Abstract
Purpose:
The purpose of this study was to analyze the probability and time course of fibrotic changes in breast reconstruction before or after postmastectomy radiotherapy (PMRT).
Materials and Methods:
Between 1995 and 2004, 109 patients were treated with PMRT at Tübingen University and underwent heterologous (HL) or autologous (AL) breast reconstruction prior or subsequent to radiation therapy. Fibrosis of the reconstructed breast after radiotherapy was assessed using the Baker score for HL reconstructions and the Common Terminology Criteria for Adverse Events (CTCAE) for all patients. Actuarial rates of fibrosis were calculated for the maximum degree acquired during follow- up and at the last follow-up visit documented.
Results:
Median time to follow-up was 34 months (3–227 months). Radiotherapy was applied with a median total dose of 50.4 Gy. A total of 44 patients (40.4%) received a boost treatment with a median dose of 10 Gy. Breast reconstruction was performed with AL, HL, or combined techniques in 20, 82, and 7 patients, respectively. The 3-year incidence of ¡Ý grade III maximum fibrosis was 20% and 43% for Baker and CTCAE scores, respectively. The corresponding figures for fibrosis at last follow-up visit were 18% and 2%. The 3-year rate of surgical correction of the contralateral breast was 30%. Initially unplanned surgery of the reconstructed breast was performed in 39 patients (35.8%). Boost treatment and type of cosmetic surgery (HL vs. AL) were not significantly associated with the incidence of fibrosis.
Conclusions:
We found severe fibrosis to be a frequent complication after PMRT radiotherapy and breast reconstruction. However, surgical intervention can ameliorate the majority of high grade fibrotic events leading to acceptable long-term results. No treatment parameters associated with the rate of fibrosis could be identified.
Zusammenfassung
Zielsetzung:
Ziel der Arbeit war es, die Frequenz und den zeitlichen Verlauf fibrotischer Veränderungen nach Thoraxwandbestrahlung und plastischer Rekonstruktion der Mamma zu analysieren.
Material und Methoden:
Zwischen 1995 und 2004 wurde bei 109 Patientinnen in der Klinik für Radioonkologie des Universitätsklinikums Tübingen eine Thoraxwandbestrahlung nach Mastektomie durchgeführt. Vor oder nach der Bestrahlung erfolgte eine autologe (AL) oder heterologe (HL) Brustrekonstruktion. Fibrotische Veränderungen der rekonstruierten Brust wurden retrospektiv anhand des Baker-Scores (AL) bzw. der Definition der Common Terminology Criteria for Adverse Events (CTCAE) erhoben. Es wurden aktuarische Raten der stärksten beobachteten Ausprägung der Fibrose bzw. des Fibrosegrades zum letzten Beobachtungszeitpunkt für beide Scores erhoben.
Ergebnisse:
Die mediane Nachbeobachtungszeit betrug 34 Monate (3–227). Die Strahlentherapie wurde mit einer medianen Gesamtdosis von 50.4 Gy appliziert. 44 Patientinnen (40.4%) erhielten eine Boostbestrahlung mit einer medianen Gesamtdosis von 10 Gy. Die Brustrekonstruktion erfolgte in AL- bzw. HL- oder kombinierter Technik bei 20, 82, bzw. 7 Patientinnen. Die 3-Jahresinzidenz der maximal beobachteten Fibrose ¡Ý Grad III betrug 20% nach der Baker-Klassifikation bzw. 43% nach CTCAE-Score. Die entsprechenden Fibroseraten für den letzten Beobachtungszeitpunkt betrugen 18% bzw. 2%. Die 3-Jahresrate operativer Korrekturen der kontralateralen Brust betrug 30%. Bei 39 Patientinnen (35.8 %) wurden initial ungeplante operative Zweiteingriffe an der rekonstruierten Brust durchgeführt. Die Boostbestrahlung und die Rekonstruktionstechnik (AL bzw. HL) hatten keinen signifikanten Einfluss auf die Fibroserate.
Schlussfolgerung:
Höhergradige Fibrosen stellen eine regelmäßige Komplikation nach Thoraxwandbestrahlung und plastischer Brustrekonstruktion dar. Offenbar kann der überwiegende Teil der fibrotischen Komplikationen operativ korrigiert werden. Wir konnten keine Risikofaktoren für die Entwicklung höhergradiger Fibrosen identifizieren.
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Claßen, J., Nitzsche, S., Wallwiener, D. et al. Fibrotic Changes after Postmastectomy Radiotherapy and Reconstructive Surgery in Breast Cancer. Strahlenther Onkol 186, 630–636 (2010). https://doi.org/10.1007/s00066-010-2158-6
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DOI: https://doi.org/10.1007/s00066-010-2158-6