Der Onkologe

, Volume 11, Issue 4, pp 457–470 | Cite as

Postoperative Strahlentherapie beim invasiven Mammakarzinom

Weiterbildung · Zertifizierte Fortbildung
  • 36 Downloads

Zusammenfassung

Die Strahlentherapie ist wichtiger Bestandteil des kurativ ausgerichteten, üblicherweise multimodalen Therapiekonzepts nach operativer Primärbehandlung beim lokal begrenzten Mammakarzinom. Ihr Stellenwert wurde auf der Basis aktueller Ergebnisse prospektiver und randomisierter Studien und somit auf hohem Evidenzniveau präzisiert. Die Radiotherapie nach Brust erhaltender Operation ist unverzichtbar für die prognostisch entscheidende lokale Tumorkontrolle als wichtigstem Therapieziel. Sie verbessert diese sowie das Überleben. Therapiesequenz und mögliche Interaktionen der Radiotherapie mit neuen systemischen, potenziell kardiotoxischen Behandlungen sind klinisch wichtige, aktuell diskutierte Fragestellungen. Die radiogene Kardiotoxizität kann beim Einsatz heutiger Bestrahlungstechniken als gering angesehen werden. Daten über eventuelle adverse kardiologische Interaktionen von diesen Substanzen bei kombiniertem Einsatz mit der perkutanen Radiotherapie liegen allerdings nur in begrenztem Umfang vor.

Schlüsselwörter

Lokal begrenztes Mammakarzinom Radiotherapie Therapiesequenz Interaktionen mit systemischer Therapie Kardiotoxizität 

Postoperative radiotherapy for invasive breast cancer

Abstract

After primary surgery, radiation therapy is considered an important part of the curative, usually multimodal treatment regimen for patients with locally limited breast cancer. Based on the current results of prospective and randomized studies, its role has been confirmed with a high level of evidence. Radiotherapy following breast-preserving surgery is indispensable for crucial prognostic, local tumor control, which is the most important therapeutic goal. Radiation therapy improves both local disease control and survival. The sequence of radiation and systemic therapies and possible interactions between radiotherapy and new systemic potentially cardiotoxic antineoplastic agents are clinically important, topical questions. Using up-to-date standard irradiation techniques, the cardiotoxicity induced by radiotherapy is considered to be very low. Data on adverse cardiologic interactions of these substances with combined use of percutaneous radiotherapy exist only on a small scale.

Keywords

Early breast cancer Radiation therapy Sequencing of radiation and chemotherapy Interactions between radiation and systemic antineoplastic therapy Cardiotoxicity 

