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Brusterhaltende Chirurgie des Mammakarzinoms

Erfahrungen und Ergebnisse der letzten 20 Jahre

Conservative surgery in breast cancer

Results of the last 20 years

  • Themenschwerpunkt: Therapiekonzepte Beim Operablen Mammakarzinom
  • Published:
Acta Chirurgica Austriaca Aims and scope Submit manuscript

Zusammenfassung

Seit 1970 wird das Mammakarzinom an der I. Chirurgischen Universitätsklinik Wien zunehmend brusterhaltend operiert. Seit 1980 wurden 516 Patientinnen mit einem Mammakarzinom im klinischen Stadium T1,2, N0,I, Mx nach einheitlichem chirurgischem Vorgehen operiert, davon 296 Patientinnen lokal mit 45 bis 50 Gy Iridium 192 nachbestrahlt, wobei die Applikation rein perkutan (23 Patientinnen), mit zusätzlichem Elektronenboost (55 Patientinnen) oder mit interstitiellem Boost (212 Patientinnen) erfolgte. Nach einer mittleren Beobachtungsdauer von 4 Jahren entwikkelten 3,7% der nachbestrahlten Patientinnen und 5,9% der nichtbestrahlten Patientinnen ein alleiniges Lokalrezidiv. Das Auftreten des Lokalrezidivs war in beiden Gruppen unabhängig von Tumorgröße und Status der axillären Lymphknoten, während Hormonrezeptorstatus und Tumorgrading die Lokalrezidivrate deutlich beeinflußten. Östrogenrezeptor-negative Primärtumoren rezidivierten lokal 2,5mal so häufig wie östrogenrezeptor-positive, G1-Tumoren seltener als G2-und G3-Tumoren. Die Lokalrezidivrate war nach kombinierter perkutaner Bestrahlung mit interstitiellem Boost mit 3,3% niedriger als nach perkutanem Boost (5,4%) oder nach alleiniger perkutaner Bestrahlung (8,5%). Die geringe Lokalrezidivrate bei Patientinnen über 60 Jahren mit hormonrezeptor-positivem Tumor im Stadium T1 läßt eine Brusterhaltung ohne Nachbestrahlung in diesen prognostisch begünstigten Fällen gerechtfertigt erscheinen.

Summary

Since 1970 conservative breast surgery is increasingly performed at the First Department of Surgery of the University of Vienna. Since 1980 516 patients with breast carcinoma of clinical stage T1,2,N0,1, Mx have been operated following a unified concept. 296 were treated with adjuvant radiotherapy through application of 45 to 50 gy Iridium 192 percutaneously only (23 patients), with additional electron boost (55 patients) or with additional interstitial boost (212 patients). Tumor recurred locally in 3.7% of patients following radiation and 5.9% of patients without radiotherapy after a median of 4 years of observation. Local recurrence of disease was, in both groups, independent of tumor size and axillary lymphnode involvement, whereas estrogen (and progresterone) receptor status and tumor grading clearly influenced the rate of local recurrence, which was 2.5 times higher for receptor-negative than for receptor-positive tumors and lower for G1 than for G2 or G3 tumors. Local recurrence rate following combined percutaneous and interstitial irradiation with iridium 192 was 3.3% compared to 5.4% after combination with percutaneous boost or 8.4% after percutaneous irradiation only. The low incidence of local recurrence in patients over 60 years with hormone receptor positive tumors staged T1 seems to justify conservation of the breast without radiation therapy in these cases.

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Authors and Affiliations

  1. I. Chirurgischen Universitätsklinik Wien, Alserstraße 4, A-1090, Wien

    Claudia Hausmaninger, B. Teleky, Gabriele Berlakovich, Th. Hölzenbein, G. Reiner &  R. Jakesz

  2. Institut für Pathologische Anatomie und Histologie der Universität Wien, Alserstraße 4, A-1090, Wien

    Angelika Reiner

  3. Universitätsklinik für Strahlentherapie und Strahlenbiologie Wien, Alerstraße 4, A-1090, Wien

    W. Seitz & Ch. Stanek

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  1. Claudia Hausmaninger
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  2. B. Teleky
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  4. Th. Hölzenbein
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  5. G. Reiner
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  7. W. Seitz
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  9. R. Jakesz
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Herrn Prof. Dr.A. Fritsch zum 65. Geburtstag gewidmet.

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Hausmaninger, C., Teleky, B., Berlakovich, G. et al. Brusterhaltende Chirurgie des Mammakarzinoms. Acta Chir Austriaca 23, 35–42 (1991). https://doi.org/10.1007/BF02658921

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  • DOI: https://doi.org/10.1007/BF02658921

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