乳癌術後42年間にわたり治療に難渋した慢性放射線潰瘍の1例

A Chronic Radiation Ulcer Refractory to Treatment for 42 Years After Breast Cancer Surgery

　本論文の症例は以前に発表されている引用文献1（筋膜上で剥離既往のある部位から遊離腹直筋皮弁を採取したという内容） 1）と，引用文献2（乳癌術後放射線潰瘍に対して胸壁合併切除が有用であるという内容） 2）で使用された症例である。

　Chronic radiation ulcers often occur >6 months after radiotherapy and even >10 years later. These ulcers are linked to abnormal wound healing (which reduces the number of stem cells after irradiation, thus damaging the vascular lining through ischemia and gradually hardening the tissue). Here we provide the case details of a patient with chronic ulceration that was caused by postoperative radiotherapy for breast cancer and required multiple surgeries over a period of 42 years. Such ulceration cases are typically treated by completely excising the radiation-damaged tissue and covering it with tissue rich that is in blood flow. However, it is difficult to determine the precise extent of resection due to various factors, and the recurrence of ulcers or the development of new ulcers from the remaining diseased tissue or the margins of the resection site often compromises treatment. Each successive surgery further hinders reconstruction options. Optimizing the treatment plans becomes difficult when the details of the initial treatment are unknown many years after treatment. A long-term approach that includes surgery for chronic radiodermatitis must therefore be considered from the earliest disease stage.