Der Onkologe

, Volume 14, Issue 5, pp 497–503 | Cite as

Strahlentherapie des Mammakarzinoms

Primär operables inklusive nichtinvasives Karzinom
Leitthema
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Zusammenfassung

Der Nutzen der Nachbestrahlung nach brusterhaltender Operation des Mammakarzinoms ist gut belegt. Man sieht nach den Ergebnissen der Metaanalyse der Early Breast Cancer Trialists Collaborative Group, basierend auf Untersuchungen an 7311 Patientinnen, eine deutliche Reduktion des Lokalrezidivrisikos verbunden mit einem Überlebensvorteil von ca. 5% nach 15 Jahren (p=0,005). Durch Strahlentherapie wird das Lokalrezidivrisiko etwa um den Faktor 3 gesenkt. Vier verhinderte Lokalrezidive verhindern einen Todesfall. Fast alle Brustkebspatientinnen benötigen nach brusterhaltender Operation eine Strahlenbehandlung. In der Regel wird diese gut vertragen. Als wesentliche Akutnebenwirkung sind das Erythem der Haut und ein geringes bis mäßiges Ödem der Brust zu nennen. Fibrosebedingte Formveränderungen der Brust als Spätnebenwirkung der Strahlentherapie sind durch den Einsatz moderner Bestrahlungstechniken seltener geworden. Dasselbe gilt für lebensbedrohliche Spätfolgen einer Strahlentherapie wie induzierte Zweittumoren und Herzschädigungen. Insbesondere Letztere können heute fast vollständig vermieden werden. Der folgende Beitrag versucht, die aktuellen Studien nach Subgruppen zu analysieren und evt. Subgruppen zu definieren, die von einer Strahlentherapie nicht profitieren.

Schlüsselwörter

Mammakarzinom Brusterhaltende Operation Adjuvante Strahlentherapie Lokalrezidiv Mastektomie 

Radiotherapy for breast cancer

Primary operable cancer including noninvasive carcinoma

Abstract

The benefit of adjuvant radiotherapy after breast-conserving therapy is well established. A significant reduction of the local recurrence rate according to the results of the Early Breast Cancer Trialists’ Collaborative Group has been sufficiently demonstrated. The overall survival rate is increased by about 5% after 15 years (p=0.005). Radiotherapy reduces the local recurrence rate by about a factor of 3. Four prevented local recurrences prevent one death. Almost all breast cancer patients need radiotherapy after breast-conserving surgery. In most cases the therapy is well tolerated. One of the most common acute side effects however is skin erythema and mild to moderate edema of the irradiated breast. Deformation of the breast as a late side effect induced by radiotherapy rarely occurs since the advent of modern radiation techniques. The same is valid for potentially life-threatening late effects of radiotherapy like secondary cancers or heart damage. The last-mentioned can be avoided with modern techniques. One objective of this article is to analyze current studies and identify subgroups of patients who do not benefit from radiotherapy.

Keywords

Breast cancer Breast-conserving surgery Adjuvant radiotherapy Local recurrence Mastectomy 

