创新背景

乳房切除术前的放射治疗和自体游离瓣乳房重建可以辅助放疗的延迟和避免对健康供体组织的不良辐射影响，许多乳腺癌患者也希望进行放射治疗并重建。目前许多医院对乳腺癌的治疗往往是先进行乳房切除术，然后实施放射治疗，之后再重建，中间的时间间隔太长导致许多患者得不到延迟重建。而有的医院会在乳房切除术时进行重建，然后对胸壁进行放射治疗。但这种方法很可能导致并发症。

创新过程

帝国理工学院研究团队对于乳腺癌治疗的方法提出新的方案，想要改变治疗顺序，探讨在术前放疗后进行保肤乳房切除术和深下腹穿孔器皮瓣重建对于治疗是否有用，能否在短期内保证治疗安全并在长期中减少并发症。

团队在近一年时间内招募了33名需要乳房切除术和乳房切除术后放疗的乳腺癌女性志愿者，在保障安全的情况下对她们进行初级放疗和深下腹穿孔皮瓣重建（PRADA）试验。试验先对患者进行化疗，3-4周后进行放疗，放疗完成后2-6周进行保留皮肤乳房切除术和DIEP皮瓣重建。术后四周，33名患者中有12.1%（4例）的开放性乳房伤口大于1 cm，3%（1例）有3级融合性湿润脱屑，需要重新手术解决死皮问题。治疗没有发生严重的不良事件，也没有与治疗相关的死亡。

试验结果证明了改变顺序的治疗方法是可行的，副作用很低，安全性得到保障，乳房开放性伤口的发生率与乳房切除术后放疗报告的相似。研究团队在手术后3个月和12个月重新调查了患者的乳房重建，发现患者的满意度高达77%，并且术后12个月内没有患者癌症复发。

研究结果表明，在乳房切除术和立即微血管乳房重建之前进行放射治疗是安全的，术后的并发症发生率低，放疗不会影响外科医生进行复杂乳房重建，成果论文《乳腺癌患者的原发性放疗和上腹部下穿孔皮瓣重建（PRADA）：多中心、前瞻性、非随机的可行性研究》2022年发表在《柳叶刀肿瘤学》上。研究将进行下一步实验，扩大试验规模，确认新的治疗方法对于患者生活质量、治疗计划时间表以及长期癌症的益处。

创新关键点

改变乳腺癌治疗顺序，确定改变顺序对于可改善现有治疗和护理效率。

创新价值

新的治疗方法可能缩短患者的整体治疗过程，将改善患者的身心健康和生活质量，让她们对重建乳房的满意度更高。

Changing the sequence of treatments has the potential to improve breast cancer treatment and care

The Imperial College research team proposed a new plan for breast cancer treatment. They wanted to change the treatment sequence and explore whether skin-conserving mastectomy and deep abdominal perforator flap reconstruction after preoperative radiotherapy are useful for treatment, and whether they can be used in the treatment of breast cancer. Safe treatment in the short term and fewer complications in the long term. The team recruited 33 volunteers with breast cancer who required mastectomy and post-mastectomy radiotherapy over a nearly one-year period, and provided them with primary radiotherapy and deep abdominal perforation flap resection when it was safe to do so.

The trial started with chemotherapy, followed by radiotherapy 3-4 weeks later, followed by skin-sparing mastectomy and DIEP flap reconstruction (PRADA) trial reconstruction 2-6 weeks after completion of radiotherapy. Four weeks after surgery, 12.1% (4 patients) of the 33 patients had open breast wounds larger than 1 cm, and 3% (1 patient) had grade 3 confluent moist desquamation requiring reoperation to resolve the dead skin problem. There were no serious adverse events and no treatment-related deaths.

The trial results demonstrated that the reordered treatment approach was feasible, with low side effects, guaranteed safety, and rates of open breast wounds similar to those reported for post-mastectomy radiotherapy. .The research team re-investigated the patients' breast reconstruction at 3 and 12 months after surgery and found that patient satisfaction was as high as 77%, and no patients had cancer recurrence within 12 months after surgery.

The findings suggest that radiation therapy prior to mastectomy and immediate microvascular breast reconstruction is safe, has low postoperative complication rates, and that radiation therapy does not interfere with surgeons performing complex breast reconstructions. Sexual radiotherapy and upper abdominal subperforated flap reconstruction (PRADA): a multicenter, prospective, nonrandomized feasibility study" published in The Lancet Oncology 2022. The research will carry out the next step of experimenting, expanding the scale of the trial to confirm the benefits of the new treatment for patients' quality of life, treatment planning schedule, and long-term cancer.