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Kosmetische Ergebnisse der brusterhaltenden Therapie des Mammakarzinoms

Cosmetic results of breast conserving therapy

Behandlungsresultate der Heidelberger Strahlenklinik aus den Jahren 1984 bis 1992

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Zusammenfassung

Ziel

Die brusterhaltende Therapie des Mammakarzinoms mit konservativer Operation und konsekutiver Bestrahlung wird im Rahmen dieser retrospektiven Studie in Hinblick auf lokale Tumorkontrolle, Überleben und kosmetische Ergebnisse überprüft.

Patienten und Methode

Alle Mammakarzinom-Patientinnen der Heidelberger Strahlenklinik mit brusterhaltender Therapie aus den Jahren 1984 bis 1992 wurden befragt und einbestellt. Mittels Fragebogen wurde die persönliche Einschätzung des kosmetischen Ergebnisses der Behandlung erfaßt. Kosmetik, Umfänge und Temperaturen verschiedener Brustregionen wurden vom Untersucher beurteilt und gemessen. Nebenwirkungen und Spätfolgen der Bestrahlung wurden nach dem EORTC/RTOG-Score bewertet.

Ergebnisse

192 Patientinnen der Stadien pT1 (71,9%) und pT2 (28,1%) konnten durchschnittlich 4,5 Jahre (Median: vier Jahre) nachbeobachtet werden. Nodal positiv waren 26,6% der Patientinnen. Lymphknotenbefall korrelierte mit schlechtem Grading des Tumors (p=0,0001). Zehnmal traten Fernmetastasen auf, davon einmal bei Lokalrezidiv. Acht Patientinnen hatten Lokalrezidive, drei davon traten vor Bestrahlung (Salvage) auf. Insgesamt traten nach Bestrahlung füf Lokalrezidive auf (=2,6%), davon waren drei Frauen prä-, zwei postmenopausal. Drei der betroffenen Patientinnen sind verstorben, einmal traten Fernmetastasen auf. 17 der 192 Patientinnen verstarben, drei davon wiesen ein Lokalrezidiv, acht Fernmetastasen auf. 64 Patientinnen wurden im Hinblick auf das kosmetische Ergebnis untersucht. Es war zweimal schlecht, 13mal mäßig, 34mal gut, 15mal sehr gut bei signifikant besserer Selbsteinschätzung als durch den Untersucher. Das Ergebnis der späten Strahlenreaktion: einmal trat eine drittgradige Spätfolge auf, elfmal zweitgradige, 38mal erstgradige und 14mal keine sichtbare. Bei Bestrahlung mit Keilfilter zeigte sich ein tendenziell besseres Langzeit- und kosmetisches Ergebnis (p=0,06). Weder die Operationsmethode (Quadranten-, Segmentresektion, Tumorexzision) noch die Breite des Bestrahlungsfeldes, die Strahlenqualität (Co60 oder 6 MVX) oder die Applikation eines Boosts auf das ehemalige Tumorbett hatten Einfluß auf die Kosmetik. Kein signifikanter Unterschied fand sich bei den Armumfängen der befallenen und unbefallenen Seite. Bei Temperaturmessungen korrespondierender Areale der erkrankten und der kontralateralen Brust fanden sich keine signifikanten Differenzen. Mit zunehmendem zeitlichen Abstand zur Primärbehandlung verschlechterten sich die kosmetischen Ergebnisse.

Schlußfolgerung

Die brusterhaltende Therapie des Mammakarzinoms erbringt bei wirksamer lokaler Tumorkontrolle gute bis sehr gute kosmetische Resultate mit akzeptablen Nebenwirkungen. Die geringfügige Verschlechterung der kosmetischen Ergebnisse im längeren zeitlichen Verlauf ist biologisch interessant und bedarf weiterer Klärung.

Abstract

Purpose

In this study we retrospectively analyzed local control, survival rate and late cosmetic results of women with early breast cancer receiving breast conserving therapy.

Patients and Methods

All patients (1984 through 1992) of the Department of Radio-Oncology (University of Heidelberg), who received breast conserving therapy consisting of conservative surgery followed by radiotherapy, were interviewed and asked to come. Subjective estimation of the cosmetic results of therapy was evaluated by means of a questionnaire. Cosmesis, circumferences and temperatures of different mammary regions were assessed and measured. Side effects and late sequelae were valued by the EORTC/RTOG-score.

Results

Mean follow-up time of 192 women (pT1: 71.9%, pT2: 28.1%) was 4.5 years (median: 4.0 years). 26.6% of them were nodal positive. Positive nodal status correlated with high tumor grading (p=0.0001). Ten patients developed distant metastases; one of them subsequent to having suffered a loco-regional failure. Eight loco-regional failures occurred, 3 of them before radiotherapy (salvage). Following radiotherapy altogether 5 loco-regional failures (=2.6%) were found; 3 women concerning were pre-, 2 postmenopausal. Three of these patients died, in 1 case occurred distant metastasis. Seventeen patients died, 3 of them presenting loco-regional failure, 8 of them showing distant metastasis. Sixty-four women were examined for cosmesis with the following result: a poor result was observed twice, a fair result 13 times, a good result 34 and an excellent result 15 times. Self-assessment was significantly better than observer’s assessment. Third-degree late sequelae were found once, second-degree was seen 11 times, first-degree 38 times and no visible late sequelae were observed 14 times. The use of wedges was followed with borderline significance (p=0.06) either by a better cosmesis and fewer late sequelae. Neither the type of surgery nor the width of the fields nor the quality of radiation (Co60 or 6 MVX) nor boost-application influenced the cosmetic result. Measured circumferences and distances showed no significant differences in the groups of the patients with poor or fair and good or excellent cosmesis. The temperature of the seized and contralateral breast showed no significant difference as well. With increasing distance from primary therapy the cosmetic results deteriorated.

Conclusion

Breast conserving therapy consisting of conservative surgery followed by radiotherapy causes predominantly excellent to good cosmetic results combined with an acceptable amount of late side effects. The decreased rate of good and excellent cosmetic long-term results is biological interesting and requires further studies.

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Authors and Affiliations

  1. Radiologische Klinik der Universität Heidelberg, Heidelberg, Deutschland

    Ursula Weischedel

  2. Universitätsklinik und-poliklinik für Strahlentherapie Würzburg, Würzburg, Deutschland

    Dirk Maessen & Michael Flentje

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  1. Dirk Maessen
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  2. Michael Flentje
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  3. Ursula Weischedel
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Maessen, D., Flentje, M. & Weischedel, U. Kosmetische Ergebnisse der brusterhaltenden Therapie des Mammakarzinoms. Strahlenther Onkol 174, 251–256 (1998). https://doi.org/10.1007/BF03038717

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  • DOI: https://doi.org/10.1007/BF03038717

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