乳术后放射治疗疗效评估
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摘要
目的随着隆胸人群的不断增加,假体隆胸后乳腺癌患者不鲜见,保留假体对保乳术后放疗有何影响是医患共同关心的问题。本研究通过有无假体乳腺癌保乳术后调强放疗剂量学对比,探讨放疗对假体隆乳后乳腺癌保乳术后的影响。方法对大连市中心医院放疗科2010-04-10-2016-05-20就诊的276例早期乳腺癌保乳术后调强放疗患者临床资料进行回顾性分析,其中隆乳后保留假体保乳患者17例,在常规保乳(无假体)病例中选取与假体保乳组临床分期、肿瘤部位相同,乳腺体积相当的患者34例进行对比分析,比较假体保乳组与常规保乳组术后放疗剂量学参数、放疗反应及放疗后乳房美容学评定的差异。结果假体保乳组与常规保乳组靶区剂量学参数比较,D2分别为(62.38±0.67)和(62.51±0.76)Gy,D98分别为(47.19±0.56)和(46.59±0.53)Gy,Dmean分别为(50.80±0.66)和(50.53±0.76)Gy,V95分别为(98.49±0.92)%和(98.16±1.09)%,V105分别为(36.12±0.83)%和(35.84±0.65)%,V110值分别为(16.66±0.47)%和(16.89±0.72)%,差异无统计学意义,均P>0.05;假体保乳组与常规保乳组患侧肺危及器官(organ at risks,OARs)剂量学参数比较,V5分别为(42.98±0.93)%和(42.67±0.78)%,V10分别为(25.85±0.88)%和(26.10±0.89)%,V15分别为(21.12±0.72)%和(21.66±1.07)%,V20分别为(17.72±0.67)%和(17.35±0.67)%,V30分别为(13.39±1.07)%和(12.92±0.64)%,差异无统计学意义,均P>0.05,但假体保乳组患侧肺V40(5.63±0.67)%小于常规保乳组(6.76±0.57)%,差异有统计学意义,P<0.001;假体保乳组(n=11)与常规保乳组(n=22)心脏剂量学比较,V5分别为(16.08±0.86)%和(16.52±0.74)%,V10分别为(8.30±0.73)%和(8.65±0.35)%,V15值分别为(4.52±0.27)%和(4.72±0.26)%,差异无统计学意义,均P>0.05,但V20分别为(2.41±0.18)%和(2.62±0.10)%,V30分别为(1.47±0.13)%和(1.70±0.11)%,V40分别为(0.52±0.23)%和(0.96±0.12)%,差异有统计学意义,均P<0.05;假体保乳组1～2级血液学急性毒性反应发生率为47%,常规保乳组为52.9%,差异无统计学意义,P>0.05;假体保乳组和常规保乳组急性毒性反应发生率比较,1级分别为64.7%和61.7%,2级分别为35.3%和38.2%,差异无统计学意义,均P>0.05;假体保乳组美容效果满意度为82.3%,常规保乳组为79.4%,差异无统计学意义,P>0.05;随访期间保留假体患者未发生乳房变形、假体破裂及移位。结论目前临床资料显示,保留假体不影响保乳术后调强放疗质量,未增加放射反应发生率。
OBJECTIVE Accompany with the population increase of breast augmentation,patients of breast cancer whose tumor occurs after prosthesis implantation are not rare,whether prothesis retention can affect the radiotherapy after breast-conserving surgery is getting more and more attention from doctors and patients.This study investigated and compared the dosimetry of breast cancer patients with prosthesis or without,who treated with intensity modulated radiotherapy after breast sparing surgery,in order to probe the effect of radiotherapy on breast cancer after augmentation mammaplasty.METHODS A total of 276 patients with early breast cancer after breast conserving surgery treated by IMRT were retrospectively analyzed in Dalian Central Hospital from April 10,2010 to May 20,2016.Seventeen prosthetic breast-conserving patients and 34 routine breast-conserving patients with the same clinical stage,tumor location and breast volume were selected for comparative analysis.The differences of dosimetric parameters,radiotherapy response and cosmetic evaluation of breast between prosthesis breast-conserving group and routine breast-conserving group were compared.RESULTS Compared with the target dose parameters between prosthetic breast-conserving group and conventional breastconserving group,D2 was(62.38±0.67)and(62.51±0.76)Gy,D98 was(47.19±0.56)and(46.59±0.53)Gy,Dmean was(50.80±0.66)and(50.53±0.76)Gy,V95 was(98.49±0.92)%and(98.16±1.09)%,V105 was(36.12±0.83)%and(35.84±0.65)%,V110 was(16.66±0.47)%and(16.89±0.72)%respectively,there was no statistically significant difference(all P>0.05).Compared with the dosimetry parameters of organ at risk(OARs)of sick lung between prosthetic breast-conserving group and conventional breast-conserving group,V5 was(42.98±0.93)%and(42.67±0.78)%,V10 was(25.85±0.88)% and(26.10±0.89)%,V15 