Literatur

  1. 1.
    Adams MJ, Lipshultz SE, Schwartz C et al. (2003) Radiation-associated cardiovascular disease: manifestations and management. Semin Radiat Oncol 13: 346–356Google Scholar
  2. 2.
    Bartelink H, Horiot JC, Poortmans P et al. (2001) European Organization for Research and Treatment of Cancer Radiotherapy and Breast Cancer Groups. Recurrence rates after treatment of breast cancer with standard radiotherapy with or without additional radiation. N Engl J Med 345: 1378–1387Google Scholar
  3. 3.
    Bear HD, Anderson S, Brown A et al. (2003) National Surgical Adjuvant Breast and Bowel Project Protocol B-27. The effect on tumor response of adding sequential preoperative docetaxel to preoperative doxorubicin and cyclophosphamide: preliminary results from National Surgical Adjuvant Breast and Bowel Project Protocol B-27. J Clin Oncol 21: 4165–4174CrossRefPubMedGoogle Scholar
  4. 4.
    Cuzick J, Stewart H, Peto R et al. (1987) Overview of randomized trials comparing radical mastectomy without radiotherapy against simple mastectomy with radiotherapy in breast cancer. Cancer Treat Rep 71: 7–14Google Scholar
  5. 5.
    Cuzick J, Stewart H, Rutqvist L et al. (1994) Cause-specific mortality in long-term survivors of breast cancer who participated in trials of radiotherapy. J Clin Oncol 12: 447–453Google Scholar
  6. 6.
    De Graaf H, Dolsma WV, Willemse PH et al. (1997) Cardiotoxicity from intensive chemotherapy combined with radiotherapy in breast cancer. Br J Cancer 76: 943–945Google Scholar
  7. 7.
    De Zarraga FI, Doliny P, Reis I et al. (2003) Cardiotoxity of neoadjuvant trastuzumab, doxetaxel and cisplatin is related to BMI. Proc Am Soc Clin Oncol 22: 57Google Scholar
  8. 8.
    DiBiase SJ, Komarnicky LT, Heron DE et al. (2002) Influence of radiation dose on positive surgical margins in women undergoing breast conservation therapy. Int J Radiat Oncol Biol Phys 53: 680–686Google Scholar
  9. 9.
    Dunst J, Steil B, Furch S et al. (2001) Prognostic significance of local recurrence in breast cancer after postmastectomy radiotherapy. Strahlenther Onkol 117: 504–510Google Scholar
  10. 10.
    Early Breast Cancer Trialists‘ Collaborative Group (1995) Effects of radiotherapy and surgery in early breast cancer: an overview of the randomised trials. N Engl J Med 333: 1444–1455Google Scholar
  11. 11.
    Early Breast Cancer Trialists‘ Collaborative Group (2000) Favourable and unfavourable effects on long-term survival of radiotherapy for early breast cancer: an overview of the randomised trials. Lancet 355: 1757–1770Google Scholar
  12. 12.
    Early Breast Cancer Trialists‘ Collaborative Group (2002) Radiotherapy for early breast cancer. Cochrane Database Syst Rev 2: CD003647Google Scholar
  13. 13.
    Feigenberg SJ, Price Mendenhall N, Benda RK et al. (2003) Postmastectomy radiotherapy: patterns of recurrence and long-term disease control using electrons. Int J Radiat Oncol Biol Phys 56: 716–725Google Scholar
  14. 14.
    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: 1233–1241Google Scholar
  15. 15.
    Fisher B, Bryant J, Dignam JJ et al. (2002) Tamoxifen, radiation therapy, or both for prevention of ipsilateral breast tumor recurrence after lumpectomy in women with invasive breast cancers of one centimeter or less. J Clin Oncol 20: 4141–4149Google Scholar
  16. 16.
    Fisher B, Jeong JH, Anderson S et al. (2002) Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation. N Engl J Med 347: 567–575Google Scholar
  17. 17.
    Formenti SC, Volm M, Skinner KA et al. (2003) Preoperative twice-weekly paclitaxel with concurrent radiation therapy followed by surgery and postoperative doxorubicin-based chemotherapy in locally advanced breast cancer: a phase I/II trial. J Clin Oncol 21: 864–870Google Scholar
  18. 18.
    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: 963–970Google Scholar
  19. 19.
    Gehl J, Boesgaard M, Paaske T et al. (1996) Combined doxorubicin and paclitaxel in advanced breast cancer: effective and cardiotoxic. Ann Oncol 7: 687–693Google Scholar
  20. 20.
