Abstract： The increasing need for ideal body shape makes more and more patients choose to receive different types of breast reconstruction surgery after mastectomy. Right now, it is a key problem for the multidisciplinary treatment to find an optimal sequence of comprehensive treatment from which those patients can receive the maximum benefits and a good balance between ideal body shape and satisfactory antitumor outcomes. This paper reviews the latest research advances in the effect of postoperative radiotherapy on breast shape after breast reconstruction, the sequential relationship between the replacement of the temporary tissue expander with the permanent breast prosthesis and postoperative radiotherapy, breast construction surgery, and radiotherapy techniques. To provide a basis for clinical practice, this paper proposes a flow chart for decision-making in reconstruction surgery and adjuvant treatment based on the current literature and clinical data.
Cao Lu,Chen Jiayi. Research advances in radiotherapy after mastectomy combined with phase I breast reconstruction for invasive breast cancer[J]. Chinese Journal of Radiation Oncology, 2016, 25(10): 1125-1129.
[1] Early Breast Cancer Trialists′ Collaborative Group. Favourable and unfavourable effects on long-term survival of radiotherapy for early breast cancer:an overview of the randomised trials[J].Lancet,2000,355(9217):1757-1770.DOI:10.1016/S0140-6736(00)02263-7. [2] Early Breast Cancer Trialists′ Collaborative Group (EBCTCG).Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival:an overview of the randomised trials[J].Lancet,2005,366(9503):2087-2106.DOI:10.1016/S0140-6736(05)67887-7. [3] EBCTCG (Early Breast Cancer Trialists′ Collaborative Group).Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality:meta-analysis of individual patient data for 8135 women in 22 randomised trials[J].Lancet,2014,383(9935):2127-2135.DOI:10.1016/S0140-6736(14)60488-8. [4] Pomahac B,Recht A,May JW,et al. New trends in breast cancer management:is the era of immediate breast reconstruction changing?[J].Ann Surg,2006,244(2):282-288.DOI:10.1097/01.sla.0000217626.88430.c3. [5] Spear SL,Baker JL Jr. Classification of capsular contracture after prosthetic breast reconstruction[J].Plast Reconstr Surg,1995,96(5):1119-1123.DOI:10.1097/00006534-199510000-00018. [6] Spear SL,Onyewu C.Staged breast reconstruction with saline-filled implants in the irradiated breast:recent trends and therapeutic implications[J].Plast Reconstr Surg,2000,105(3):930-942.DOI:10.1097/00006534-200003000-00016. [7] Krueger EA,Wilkins EG,Strawderman M,et al. Complications and patient satisfaction following expander/implant breast reconstruction with and without radiotherapy[J].Int J Radiat Oncol Biol Phys,2001,49(3):713-721.DOI:10.1016/S0360-3016(00)01402-4. [8] Wright JL,Cordeiro PG,Ben-Porat L,et al. Mastectomy with immediate expander-implant reconstruction,adjuvant chemotherapy,and radiation for stage Ⅱ-Ⅲ breast cancer:treatment intervals and clinical outcomes[J].Int J Radiat Oncol Biol Phys,2008,70(1):43-50.DOI:10.1016/j.ijrobp.2007.05.032. [9] Jhaveri JD,Rush SC,Kostroff K,et al. Clinical outcomes of postmastectomy radiation therapy after immediate breast reconstruction[J].Int J Radiat Oncol Biol Phys,2008,72(3):859-865.DOI:10.1016/j.ijrobp.2008.01.055. [10] McKeown DJ,Hogg FJ,Brown IM,et al. The timing of autologous latissimus dorsi breast reconstruction and effect of radiotherapy on outcome[J].J Plast Reconstr Aesthet Surg,2009,62(4):488-493.DOI:10.1016/j.bjps.2007.11.046. [11] Foster RD,Hansen SL,Esserman LJ,et al. Safety of immediate transverse rectus abdominis myocutaneous breast reconstruction for patients with