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Stellenwert der neoadjuvanten Chemotherapie in der Therapie des Mammakarzinoms

The value of neoadjuvant chemotherapy in the management of breast cancer

  • Themenschwerpunkt: Neue Adjuvante Therapiekonzepte Beim Mammakarzinom
  • Published:
Acta chirurgica Austriaca Aims and scope Submit manuscript

Zusammenfassung

Grundlagen: Trotz verbesserter Untersuchungsmethoden und zunehmender Früherkennung haben zum Zeitpunkt der Diagnose 10% bis 20% der Frauen mit Brustkrebs ein lokal fortgeschrittenes Mammakarzinom. Der Anteil der inflammatorischen Mammakarzinome, die sich durch eine besonders ungünstige Prognose ausweisen, beträgt maximal 4%. Die Lokalrezidivrate nach alleiniger Radiotherapie beträgt 61%, während durch die Kombinationstherapie Operation und Radiotherapie die Lokalrezidivrate auf 13% gesenkt werden kann. Unabhängig von der Lokaltherapie kommt es in beiden Gruppen gleich häufig zum Auftreten von Fernmetastasen.

Methodik: Anhand einer Literaturübersicht werden Ergebnisse und der Stellenwert einer neoadjuvanten Chemotherapie beim inflammatorischen, lokal fortgeschrittenen und primär operablen Mammakarzinom zusammengefaßt und analysiert.

Ergebnisse: Beim inflammatorischen Mammakarzinom hat die neoadjuvante Chemotherapie zu einer signifikanten Verbesserung des Überlebens geführt. Bei lokal fortgeschrittenen und primär operablen Mammakarzinomen kommt es durch Verabreichung einer neoadjuvanten Chemotherapie in bis zu 95% zu einem klinischem Ansprechen, wodurch in 63% bis 97% eine brusterhaltende Operation durchgeführt werden kann.

Schlußfolgerungen: Obwohl der Stellenwert der neoadjuvanten Chemotherapie in der Therapie des inflammatorischen und lokal fortgeschrittenen Mammakarzinoms gesichert ist, besteht vor allem beim inflammatorischen Mammakarzinom und im Stadium IIIB eine hohe Lokalrezidiv- und Metastasierungsrate, die innovativer Behandlungsverfahren bedarf. Beim primär operablen Mammakarzinomen muß der Stellenwert der neoadjuvanten Chemotherapie hinsichtlich Gesamtüberleben erst durch randomisierte Studien geklärt werden. Wobei viele Fragen hinsichtlich Substanzauswahl, Therapiedauer und Dosisintensivierung noch offen sind.

Summary

Background: Despite improved screening methods and increased early detection 10% to 20% of women with breast cancer have locally advanced disease at diagnosis. Up to 4% of these breast cancers are inflammatory with a very poor prognosis. With radiotherapy alone the local recurrence rate is about 61%, whereas with the combined therapy of surgery and radiotherapy the local recurrence rate is decreased to 13%. But the local therapy has no effect on distant metastasis.

Methods: A review of the literature and the value of the neoadjuvant chemotherapy in the treatment of inflammatory, locally advanced and primary operable breast cancer is presented.

Results: The neoadjuvant chemotherapy has significantly improved overall survival of women with inflammatory breast cancer. In locally advanced and primary operable tumors clinical response rates up to 95% are achieved with the application of neoadjuvant chemotherapy. This leads to a breast conserving rate of 63% to 97%.

Conclusions: The value of neoadjuvant chemotherapy in the treatment of inflammatory and locally advanced breast cancer is proved. Despite this fact there remains a high local recurrence rate and a frequent occurrence of distant metastases in inflammatory and stadium IIIB breast cancer, which leads to search for new treatment strategies. If neoadjuvant chemotherapy achieves a better overall survival in primary operable breast cancer is not clear and is the subject of ongoing randomized studies. Many questions regarding the choice of chemotherapeutical agents, duration of treatment and dose intensification are still not answered.

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  1. Klinische Abteilung für Onkologie, Medizinische Universitätsklinik, Auenbruggerplatz 15, A-8036, Graz, Austria

    M. Schmid & H. Samonigg

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  1. M. Schmid
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Schmid, M., Samonigg, H. Stellenwert der neoadjuvanten Chemotherapie in der Therapie des Mammakarzinoms. Acta Chir Austriaca 29, 68–72 (1997). https://doi.org/10.1007/BF02619742

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