was(21.12±0.72)% and(21.66±1.07)%,V20 was(17.72±0.67)% and(17.35±0.67)%,V30 was(13.39±1.07)% and(12.92±0.64)%,there was no statistically significant difference(all P>0.05),but the V40 in prosthetic breast-conserving group(5.63±0.67)% was lower than that in conventional breast-conserving group(6.76±0.57)%,the difference was statistically significant,(P<0.05).Compared with the dosimetry parameters of heart between prosthetic breast-conserving group and conventional breast-conserving group,V5 was(16.08±0.86)%and(16.52±0.74)%,V10 was(8.30±0.73)%and(8.65±0.35)%,V15 was(4.52±0.27)%and(4.72±0.26)%,there was no statistically significant difference(all P>0.05),but V20 was(2.41±0.18)% and(2.62±0.10)%,V30 was(1.47±0.13)% and(1.70±0.11)%,V40 was(0.52±0.23)% and(0.96±0.12)%,the difference was statistically significant(all P<0.05).The incidence of acute hematological toxicity was 47%in prosthesis breast-conserving group and 52.9%in routine breast-conserving group.There was no significant difference,(P>0.05).Compare with the incidence of acute toxicity between prosthetic breast-conserving group and conventional breast-conserving group,grade 1 was 64.7%and 61.7%,grade 2 was 35.3%and 38.2%respectively,there was no statistically significant difference(all P>0.05).The satisfaction rate of cosmetic effect of prosthesis breast-conserving group was 82.3%,and that of conventional breast-conserving group was 79.4%.There was no significant difference(P>0.05).No breast deformation,prosthesis rupture or displacement occurred in the patients who retained the prosthesis during follow-up.CONCLUSION The current clinical data showed that the retention of the prosthesis did not affect the quality of intensity modulated radiotherapy after breast-conserving surgery,and did not increase the incidence of radiation response in short-term.
OBJECTIVE Accompany with the population increase of breast augmentation,patients of breast cancer whose tumor occurs after prosthesis implantation are not rare,whether prothesis retention can affect the radiotherapy after breast-conserving surgery is getting more and more attention from doctors and patients.This study investigated and compared the dosimetry of breast cancer patients with prosthesis or without,who treated with intensity modulated radiotherapy after breast sparing surgery,in order to probe the effect of radiotherapy on breast cancer after augmentation mammaplasty.METHODS A total of 276 patients with early breast cancer after breast conserving surgery treated by IMRT were retrospectively analyzed in Dalian Central Hospital from April 10,2010 to May 20,2016.Seventeen prosthetic breast-conserving patients and 34 routine breast-conserving patients with the same clinical stage,tumor location and breast volume were selected for comparative analysis.The differences of dosimetric parameters,radiotherapy response and cosmetic evaluation of breast between prosthesis breast-conserving group and routine breast-conserving group were compared.RESULTS Compared with the target dose parameters between prosthetic breast-conserving group and conventional breastconserving group,D2 was(62.38±0.67)and(62.51±0.76)Gy,D98 was(47.19±0.56)and(46.59±0.53)Gy,Dmean was(50.80±0.66)and(50.53±0.76)Gy,V95 