    Goldhirsch A, Glick JH, Gelber RD et al. (2001) Meeting highlights: International Consensus Panel on the Treatment of Primary Breast Cancer. Seventh International Conference on Adjuvant Therapy of Primary Breast Cancer. J Clin Oncol 19: 3817–3827Google Scholar
  21. 21.
    Goldhirsch A, Wood WC, Gelber RD et al. (2003) Meeting highlights: updated international expert consensus on the primary therapy of early breast cancer. J Clin Oncol 21: 3357–3365CrossRefPubMedGoogle Scholar
  22. 22.
    Grabenbauer GG (2004) Internal mammary nodes in invasive breast carcinoma — to treat or not to treat? Strahlenther Onkol 180: 690–694Google Scholar
  23. 23.
    Gruber G, Berclaz G, Altermatt HJ et al. (2003) Can the addition of regional radiotherapy counterbalance important risk factors in breast cancer patients with extracapsular invasion of axillary lymph node metastases? Strahlenther Onkol 179: 661–666Google Scholar
  24. 24.
    Gyenes G, Rutqvist LE, Liedberg A et al. (1998) Long-term cardiac morbidity and mortality in a randomized trial of pre- and postoperative radiation therapy versus surgery alone in primary breast cancer. Radiother Oncol 48: 185–190Google Scholar
  25. 25.
    Hall KS, Wiklund T, Erikstein B et al. (2001) Effects of dose-intensive chemotherapy and radiotherapy on serum N-terminal proatrial natriuretic peptide in high-risk breast cancer patients. Breast Cancer Res Treat 67: 235–244Google Scholar
  26. 26.
    Hardenbergh PH, Recht A, Gollamudi S et al. (1999) Treatment-related toxicity from a randomized trial of the sequencing of doxorubicin and radiation therapy in patients treated for early stage breast cancer. Int J Radiat Oncol Biol Phys 45: 69–72Google Scholar
  27. 27.
    Hardenbergh PH, Munley MT, Bentel GC et al. (2001) Cardiac perfusion changes in patients treated for breast cancer with radiation therapy and doxorubicin: preliminary results. Int J Radiat Oncol Biol Phys 49: 1023–1028Google Scholar
  28. 28.
    Harris JR, Halpin-Murphy P, McNeese M et al. (1999) Consensus statement on postmastectomy radiation therapy. Int J Radiat Oncol Biol Phys 44: 989–990Google Scholar
  29. 29.
    Hartsell WF, Recine DC, Griem KL et al. (1995) Delaying the initiation of intact breast irradiation for patients with lymph node positive breast cancer increases the risk of local recurrence. Cancer 76: 2497–2503PubMedGoogle Scholar
  30. 30.
    Hébert-Croteau N, Freeman C, Latreille J et al. (2004) Delay of radiation therapy and outcomes of breast cancer. J Clin Oncol 22: 1342–1343Google Scholar
  31. 31.
    Hetelekidis S, Schnitt SJ, Silver B et al. (2000) The significance of extracapsular extension of axillary lymph node metastases in early-stage breast cancer. Int J Radiat Oncol Biol Phys 46: 31–34Google Scholar
  32. 32.
    Hölzel D, Engel J, Schmidt M et al. (2001) Sekundäre Metastasierung aus lokoregionalen Rezidiven eines Mammakarzinoms. Strahlenther Onkol 177: 10–24Google Scholar
  33. 33.
    Huang J, Barbera L, Brouwers M et al. (2003) Does delay in starting treatment affect the outcomes of radiotherapy? A systematic review. J Clin Oncol 21: 555–563Google Scholar
  34. 34.
    Huang EH, Tucker SL, Strom EA et al. (2004) Postmastectomy radiation improves local-regional control and survival for selected patients with locally advanced breast cancer treated with neoadjuvant chemotherapy and mastectomy. J Clin Oncol 22: 4691–4699Google Scholar
  35. 35.
    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: 971–977Google Scholar
  36. 36.
    Katz A, Buchholz TA, Thames H et al. (2001) Recursive partitioning analysis of locoregional recurrence patterns following mastectomy: implications for adjuvant irradiation. Int J Radiat Oncol Biol Phys 50: 397–403Google Scholar
  37. 37.
    Katz A, Strom EA, Buchholz TA et al. (2001) The influence of pathologic tumor characteristics on locoregional recurrence rates following mastectomy. Int J Radiat Oncol Biol Phys 50: 735–742Google Scholar
  38. 38.
    Krueger EA, Schipper MJ, Koelling T et al. (2004) Cardiac chamber and coronary artery doses associated with postmastectomy radiotherapy techniques to the chest wall and regional nodes. Int J Radiat Oncol Biol Phys 60: 1195–1203Google Scholar
  39. 39.
