Der Gynäkologe

, Volume 43, Issue 12, pp 989–995 | Cite as

Strahlentherapie nach brusterhaltender Therapie

Für die ältere Patientin obsolet?


Die steigende Lebenserwartung stellt die Frage nach der besten Behandlungsform für ältere Brustkrebspatientinnen im Frühstadium nach brusterhaltender Operation. Im generellen Therapiekonzept des Brusterhalts nehmen die adjuvante Strahlentherapie seit über 20 Jahren und die antihormonelle Therapie einen festen Platz ein. Die Veröffentlichung der Studie von Hughes et al. auf dem ASCO-Kongress 2010 stellt die Notwendigkeit der etablierten adjuvanten Strahlentherapie bei der älteren Patientin infrage. Durch Vergleich verschiedener Untersuchungen soll versucht werden, Lösungsansätze für die Indikationsstellung zur adjuvanten Strahlentherapie zu ermöglichen. Dabei muss beachtet werden, dass es eine allgemein gültige Methode auch hier nicht gibt.


Mammakarzinom Geriatrie Strahlentherapie Intraoperative Strahlentherapie Akzelerierte partielle Brustbestrahlung (ABPI) Hormontherapie 

Radiotherapy after breast preserving therapy

Is it obsolete for elderly patients?


The increase in life expectancy generates the question for the most suitable therapy concept in the setting of breast preserving therapy for early breast cancer in elderly patients. In general adjuvant radiotherapy of the remaining breast and thoracic wall and anti-hormonal therapy are established and approved concepts also in the treatment of elderly women. The recent publication by Hughes et al. at the annual ASCO meeting 2010 challenged the question of the necessity of adjuvant radiotherapy in the case of early breast cancer in elderly women. By a comparison of data from the literature this paper tries to find suitable approaches to the assessment of the indications for adjuvant radiotherapy. However, it has to be taken into account that there is no generally acceptable answer to the problem.


Breast cancer Geriatrics Radiotherapy Intraoperative radiation therapy Accelerated partial breast irradiation  Hormonal therapy 


