Effect of exempting radiotherapy in implant area on complications, recurrence and metastasis of breast cancer patients undergoing primary breast reconstruction

doi:10.3877/cma.j.issn.1674-0807.2020.03.002

Abstract

Abstract:

Objective

To explore the effect of exempting radiotherapy in implant area on the complications, recurrence and metastasis of patients undergoing primary breast reconstruction after breast cancer surgery.

Methods

A total of 95 patients with breast cancer who underwent radiotherapy after mastectomy and immediate implant breast reconstruction in the Department of Breast and Thyroid Surgery, First Affiliated Hospital of Army Medical University from January 2012 to December 2014 were enrolled into a retrospective study according to the inclusion and exclusion criteria. Fifty-six patients received radiotherapy in implant area and lymph node drainage area (control group) and 39 patients received radiotherapy only in lymph node drainage area (experimental group). All patients were followed up for over five years. The radiotherapy-related complications (radiation skin injury, radiation pneumonitis, capsule contracture and implant removal), local recurrence and distant metastasis of breast cancer were compared between two groups. The incidences of radiotherapy-related complications, local recurrence and distant metastasis were compared using the χ² test or Fisher’s exact test between two groups.

Results

In the 56 patients of the control group, 5 cases(8.9%) had radiation skin injury, 2 (3.6%) radiation pneumonia, and 5 (8.9%) capsular contracture caused by radiotherapy (2 in grade Ⅱ, 2 in grade Ⅲ and 1 in grade Ⅳ), resulting implant removal in 2 cases(3.6%). Only one case (2.6%) had radiation skin injury in the experimental group. There were no significant differences in the incidences of radiation skin damage (P=0.395), radiation pneumonia (P=0.511), radiation-induced capsular contractures (P=0.076) and implant removal (P=0.511) between two groups. Twelve patients (21.4%, 12/56)in the control group and only one patient(2.6%, 1/39) in the experimental group had radiotherapy-related complications, indicating a significant difference between two groups (χ²=6.926, P=0.008). All patients were followed up for 60-81 months (median 66 months). Four cases (7.1%, 4/56) had local recurrence and 5 cases (8.9%, 5/56) had distant metastasis in the control group. Three cases(7.7%, 3/39) had local recurrence and 3 cases(7.7%, 3/39) had distant metastasis in the experimental group. There was no significant difference in the incidences of local recurrence (P=0.999) and distant metastasis (P=0.999) between two groups.

Conclusion

For patients undergoing primary implant breast reconstruction after mastectomy, exempting radiotherapy in implant area can reduce the incidence of radiation-related complications and improve the quality of life after surgery, without affecting efficacy.

Key words: Breast neoplasms, Radiation oncology, Postoperative complications, Neoplasm recurrence, local, Neoplasm metastasis, Disease-free survival

Xinggang Li, Ye Zhang, Fengwei Ran, Junze Du, Ling Zhong, Xiang Cui, Yi Zhang, Jun Jiang, Linjun Fan. Effect of exempting radiotherapy in implant area on complications, recurrence and metastasis of breast cancer patients undergoing primary breast reconstruction[J]. Chinese Journal of Breast Disease(Electronic Edition), 2020, 14(03): 134-140.

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References 29

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组别	例数	年龄(岁，±s)	TNM分期(例)		腋窝淋巴结转移数目[枚，M(P₂₅～P₇₅)]	ER(例)		PR(例)		HER-2(例)
组别	例数	年龄(岁，±s)	Ⅱ期	Ⅲ期	腋窝淋巴结转移数目[枚，M(P₂₅～P₇₅)]	阳性	阴性	阳性	阴性	阳性	阴性
对照组	56	38.9±7.4	33	23	2(2～4)	39	17	35	21	11	45
试验组	39	39.4±7.0	26	13	2(2～4)	32	7	29	10	8	31
检验值	?	t＝0.331	χ²＝0.585		Z＝0.085	χ²＝1.875		χ²＝1.471		χ²＝0.011
P值	?	0.741	0.444		0.932	0.171		0.225		0.917

组别	例数	年龄(岁，±s)	TNM分期(例)		腋窝淋巴结转移数目[枚，M(P₂₅～P₇₅)]	ER(例)		PR(例)		HER-2(例)
组别	例数	年龄(岁，±s)	Ⅱ期	Ⅲ期	腋窝淋巴结转移数目[枚，M(P₂₅～P₇₅)]	阳性	阴性	阳性	阴性	阳性	阴性
对照组	56	38.9±7.4	33	23	2(2～4)	39	17	35	21	11	45
试验组	39	39.4±7.0	26	13	2(2～4)	32	7	29	10	8	31
检验值	?	t＝0.331	χ²＝0.585		Z＝0.085	χ²＝1.875		χ²＝1.471		χ²＝0.011
P值	?	0.741	0.444		0.932	0.171		0.225		0.917

组别	例数	胸壁野		锁骨上/下野		腋窝		内乳野
组别	例数	是	否	是	否	是	否	是	否
对照组	56	56	0	48	8	32	24	15	41
试验组	39	0	39	34	5	27	12	10	29
χ²值	?	95.000		0.042		1.427		0.016
P值	?	<0.001		0.838		0.232		0.901

组别	例数	胸壁野		锁骨上/下野		腋窝		内乳野
组别	例数	是	否	是	否	是	否	是	否
对照组	56	56	0	48	8	32	24	15	41
试验组	39	0	39	34	5	27	12	10	29
χ²值	?	95.000		0.042		1.427		0.016
P值	?	<0.001		0.838		0.232		0.901

组别	例数	放射性皮肤损伤		放射性肺炎		包膜挛缩		假体取出		并发症合计
组别	例数	是	否	是	否	是	否	是	否	并发症合计
对照组	56	5	51	2	54	5	51	2	54	12
试验组	39	1	38	0	39	0	39	0	39	1
χ²值	?	?	?	?	?	?	?	?	?	6.926^a
P值	?	0.395		0.511		0.076		0.511		0.008

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