    Landau D, Adams EJ, Webb S et al. (2001) Cardiac avoidance in breast radiotherapy: a comparison of simple shielding techniques with intensity-modulated radiotherapy. Radiother Oncol 60: 247–255Google Scholar
  40. 40.
    Lerouge D, Touboul E, Lefranc JP et al. (2004) Combined chemotherapy and preoperative irradiation for locally advanced noninflammatory breast cancer: updated results in a series of 120 patients. Int J Radiat Oncol Biol Phys 59: 1062–1073Google Scholar
  41. 41.
    Lind PA, Pagnanelli R, Marks LB et al. (2003) Myocardial perfusion changes in patients irradiated for left-sided breast cancer and correlation with coronary artery distribution. Int J Radiat Oncol Biol Phys 55: 914–920Google Scholar
  42. 42.
    Louis-Sylvestre C, Clough K, Asselain B et al. (2004) Axillary treatment in conservative management of operable breast cancer: dissection or radiotherapy? Results of a randomized study with 15 years of follow-up. J Clin Oncol 22: 97–101Google Scholar
  43. 43.
    Meinardi MT, Van Veldhuisen DJ, Gietema JA et al. (2001) Prospective evaluation of early cardiac damage induced by epirubicin-containing adjuvant chemotherapy and locoregional radiotherapy in breast cancer patients. J Clin Oncol 19: 2746–2753Google Scholar
  44. 44.
    Meinardi MT, Van Der Graaf WT, Gietema JA et al. (2002) Evaluation of long term cardiotoxicity after epirubicin containing adjuvant chemotherapy and locoregional radiotherapy for breast cancer using various detection techniques. Heart 88: 81–82Google Scholar
  45. 45.
    Morris AD, Morris RD, Wilson JF et al. (1997) Breast-conserving therapy vs mastectomy in early-stage breast cancer: a meta-analysis of 10-year survival. Cancer J Sci Am 3: 6–12Google Scholar
  46. 46.
    National Cancer Institute (NCI USA) (2004) Breast cancer. http://www.meb.uni-bonn.de/cancer.gov./CDR0000062787.html
  47. 47.
    Neuschatz AC, DiPetrillo T, Safaii H et al. (2003) Long-term follow-up of a prospective policy of margin-directed radiation dose escalation in breast-conserving therapy. Cancer 97: 30–39Google Scholar
  48. 48.
    Nixon AJ, Manola J, Gelman R et al. (1998) No long-term increase in cardiac-related mortality after breast-conserving surgery and radiation therapy using modern techniques. J Clin Oncol 16: 1374–1379Google Scholar
  49. 49.
    Overgaard M (2001) Radiotherapy as part of a multidisciplinary treatment strategy in early breast cancer. Eur J Cancer 37: S33–43Google Scholar
  50. 50.
    Overgaard M, Jensen MB, Overgaard J et al. (1999) Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomised trial. Lancet 353: 1641–1648Google Scholar
  51. 51.
    Pegram MD, Pienkowski T, Northfelt DW et al. (2004) Results of two open-label, multicenter phase II studies of docetaxel, platinum salts, and trastuzumab in HER2-positive advanced breast cancer. J Natl Cancer Inst 96: 759–769Google Scholar
  52. 52.
    Pierce LJ, Lew D, Hutchins L et al. (2003) Patterns of recurrence by sequence of chemotherapy and radiotherapy in early stage breast cancer. Int J Radiat Oncol Biol Phys [Suppl 2] 57: S127Google Scholar
  53. 53.
    Poortmans P, Bartelink H, Horiot JC et al. (2004) The influence of the boost technique on local control in breast conserving treatment in the EORTC ‚boost versus no boost‘ randomised trial. Radiother Oncol 72: 25–33Google Scholar
  54. 54.
    Punglia RS, Kuntz KM, Lee JH et al. (2003) Radiation therapy plus tamoxifen versus tamoxifen alone after breast-conserving surgery in postmenopausal women with stage I breast cancer: a decision analysis. J Clin Oncol 21: 2260–2267Google Scholar
  55. 55.
    Ragaz J, Olivotto IA, Spinelli JJ et al. (2005) Locoregional radiation therapy in patients with high-risk breast cancer receiving adjuvant chemotherapy: 20-year results of the British Columbia randomized trial. J Natl Cancer Inst 97: 116–126Google Scholar
  56. 56.
    Recht A (2003) Integration of systemic therapy and radiation therapy for patients with early-stage breast cancer treated with conservative surgery. Clin Breast Cancer 4: 104–113Google Scholar
  57. 57.
    Recht A (2004) Impact on outcome of delay in starting radiotherapy. J Clin Oncol 22: 1341–1342Google Scholar
  58. 58.