  1. 1.
    Barron TI, Connolly R, Bennett K et al (2007) Early discontinuation of tamoxifen: A lesson for oncologists. Cancer 109:832–839CrossRefPubMedGoogle Scholar
  2. 2.
    Bartelink H, Horiot JC, Poortmans PM et al (2007) Impact of a higher radiation dose on local control and survival in breast conserving therapy of early breast: 10-year results of the randomized boost versus no boost EORTC 22881–10882 trial. J Clin Oncol 25:3259–3265CrossRefPubMedGoogle Scholar
  3. 3.
    Baum M, Joseph DJ, Tobias JS et al (2010) Safety and efficacy of targeted intraoperative radiotherapy (TARGIT) for early breast cancer: First report of a randomized controlled trial at 10-years maximum follow-up. J Clin Oncol 28:18 s (suppl; abstr LBA517)Google Scholar
  4. 4.
    Bryant J, Fisher B, Dignam J (2001) Duration of adjuvant tamoxifen therapy. J Natl Cancer Inst Monogr 30:56–61PubMedGoogle Scholar
  5. 5.
    Chlebowski RT, Geller ML (2006) Adherence to endocrine therapy for breast cancer. Oncology 71:1–9PubMedGoogle Scholar
  6. 6.
    Clark RM, Wilkinson RH, Mahoney LJ et al (1982) Breast cancer: a 21 year experience with conservative surgery and radiation.Int J Radiat Oncol Biol Phys 8(6):967–979PubMedGoogle Scholar
  7. 7.
    Clarke M, Collins R, Darby S et al (2005) Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: An overview of the randomised trials. Lancet 366:2087–2106PubMedGoogle Scholar
  8. 8.
    Cutuli B, Aristei C, Martin C et al (2004) Breast-conserving therapy for stage I-II breast cancer in elderly women. Int J Radiat Oncol Biol Phys 60(1):71–76CrossRefPubMedGoogle Scholar
  9. 9.
    Fisher B, Anderson S, Bryant J et al (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347:1233–1241CrossRefPubMedGoogle Scholar
  10. 10.
    Fyles AW, McCready DR, Manchul LA et al (2004) Tamoxifen with or without breast irradiation in women 50 years of age or older with early breast cancer. N Engl J Med 351:963–970CrossRefPubMedGoogle Scholar
  11. 11.
    Geiger AM, Thwin SS, Lash TL et al (2007) Recurrences and second primary breast cancers in older women with initial early-stage disease. Cancer 109:966–974CrossRefPubMedGoogle Scholar
  12. 12.
    Harbeck N, Hadji P, Jackisch C et al (2010) First results from the Patient’s Anastrozole Compliance to Therapy (PACT) program evaluating the influence of a standardized information service on compliance in postmenopausal women with early breast cancer (EBC). J Clin Oncol 28:15 s (suppl; abstr 523)CrossRefGoogle Scholar
  13. 13.
    Hughes KS, Schnaper LA, Berry D et al (2004) Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer. N Engl J Med 351:971–977CrossRefPubMedGoogle Scholar
  14. 14.
    Hughes KS, Schnaper LA, Cirrincione C et al (2010) Lumpectomy plus tamoxifen with or without irradiation in women age 70 or older with early breast cancer. J Clin Oncol 28:15 s (suppl; abstr 507)CrossRefGoogle Scholar
  15. 15.
    Kimmick G, Anderson R, Camacho F et al (2009) Adjuvant hormonal therapy use among insured, lowincome women with breast cancer. J Clin Oncol 27:3445–3451CrossRefPubMedGoogle Scholar
  16. 16.
    Kirova YM, Campana F, Savignoni A et al (2009) Breast-conserving treatment in the elderly: long-term results of adjuvant hypofractionated and normofractionated radiotherapy. Int J Radiat Oncol Biol Phys 75(1):76–81CrossRefPubMedGoogle Scholar
  17. 17.
    Lash TL, Fox MP, Westrup JL et al (2006) Adherence to tamoxifen over the five-year course. Breast Cancer Res Treat 99:215–220CrossRefPubMedGoogle Scholar
  18. 18.
    Lim M, Bellon JR, Gelman R et al (2006) A prospective study of conservative surgery without radiation therapy in select patients with Stage I breast cancer. Int J Radiat Oncol Biol Phys 65(4):1149–1154CrossRefPubMedGoogle Scholar
  19. 19.
    Mamounas EP, Tang G, Fisher B et al (2010) Association between the 21-gene recurrence score assay and risk of locoregional recurrence in node-negative, estrogen receptor – positive breast cancer: Results from NSABP B-14 and NSABP B-20. J Clin Oncol doi:10.1200/JCO.2009.23.7610Google Scholar
  20. 20.
    McCowan C, Shearer J, Donnan PT et al (2008) Cohort study examining tamoxifen adherence and its relationship to mortality in women with breast cancer. Br J Cancer 99:1763–1768CrossRefPubMedGoogle Scholar
  21. 21.
    Nagel G, Röhrig B, Hoyer H et al (2002) A population-based study on variations in the use of adjuvant radiotherapy in breast cancer patients. Strahlenther Onkol 178(11):589–596CrossRefPubMedGoogle Scholar
