局部晚期乳腺癌患者接受放疗和自体组织乳房重建的时序选择

The appropriate sequence of radiotherapy and autologous breast reconstruction for locally advanced breast cancer

随着医疗诊治技术的发展,乳腺癌患者术后生存期延长,患者术后的生活质量及身心健康日益受到关注,乳房重建的需求越来越多。然而,在局部晚期乳腺癌患者中行乳房重建的安全性、时序性及重建方式的选择仍备受争议。通过对现有文献报道和数据分析的整合,我们建议患者在完成术后放疗后再行Ⅱ期乳房重建术,放疗与重建术的时间间隔可延至12个月以上。对于术前无法明确是否有放疗指征的患者,可尝试行"延期-即刻乳房重建"。为了更直接高效地观察两种不同时序的方案(Ⅰ期重建后行放疗和放疗后行Ⅱ期重建)为患者带来的益处及存在的弊端,大型多中心随机临床对照试验亟需确立,力求为局部晚期乳腺癌患者术后放疗和乳房重建的时序选择提供更强有力的依据。

Breast cancer is now associated with long-term disease-free and overall survival, and in the setting of mastectomy, long term psycho-sexual health becomes an important consideration. At present, the demand for breast reconstruction grows significantly. However, the safety and operation method of reconstruction and appropriate sequence of radiotherapy and breast reconstruction for locally advanced breast cancer still remain controversial. After consulting the recent papers in this field, we prefer to undergo breast reconstruction for locally advanced breast cancer patients until completion of adjuvant radiotherapy. The span between radiotherapy and reconstruction could be prolonged to at least 12 months. In addition, delayed-immediate autologous reconstruction provides a means of optimizing outcomes in those patients where the requirement for radiotherapy is unknown at the time of mastectomy.