    Recht A, Come SE, Henderson IC et al. (1996) The sequencing of chemotherapy and radiation therapy after conservative surgery for early-stage breast cancer. N Engl J Med 334: 1356–1361CrossRefPubMedGoogle Scholar
  59. 59.
    Recht A, Gray R, Davidson NE et al. (1999) Locoregional failure 10 years after mastectomy and adjuvant chemotherapy with or without tamoxifen without irradiation: experience of the Eastern Cooperative Oncology Group. J Clin Oncol 17: 1689–1700Google Scholar
  60. 60.
    Recht A, Edge SB, Solin LJ et al. (2001) Postmastectomy radiotherapy: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol 19: 1539–1569Google Scholar
  61. 61.
    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: 963–968Google Scholar
  62. 62.
    Rutqvist LE, Rose C, Cavallin-Stahl E (2003) A systematic overview of radiation therapy effects in breast cancer. Acta Oncol 42: 532–545Google Scholar
  63. 63.
    Sack H (1994) Verkürzt die adjuvante Strahlentherapie nach Mastektomie die Lebenserwartung der Patientinnen? Strahlenther Onkol 170: 673–674Google Scholar
  64. 64.
    Sack H (1998) Brusterhaltende Behandlung im Vergleich zur Mastektomie bei frühem Mammakarzinom: eine Metaanalyse des zehnjährigen Überlebens. Strahlenther Onkol 174: 443–444Google Scholar
  65. 65.
    Sack H (1999) Strahlenfolgen am Herzen nach adjuvanter Doxorubicin- und Strahlentherapie bei Patientinnen nach Brustkrebs. Strahlenther Onkol 175: 293–294Google Scholar
  66. 66.
    Sauer R, Schulz KD, Hellriegel KP (2001) Strahlentherapie nach Mastektomie: interdisziplinärer Konsensus beendet Kontroverse. Strahlenther Onkol 177: 1–9Google Scholar
  67. 67.
    Schmidberger H, Hermann RM, Hess CF et al. (2003) Interactions between radiation and endocrine therapy in breast cancer. Endocr Relat Cancer 10: 375–388Google Scholar
  68. 68.
    Schmoor C, Sauerbrei W, Bastert G et al. (2000) Role of isolated locoregional recurrence of breast cancer: results of four prospective studies. J Clin Oncol 18: 1696–1708Google Scholar
  69. 69.
    Seidman A, Hudis C, Pierri MK et al. (2002) Cardiac dysfunction in the trastuzumab clinical trials experience. J Clin Oncol 20: 1215–1221Google Scholar
  70. 70.
    Shan K, Lincoff AM, Young JB (1996) Anthracycline-induced cardiotoxicity. Ann Intern Med 125: 47–58PubMedGoogle Scholar
  71. 71 .
    Shapiro CL, Recht A (2001) Side effects of adjuvant treatment of breast cancer. N Engl J Med 344: 1997–2008Google Scholar
  72. 72 .
    Shapiro CL, Hardenbergh PH, Gelman R et al. (1998) Cardiac effects of adjuvant doxorubicin and radiation therapy in breast cancer patients. J Clin Oncol 16: 3493–3501Google Scholar
  73. 73.
    Smith IE, Ross GM (2004) Breast radiotherapy after lumpectomy — no longer always necessary. N Engl J Med 351: 1021–1023Google Scholar
  74. 74.
    Strotmann J (2003) Anthrazyklintherapie beim Mammakarzinom. Onkologe 9: 1366–1374Google Scholar
  75. 75.
    Taghian AG, Bryant J, Anderson S et al. (2003) Pattern of regional failure in patients with breast cancer treated by lumpectomy, breast radiation±chemotherapy and/or tamoxifen with no regional radiation: results from 10 NSABP randomized trials. Int J Radiat Oncol Biol Phys [Suppl 2] 57: S168Google Scholar
  76. 76.
    Taghian A, Jeong JH, Mamounas E et al. (2004) Patterns of locoregional failure in patients with operable breast cancer treated by mastectomy and adjuvant chemotherapy with or without tamoxifen and without radiotherapy: results from five National Surgical Adjuvant Breast and Bowel Project randomized clinical trials. J Clin Oncol 22: 4247–4254Google Scholar
  77. 77.
    Trudeau M, Pagani O (2001) Epirubicin in combination with the taxanes. Semin Oncol [Suppl 12] 28: 41–50Google Scholar
  78. 78.
    Van de Steene J, Soete G, Storme G (2000) Adjuvant radiotherapy for breast cancer significantly improves overall survival: the missing link. Radiother Oncol 55: 263–272Google Scholar
  79. 79.
    Van der Hage JA, Van de Velde CJ, Julien JP et al. (2001) Preoperative chemotherapy in primary operable breast cancer: results from the European Organization for Research and Treatment of Cancer trail 10902. J Clin Oncol 19: 4224–4237PubMedGoogle Scholar
  80. 80.