locally advanced disease[J].Arch Surg,2005,140(2):196-200.DOI:10.1001/archsurg.140.2.196. [12] Gouy S,Rouzier R,Missana MC,et al. Immediate reconstruction after neoadjuvant chemotherapy:effect on adjuvant treatment starting and survival[J].Ann Surg Oncol,2005,12(2):161-166.DOI:10.1245/ASO.2005.04.003. [13] Recht A,Edge SB,Solin LJ,et al. Postmastectomy radiotherapy:clinical practice guidelines of the American Society of Clinical Oncology[J].J Clin Oncol,2001,19(5):1539-1569. [14] Anderson PR,Freedman G,Nicolaou N,et al. Postmastectomy chest wall radiation to a temporary tissue expander or permanent breast implant-is there a difference in complication rates?[J].Int J Radiat Oncol Biol Phys,2009,74(1):81-85.DOI:10.1016/j.ijrobp.2008.06.1940. [15] Cordeiro PG,Albornoz CR,McCormick B,et al. The impact of postmastectomy radiotherapy on two-stage implant breast reconstruction:an analysis of long-term surgical outcomes,aesthetic results,and satisfaction over 13 years[J].Plast Reconstr Surg,2014,134(4):588-595.DOI:10.1097/PRS.0000000000000523. [16] Carlson GW. Discussion:postmastectomy radiation therapy after immediate two-stage tissue expander/implant breast reconstruction:a University of British Columbia perspective[J].Plast Reconstr Surg,2014,134(1):11e-12e. DOI:10.1097/PRS.0000000000000306. [17] Kronowitz SJ.Delayed-immediate breast reconstruction:technical and timing considerations[J].Plast Reconstr Surg,2010,125(2):463-474.DOI:10.1097/PRS.0b013e3181c82 d58. [18] Brooks S,Djohan R,Tendulkar R,et al. Risk factors for complications of radiation therapy on tissue expander breast reconstructions[J].Breast J,2012,18(1):28-34.DOI:10.1111/j.1524-4741.2011.01182.x. [19] Lam TC,Hsieh F,Boyages J.The effects of postmastectomy adjuvant radiotherapy on immediate two-stage prosthetic breast reconstruction:a systematic review[J].Plast Reconstr Surg,2013,132(3):511-518.DOI:10.1097/PRS.0b013e31829acc41. [20] Berbers J,van Baardwijk A,Houben R,et al.′Reconstruction:before or after postmastectomy radiotherapy？′ A systematic review of the literature[J].Eur J Cancer,2014,50(16):2752-2762.DOI:10.1016/j.ejca.2014.07.023. [21] Chung E,Marsh RB,Griffith KA,et al. Quantifying dose to the reconstructed breast:can we adequately treat?[J].Med Dosim,2013,38(1):55-59.DOI:10.1016/j.meddos.2012.06.002. [22] Liljegren A,Unukovych D,Gagliardi G,et al. No difference in dose distribution in organs at risk in postmastectomy radiotherapy with or without breast implant reconstruction[J].Radiat Oncol,2014,9(1):14.DOI:10.1186/1748-717X-9-14. [23] Motwani SB,Strom EA,Schechter NR,et al. The impact of immediate breast reconstruction on the technical delivery of postmastectomy radiotherapy[J].Int J Radiat Oncol Biol Phys,2006,66(1):76-82.DOI:10.1016/j.ijrobp.2006.03.040. [24] Ma JL,Li JY,Xie J,et al. Post mastectomy linac IMRT irradiation of chest wall and regional nodes:dosimetry data and acute toxicities[J].Radiat Oncol,2013,8(1):81.DOI:10.1186/1748-717X-8-81. [25] Ohri N,Cordeiro PG,Keam J,et al. Quantifying the impact of immediate reconstruction in postmastectomy radiation:a large,dose-volume histogram-based analysis[J].Int J Radiat Oncol Biol Phys,2012,84(2):e153-e159.DOI:10.1016/j.ijrobp.2012.03.026. [26] Massabeau C,Fournier-Bidoz N,Wakil G,et al. Implant breast reconstruction followed by radiotherapy:can helical tomotherapy become a standard irradiation treatment?[J].Med Dosim,2012,37(4):425-431.DOI:10.1016/j.meddos.2012.03.006. [27] MacDonald SM,Patel SA,Hickey S,et al. Proton therapy for breast cancer after mastectomy:early outcomes of a prospective clinical trial[J].Int J Radiat Oncol Biol Phys,2013,86(3):484-490.DOI:10.1016/j.ijrobp.2013.01.038.
2016, Vol. 25 