  22. 22.
    Ortholan C, Hannoun-Lévi JM, Ferrero JM et al (2005) Long-term results of adjuvant hypofractionated radiotherapy for breast cancer inelderly patients. Int J Radiat Oncol Biol Phys 61(1):154–162CrossRefPubMedGoogle Scholar
  23. 23.
    Pal SK, Katheria V, Hurria A (2010) Evaluating the older patient with cancer: understanding frailty and the geriatric assessment. CA Cancer J Clin 60(2):120–132CrossRefPubMedGoogle Scholar
  24. 24.
    Partridge AH, Avorn J, Wang PS et al (2002) Adherence to therapy with oral antineoplastic agents. J Natl Cancer Inst 94:652–661PubMedGoogle Scholar
  25. 25.
    Partridge AH, Wang PS, Winer EP et al (2003). Nonadherence to adjuvant tamoxifen therapy in women with primary breast cancer. J Clin Oncol 21:602–606CrossRefPubMedGoogle Scholar
  26. 26.
    Partridge AH, LaFountain A, Mayer E et al (2008) Adherence to initial adjuvant anastrozole therapy among women with early-stage breast cancer. J Clin Oncol 26:556–562CrossRefPubMedGoogle Scholar
  27. 27.
    Peschel RE, Wilson L, Haffty B et al (1993) The effect of advanced age on the efficacy of radiation therapy for early breast cancer, local prostate cancer and grade III-IV gliomas. Int J Radiat Oncol Biol Phys 26(3):539–544CrossRefPubMedGoogle Scholar
  28. 28.
    Pötter R, Gnant M, Kwasny W et al (2007) Lumpectomy plus tamoxifen or anastrozole with or without whole breast irradiation in women with favorable early breast cancer. Int J Radiat Oncol Biol Phys 26(3):539–544Google Scholar
  29. 29.
    Rodin MB, Mohile SG (2007) A practical approach to geriatric assessment in oncology. J Clin Oncol 25(14):1936–1944. ReviewCrossRefPubMedGoogle Scholar
  30. 30.
    Romestaing P, Lehingue Y, Carrie C et al (1997) Role of a 10-Gy boost in the conservative treatment of early breast cancer: Results of a randomized clinical trial in Lyon, France. J Clin Oncol 15:963–968PubMedGoogle Scholar
  31. 31.
    Sanghani M, Truong PT, Raad RA et al (2010) Validation of a web-based predictive nomogram for ipsilateral breast tumor recurrence after breast conserving therapy. J Clin Oncol 28:718–722CrossRefPubMedGoogle Scholar
  32. 32.
    Solin LJ, Hwang WT, Vapiwala N (2009) Outcome after breast conservation treatment with radiation for women with triple-negative early-stage invasive breast carcinoma. Clin Breast Cancer 9:96–100CrossRefPubMedGoogle Scholar
  33. 33.
    Schwartz GF, Veronesi U, Clough KB et al (2006) Proceedings of the Consensus Conference on Breast Conservation, April 28 to May 1, 2005, Milan, Italy. Cancer 107:242–250CrossRefPubMedGoogle Scholar
  34. 34.
    Tinterri C, Gatzemeier W, Zanini V et al (2009) Conservative surgery with and without radiotherapy in elderly patients with early-stage breast cancer: a prospective randomised multicentre trial. Breast 18(6):373–377CrossRefPubMedGoogle Scholar
  35. 35.
    Toonkel LM, Fix I, Jacobson LH et al (1988) Management of elderly patients with primary breast cancer. Int J Radiat Oncol Biol Phys 14(4):677–681CrossRefPubMedGoogle Scholar
  36. 36.
    Vaidya JS, Joseph DJ, Tobias JS et al (2010) Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial): an international, prospective, randomised, non-inferiority phase 3 trial. Lancet 376(9735):91–102. Erratum in: Lancet 376(9735):90Google Scholar
  37. 37.
    Veronesi U, Cascinelli N, Mariani L et al (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 347:1227–1232CrossRefPubMedGoogle Scholar
  38. 38.
    Yood MU, Owusu C, Buist DS et al (2008) Mortality impact of less-than-standard therapy in older breast cancer patients. J Am Coll Surg 206:66–75CrossRefPubMedGoogle Scholar
  39. 39.
    Zachariah B, Balducci L, Venkattaramanabalaji GV et al (1997) Radiotherapy for cancer patients aged 80 and older: a study of effectiveness and side effects. Int J Radiat Oncol Biol Phys 39(5):1125–1129CrossRefPubMedGoogle Scholar
  40. 40.
    Ziller V, Kalder M, Albert US et al (2009) Adherence to adjuvant endocrine therapy in postmenopausal women with breast cancer. Ann Oncol 20:431–436CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • B. Ataseven
    • 1
  • W. Eiermann
    • 1
  • M. Molls
    • 2
  • S. Pigorsch
    • 2
  1. 1.EUSOMA-BrustzentrumFrauenklinik, Rotkreuzklinikum MünchenMünchenDeutschland
  2. 2.Klinik und Poliklinik für Strahlentherapie und Radiologische OnkologieKlinikum rechts der Isar, Technische Universität MünchenMünchenDeutschland

Personalised recommendations