Literatur

  1. 1.
    Bartelink H, Horiot JC, Poortmans P et al. (2001) Recurrence rates after treatment of breast cancer with standard radiotherapy with or without additional radiation. N Engl J Med 345: 1378–1387PubMedCrossRefGoogle 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 cancer: 10-year results of the randomized boost versus no boost EORTC 22881–10882 trial. J Clin Oncol 25: 3259–3265PubMedCrossRefGoogle Scholar
  3. 3.
    Bellon JR, Come SE, Gelman RS et al. (2005) Sequencing of chemotherapy and radiation therapy in early-stage breast cancer: updated results of a prospective randomized trial. J Clin Oncol 23: 1934–1940PubMedCrossRefGoogle Scholar
  4. 4.
    Cabioglu N, Krishnamurthy S, Kuerer HM et al. (2004) Feasibility of breast-conserving surgery for patients with breast carcinoma associated with nipple discharge. Cancer 101: 508–517PubMedCrossRefGoogle Scholar
  5. 5.
    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
  6. 6.
    Cutuli B, De Lafontan B, Quetin P et al. (2005) Breast-conserving surgery and radiotherapy: a possible treatment for lobular carcinoma in situ? Eur J Cancer 41: 380–385PubMedCrossRefGoogle Scholar
  7. 7.
    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: 1233–1241PubMedCrossRefGoogle Scholar
  8. 8.
    Fisher B, Costantino J, Redmond C et al. (1993) Lumpectomy compared with lumpectomy and radiation therapy for the treatment of intraductal breast cancer. N Engl J Med 328: 1581–1586PubMedCrossRefGoogle Scholar
  9. 9.
    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: 963–970PubMedCrossRefGoogle Scholar
  10. 10.
    Giordano SH, Kuo YF, Freeman JL et al. (2005) Risk of cardiac death after adjuvant radiotherapy for breast cancer. J Natl Cancer Inst 97: 419–424PubMedGoogle Scholar
  11. 11.
    Hojris I, Overgaard M, Christensen JJ et al. (1999) Morbidity and mortality of ischaemic heart disease in high-risk breast-cancer patients after adjuvant postmastectomy systemic treatment with or without radiotherapy: analysis of DBCG 82b and 82c randomised trials. Radiotherapy Committee of the Danish Breast Cancer Cooperative Group. Lancet 354: 1425–1430PubMedCrossRefGoogle Scholar
  12. 12.
    Holland R, Veling SH, Mravunac M et al. (1985) Histologic multifocality of Tis, T1–2 breast carcinomas. Implications for clinical trials of breast-conserving surgery. Cancer 56: 979–990PubMedCrossRefGoogle Scholar
  13. 13.
    Houghton J, George WD, Cuzick J et al. (2003) Radiotherapy and tamoxifen in women with completely excised ductal carcinoma in situ of the breast in the UK, Australia, and New Zealand: randomised controlled trial. Lancet 362: 95–102PubMedCrossRefGoogle Scholar
  14. 14.
    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: 971–977PubMedCrossRefGoogle Scholar
  15. 15.
    Julien JP, Bijker N, Fentiman IS et al. (2000) Radiotherapy in breast-conserving treatment for ductal carcinoma in situ: first results of the EORTC randomised phase III trial 10853. EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group. Lancet 355: 528–533PubMedCrossRefGoogle Scholar
  16. 16.
    Kraus-Tiefenbacher U, Bauer L, Scheda A et al. (2007) Intraoperative radiotherapy (IORT) is an option for patients with localized breast recurrences after previous external-beam radiotherapy. BMC Cancer 7: 178PubMedCrossRefGoogle Scholar
  17. 17.
    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: 1641–1648PubMedCrossRefGoogle Scholar
  18. 18.
    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: 25–33PubMedCrossRefGoogle Scholar
  19. 19.
    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: 1356–1361PubMedCrossRefGoogle Scholar
  20. 20.
    Resch A, Potter R, Van Limbergen E et al. (2002) Long-term results (10 years) of intensive breast conserving therapy including a high-dose and large-volume interstitial brachytherapy boost (LDR/HDR) for T1/T2 breast cancer. Radiother Oncol 63: 47–58PubMedCrossRefGoogle Scholar
  21. 21.
    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
  22. 22.
    Sauer R, Sautter-Bihl ML, Budach W et al. (2007) Accelerated partial breast irradiation: consensus statement of 3 German Oncology societies. Cancer 110: 1187–1194PubMedCrossRefGoogle Scholar
  23. 23.
    Smith BD, Haffty BG, Hurria A et al. (2006) Postmastectomy radiation and survival in older women with breast cancer. J Clin Oncol 24: 4901–4907PubMedCrossRefGoogle Scholar
  24. 24.
    Van De Steene J, Soete G, Storme G (2000) Adjuvant radiotherapy for breast cancer significantly improves overall survival: the missing link. Radiother Oncol 55: 263–272CrossRefGoogle Scholar
  25. 25.
    Van De Steene J, Vinh-Hung V, Cutuli B et al. (2004) Adjuvant radiotherapy for breast cancer: effects of longer follow-up. Radiother Oncol 72: 35–43CrossRefGoogle Scholar
  26. 26.
    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: 1227–1232PubMedCrossRefGoogle Scholar
  27. 27.
    Vinh-Hung V, Burzykowski T, Van De Steene J et al. (2002) Post-surgery radiation in early breast cancer: survival analysis of registry data. Radiother Oncol 64: 281–290PubMedCrossRefGoogle Scholar
  28. 28.
    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: 115–121PubMedCrossRefGoogle Scholar
  29. 29.
    Wo J, Taghian A (2007) Radiotherapy in setting of collagen vascular disease. Int J Radiat Oncol Biol Phys 69: 1347–1353PubMedGoogle Scholar
  30. 30.
    Wong JS, Kaelin CM, Troyan SL et al. (2006) Prospective study of wide excision alone for ductal carcinoma in situ of the breast. J Clin Oncol 24: 1031–1036PubMedCrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag 2008

Authors and Affiliations

  1. 1.Klinik und Poliklinik für Strahlentherapie und Radiologische OnkologieUniversitätsklinikum DüsseldorfDüsseldorfDeutschland

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