was(98.49±0.92)%and(98.16±1.09)%,V105 was(36.12±0.83)%and(35.84±0.65)%,V110 was(16.66±0.47)%and(16.89±0.72)%respectively,there was no statistically significant difference(all P>0.05).Compared with the dosimetry parameters of organ at risk(OARs)of sick lung between prosthetic breast-conserving group and conventional breast-conserving group,V5 was(42.98±0.93)%and(42.67±0.78)%,V10 was(25.85±0.88)% and(26.10±0.89)%,V15 was(21.12±0.72)% and(21.66±1.07)%,V20 was(17.72±0.67)% and(17.35±0.67)%,V30 was(13.39±1.07)% and(12.92±0.64)%,there was no statistically significant difference(all P>0.05),but the V40 in prosthetic breast-conserving group(5.63±0.67)% was lower than that in conventional breast-conserving group(6.76±0.57)%,the difference was statistically significant,(P<0.05).Compared with the dosimetry parameters of heart between prosthetic breast-conserving group and conventional breast-conserving group,V5 was(16.08±0.86)%and(16.52±0.74)%,V10 was(8.30±0.73)%and(8.65±0.35)%,V15 was(4.52±0.27)%and(4.72±0.26)%,there was no statistically significant difference(all P>0.05),but V20 was(2.41±0.18)% and(2.62±0.10)%,V30 was(1.47±0.13)% and(1.70±0.11)%,V40 was(0.52±0.23)% and(0.96±0.12)%,the difference was statistically significant(all P<0.05).The incidence of acute hematological toxicity was 47%in prosthesis breast-conserving group and 52.9%in routine breast-conserving group.There was no significant difference,(P>0.05).Compare with the incidence of acute toxicity between prosthetic breast-conserving group and conventional breast-conserving group,grade 1 was 64.7%and 61.7%,grade 2 was 35.3%and 38.2%respectively,there was no statistically significant difference(all P>0.05).The satisfaction rate of cosmetic effect of prosthesis breast-conserving group was 82.3%,and that of conventional breast-conserving group was 79.4%.There was no significant difference(P>0.05).No breast deformation,prosthesis rupture or displacement occurred in the patients who retained the prosthesis during follow-up.CONCLUSION The current clinical data showed that the retention of the prosthesis did not affect the quality of intensity modulated radiotherapy after breast-conserving surgery,and did not increase the incidence of radiation response in short-term.
引文
[1]王婷,祝东升.乳房术后美容效果评价内容的研究[J].中国美容整形外科杂志,2017,28(8):475-476.
[2]周琼,陈维军,王奇,等.基于RTOG 1005早期乳腺癌调强多目标优化计划和单项目标优化计划比较[J].中国医学物理学杂志,2017,10(34):993-998.
[3]刁先民.早期乳腺癌保乳术后放疗美容效果及心理状况分析[J].中国继续医学教育,2015,7(5):65-66.
[4]杨晓萍,陈俐君,刘光耀,等.硅凝胶乳房植入的MRI评价[J].中华乳腺病杂志,2016,10(2):115-117.
[5]何益腾,宋牧,陈晶,等.硅凝胶假体植入乳房重建[J].中国组织工程研究,2015,19(3):455-459.
[6]Strlman K,Mollerup CL,Kristoffersen US,et al.Long-term outcome after mastectomy with immdediate breast reconstruction[J].Acta Oncol,2008,47(4):704-708.
[7]刘金涛,郭文斌.Ⅰ期假体植入乳房重建在乳腺癌术后的临床应用分析[J].中国妇幼健康研究,2017,28(11):1473-1475.
[8]Patel NR,Cordeiro P,Gelblum D,et al.Bilateral breast inplants do not compromise the delivery of postmastectomy radiation[J].Int J Radiat Oncol Biol Phys,2010,78(3):3-4.
[9]孙立,朱玉兰.乳腺癌改良根治术后即刻乳房重建后放疗的临床效果分析[J].中国继续医学发展,2015,7(32):87-89.
[10]Baschnagel AM,Shah C,Wilkinson JB,et al.Failuer rate and cosmesis of immediate tissue expander/implant breast reconstruction after postmastectomy irradiation[J].Clin Breast Cancer,2012,12(6):428-432.
