방사선종양학

본문글자크기
  • [Int J Radiat Oncol Biol Phys.] Influence of Hypofractionated Versus Conventional Fractionated Postmastectomy Radiation Therapy in Breast Cancer Patients With Reconstruction

    [Int J Radiat Oncol Biol Phys.] Influence of Hypofractionated Versus Conventional Fractionated Postmastectomy Radiation Therapy in Breast Cancer Patients With Reconstruction 유방전절제술후 유방재건술을 받은 환자에서 소분할방사선치료와 통상적방사선치료의 영향 비교

    서울의대 / 김동연, 김인아*

  • 출처
    Int J Radiat Oncol Biol Phys.
  • 등재일
    2022 Feb 1
  • 저널이슈번호
    112(2):445-456. doi: 10.1016/j.ijrobp.2021.09.031.
  • 내용

    바로가기  >

    이달의 연구자 바로가기 Click!

     

    Abstract
    Purpose: We aimed to compare breast-related complications between hypofractionated adjuvant postmastectomy radiation therapy (PMRT) and conventional fractionated radiation therapy (RT) in patients with breast cancer undergoing reconstruction by reconstruction surgery type.

    Methods and materials: Data from a total of 396 patients with breast cancer who underwent breast reconstruction after mastectomy between 2009 and 2018 were retrospectively reviewed. All patients received adjuvant PMRT according to either a conventional fractionation or hypofractionation schedule. We analyzed breast-related complications according to the timing of breast reconstruction (immediate or delayed). In cases of delayed reconstruction, only PMRT delivered before final delayed reconstruction was included. A major breast complication was defined as a breast-related toxicity that required reoperation or rehospitalization after the end of RT.

    Results: The median follow-up time was 35.3 months (range, 8.8-122.7 months). Of all patients, 267 received immediate breast reconstruction and 129 received delayed breast reconstruction. In patients with immediate breast reconstruction, 91 were treated with conventional RT and 176 received hypofractionated RT. The occurrence of major breast-related complications did not differ significantly between the 2 fractionation regimens. Hypofractionated RT did not increase major wound problems (infection and dehiscence) compared with conventional RT. Furthermore, major contracture occurred significantly less frequently in hypofractionated RT. Of the patients who had delayed breast reconstruction, 48 received conventional RT and 81 received hypofractionated RT. There was no difference in the incidence of major breast complications between these 2 RT groups, and no difference in major breast complications were reported for either 1- or 2-stage delayed reconstruction. A time interval of >10 months between PMRT and final definitive reconstruction had a significantly lower incidence of major breast complications.

    Conclusions: Hypofractionated RT appears to be comparable with conventional fractionated RT in terms of breast-related complications in patients with breast cancer undergoing reconstruction, regardless of breast reconstruction type. An ongoing prospective randomized trial should confirm our findings.

     

     

    Affiliations

    Dong-Yun Kim  1 , Eonju Park  2 , Chan Yeong Heo  2 , Ung Sik Jin  2 , Eun Kyu Kim  3 , Wonshik Han  4 , Kyung Hwan Shin  1 , In Ah Kim  5
    1 Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea.
    2 Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
    3 Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
    4 Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea; Cancer Research Institution, Seoul National University College of Medicine, Seoul, Republic of Korea.
    5 Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea; Cancer Research Institution, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea. Electronic address: inah228@snu.ac.kr.

  • 연구소개
    유방암의 수술 후 방사선 치료에서 저분할방사선조사는 현재 많은 기관에서 치료법으로 채택되어 사용되고 있고, 이는 기존의 통상분할방사선조사와 비교하였을 때 치료성적 및 독성에서 차이가 없다는 것이 3상 연구를 통해 밝혀진 바 있습니다. 그러나 유방전절제 후 미용목적의 유방재건을 시행받은 환자에서는 저분할방사선조사의 안전성에 대해 밝혀진 연구가 거의 없고 유방재건 방식도 다양하기 때문에 실제 임상에서 두 가지 방식이 혼용되고 있습니다. 결국 임상의의 선호도에 따라 저분할 또는 통상분할이 사용되고 있는 실정이므로, 본 연구에서는 10년간 두 기관에서 치료받은 396명의 환자들을 대상으로 유방전절제후 즉시재건, 지연재건을 받은 경우로 분류하여 저분할방사선조사와 통상분할방사선조사를 받은 경우 유방관련 부작용의 차이가 있는지를 후향적으로 분석하였습니다. 분석 결과, 즉시재건과 1,2 단계 지연재건 모두에서 저분할방사선조사가 통상분할방사선조사와 비교하여 유방관련 부작용에서 유의미한 차이를 보이지 않고 유사한 수준의 부작용을 나타냈습니다. 본 연구 결과는 다양한 방식의 유방재건을 한 환자들의 방사선치료 시 최적의 fractionation을 선택하는데 임상의에게 실질적인 도움을 줄 수 있을 것이라고 생각합니다.
  • 편집위원

    유방재건술 후 소분할방사선치료가 통상분할방사선치료에 비해 재수술 혹은 재입원을 요하는 주요 부작용이 유의하게 증가하지 않을 뿐만아니라, 즉시재건을 받은 경우 구축은 소분할방사선치료에서 유의하게 드물다는 결과를 보여줌

    2022-03-18 10:29:50

  • 편집위원2

    유방암 환자에서 재건 수술 유무에 따른 방사선 치료에 대한 영향을 분석하여, 방사선 치료에 적용할 수 있는 자료를 제시한 연구라고 사료됨.

    2022-04-05 13:56:19

  • 덧글달기
    덧글달기
       IP : 3.215.79.204

    등록