    Van der Hage JA, Van de Velde CJ, Julien JP et al. (2001) Improved survival after one course of perioperative chemotherapy in early breast cancer patients. Long-term results from the European Organization for Research and Treatment of Cancer (EORTC) trial 10854. Eur J Cancer 37: 2184–2193Google Scholar
  81. 81.
    Van der Hage JA, Putter H, Bonnema J et al. (2003) Impact of locoregional treatment on the early-stage breast cancer patients: a retrospective analysis. Eur J Cancer 39: 2192–2199Google Scholar
  82. 82.
    Van Tienhoven G, Voogd AC, Peterse JL et al. (1999) Prognosis after treatment for loco-regional recurrence after mastectomy or breast conserving therapy in two randomised trials (EORTC 10801 and DBCG-82TM). EORTC Breast Cancer Cooperative Group and the Danish Breast Cancer Cooperative Group. Eur J Cancer 35: 32–38PubMedGoogle Scholar
  83. 83.
    Venables K, Miles EA, Aird EG et al. (2004) START Trial Management Group. The use of in vivo thermoluminescent dosimeters in the quality assurance programme for the START breast fractionation trial. Radiother Oncol 71: 303–310Google Scholar
  84. 84.
    Venables K, Miles EA, Deighton A et al. (2004) Irradiation of the heart during tangential breast treatment: a study within the START trial. Br J Radiol 77: 137–142Google Scholar
  85. 85.
    Veronesi U, Marubini E, Vecchio M del et al. (1995) Local recurrences and distant metastases after conservative breast cancer treatments: partly independant events. J Natl Cancer Inst 87: 19–27Google Scholar
  86. 86.
    Vinh-Hung V, Verschraegen C (2004) Breast-conserving surgery with or without radiotherapy: pooled-analysis for risks of ipsilateral breast tumor recurrence and mortality. J Natl Cancer Inst 96: 115–121Google Scholar
  87. 87.
    Voogd AC, Nielsen M, Peterse JL et al. (2001) Differences in risk factors for local and distant recurrence after breast-conserving therapy or mastectomy for stage I and II breast cancer: pooled results of two large European randomized trials. J Clin Oncol 19: 1688–1697Google Scholar
  88. 88.
    Voordeckers M, Van de Steene J, Vinh-Hung V et al. (2003) Adjuvant radiotherapy after mastectomy for pT1–pT2 node negative (pN0) breast cancer: is it worth the effort? Radiother Oncol 68: 227–231Google Scholar
  89. 89.
    Vrieling C, Collette L, Fourquet A et al. (2003) Can patient-, treatment- and pathology-related characteristics explain the high local recurrence rate following breast-conserving therapy in young patients? Eur J Cancer 39: 932–944Google Scholar
  90. 90.
    Wallgren A, Bonetti M, Gelber RD et al. (2003) International Breast Cancer Study Group trials I through VII. Risk factors for locoregional recurrence among breast cancer patients: results from International Breast Cancer Study Group trials I through VII. J Clin Oncol 21: 1205–1213Google Scholar
  91. 91.
    Whelan T, Levine M (2005) More evidence that locoregional radiation therapy improves survival: what should we do? J Natl Cancer Inst 97: 82–84Google Scholar
  92. 92.
    Whelan TJ, Julian J, Wright J et al. (2000) Does locoregional radiation therapy improve survival in breast cancer? A meta-analysis. J Clin Oncol 18: 1220–1229Google Scholar
  93. 93.
    Woodward WA, Strom EA, McNeese MD et al. (2003) Cardiovascular death and second non-breast cancer malignancy after postmastectomy radiation and doxorubicin-based chemotherapy. Int J Radiat Oncol Biol Phys 57: 327–335Google Scholar
  94. 94.
    Yock TI, Taghian AG, Kachnic LA et al. (2004) The effect of delaying radiation therapy for systemic chemotherapy on local-regional control in breast cancer. Breast Cancer Res Treat 84: 161–171Google Scholar
  95. 95.
    Zambetti M, Moliterni A, Materazzo C et al. (2001) Long-term cardiac sequelae in operable breast cancer patients given adjuvant chemotherapy with or without doxorubicin and breast irradiation. J Clin Oncol 19: 37–43PubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag 2005

Authors and Affiliations

  1. 1.Klinik für Strahlentherapie und RadioonkologieAllgemeines Krankenhaus Hagen gGmbH
  2. 2.Klinik für StrahlentherapieMartin-Luther-Universität Halle-Wittenberg
  3. 3.Klinik für Strahlentherapie und RadioonkologieAllgemeines Krankenhaus Hagen gGmbHHagen

Personalised recommendations