[11]Chetta MD,Allu O,Zhong L,et al.Reconstruction of the irradiated breast a national claims-based asessment of postoperative morbidity[J].Plast Reconstr Surg,2017,139(4):783-792.
[12]He S,Yin J,Robb GL,et al.Considering the optimaltiming of breast reconstruction with abdominal flaps with adjuvant irradiation in 370 consecutive pedicled transverse rectus abdominis myocutaneous flap and free deep inferior epigastric perforator flap perorment in a Chinese oncology center is there a significant difference between immediate and delayed?[J].Ann Plast Surg,2017,78(6):633-640.
[13]Reely S,Patani N,Anderson A,et al.Oncological outcome and patient satisfaction with skin-sparing mastectomy and immediate breast reconstruction:aprospective observationl study[J].BMCCancer,2010,10:171.
[14]王志刚,张诚,郁培颖,等.大体积假体隆乳术的临床效果观察[J].中国美容医学,2016,25(11):15-18.
[15]Quaha O,Quaha A.PIP silicone breast implants:ruptrue rates based on the explantation of 676implants in a single surgeon series[J].J Plast Reconstr Aesthet Surg,2013,66(9):1182-1187.
[2]周琼,陈维军,王奇,等.基于RTOG 1005早期乳腺癌调强多目标优化计划和单项目标优化计划比较[J].中国医学物理学杂志,2017,10(34):993-998.
[3]刁先民.早期乳腺癌保乳术后放疗美容效果及心理状况分析[J].中国继续医学教育,2015,7(5):65-66.
[4]杨晓萍,陈俐君,刘光耀,等.硅凝胶乳房植入的MRI评价[J].中华乳腺病杂志,2016,10(2):115-117.
[5]何益腾,宋牧,陈晶,等.硅凝胶假体植入乳房重建[J].中国组织工程研究,2015,19(3):455-459.
[6]Strlman K,Mollerup CL,Kristoffersen US,et al.Long-term outcome after mastectomy with immdediate breast reconstruction[J].Acta Oncol,2008,47(4):704-708.
[7]刘金涛,郭文斌.Ⅰ期假体植入乳房重建在乳腺癌术后的临床应用分析[J].中国妇幼健康研究,2017,28(11):1473-1475.
[8]Patel NR,Cordeiro P,Gelblum D,et al.Bilateral breast inplants do not compromise the delivery of postmastectomy radiation[J].Int J Radiat Oncol Biol Phys,2010,78(3):3-4.
[9]孙立,朱玉兰.乳腺癌改良根治术后即刻乳房重建后放疗的临床效果分析[J].中国继续医学发展,2015,7(32):87-89.
[10]Baschnagel AM,Shah C,Wilkinson JB,et al.Failuer rate and cosmesis of immediate tissue expander/implant breast reconstruction after postmastectomy irradiation[J].Clin Breast Cancer,2012,12(6):428-432.
[11]Chetta MD,Allu O,Zhong L,et al.Reconstruction of the irradiated breast a national claims-based asessment of postoperative morbidity[J].Plast Reconstr Surg,2017,139(4):783-792.
[12]He S,Yin J,Robb GL,et al.Considering the optimaltiming of breast reconstruction with abdominal flaps with adjuvant irradiation in 370 consecutive pedicled transverse rectus abdominis myocutaneous flap and free deep inferior epigastric perforator flap perorment in a Chinese oncology center is there a significant difference between immediate and delayed?[J].Ann Plast Surg,2017,78(6):633-640.
[13]Reely S,Patani N,Anderson A,et al.Oncological outcome and patient satisfaction with skin-sparing mastectomy and immediate breast reconstruction:aprospective observationl study[J].BMCCancer,2010,10:171.
[14]王志刚,张诚,郁培颖,等.大体积假体隆乳术的临床效果观察[J].中国美容医学,2016,25(11):15-18.
[15]Quaha O,Quaha A.PIP silicone breast implants:ruptrue rates based on the explantation of 676implants in a single surgeon series[J].J Plast Reconstr Aesthet Surg,2013,66(9):1182-1187.