Strahlentherapie und Onkologie

, Volume 194, Issue 7, pp 607–618 | Cite as

Individualization of post-mastectomy radiotherapy and regional nodal irradiation based on treatment response after neoadjuvant chemotherapy for breast cancer

A systematic review
  • David Krug
  • René Baumann
  • Wilfried Budach
  • Jürgen Dunst
  • Petra Feyer
  • Rainer Fietkau
  • Wulf Haase
  • Wolfgang Harms
  • Thomas Hehr
  • Marc D. Piroth
  • Felix Sedlmayer
  • Rainer Souchon
  • Frederik Wenz
  • Rolf Sauer
Review Article



To review the evidence regarding post-mastectomy radiotherapy (PMRT) and regional nodal irradiation (RNI) after neoadjuvant chemotherapy (NACT) for breast cancer, with a special focus on individualization of adjuvant radiotherapy based on treatment response.


A systematic literature search using the PubMed/Medline database was performed. We included prospective and retrospective reports with a minimum of 10 patients that had been published since 1st January 2000, and provided clinical outcome data analyzed by treatment response and radiotherapy.


Out of 763 articles identified via PubMed/Medline and hand search, 68 full text-articles were assessed for eligibility after screening of title and abstract. 13 studies were included in the systematic review, 9 for PMRT and 5 for RNI. All included studies were retrospective reports.


There is a considerable lack of evidence regarding the role of adjuvant radiotherapy and its individualization based on treatment response after NACT. Results of prospective randomized trials such as NSABP B‑51/RTOG 1304 and Alliance A11202 are eagerly awaited.


Local recurrence Neoadjuvant therapy Breast neoplasms Radiotherapy 

Individualisierung von Post-Mastektomie-Radiotherapie und regionärer Lymphknotenbestrahlung anhand des Therapieansprechens nach neoadjuvanter Chemotherapie bei Brustkrebs

Ein systematischer Review



Überblick über die Datenlage zur Post-Mastektomie-Radiotherapie (PMRT) und Bestrahlung der Lymphabflusswege (RNI) nach neoadjuvanter Chemotherapie (NACT) bei Patientinnen mit Mammakarzinom mit besonderem Schwerpunkt auf der Individualisierung der adjuvanten Radiotherapie anhand des Therapieansprechens.


Es wurde eine systematische Literaturrecherche mit der PubMed/Medline-Datenbank durchgeführt. Eingeschlossen wurden prospektive und retrospektive Studien mit mindestens 10 Patientinnen, die klinische Rezidiv- und Überlebensdaten mit Subgruppenanalysen bezüglich verabreichter Bestrahlung und Therapieansprechen lieferten und seit 1. Januar 2000 veröffentlicht wurden.


Von 763 Artikeln, die durch die Datenbankabfrage und eine ergänzende händische Suche identifiziert wurden, wurden nach Prüfung von Titel und Zusammenfassung 68 einer Volltextprüfung unterzogen. Schlussendlich wurden 13 retrospektive Arbeiten in den systematischen Review eingeschlossen, hiervon 9 mit PMRT und 5 mit RNI.


Es besteht eine deutliche Evidenzlücke bezüglich der Rolle der adjuvanten Radiotherapie nach NACT sowie deren Individualisierung anhand des Therapieansprechens bei Patientinnen mit Mammakarzinom. Prospektive Daten aus randomisiert kontrollierten Studien wie NSABP B-51/RTOG 1304 und Alliance A11202 werden dringend erwartet.


Lokalrezidiv Neoadjuvante Therapie Brustkrebs Strahlentherapie 


Compliance with ethical guidelines

Conflict of interest

D. Krug, R. Baumann, W. Budach, J. Dunst, P. Feyer, R. Fietkau, W. Haase, W. Harms, T. Hehr, M.D. Piroth, F. Sedlmayer, R. Souchon, F. Wenz, and R. Sauer declare that they have no competing interests.

Ethical standards

This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • David Krug
    • 1
    • 2
  • René Baumann
    • 3
  • Wilfried Budach
    • 4
  • Jürgen Dunst
    • 3
  • Petra Feyer
    • 5
  • Rainer Fietkau
    • 6
  • Wulf Haase
    • 7
  • Wolfgang Harms
    • 8
  • Thomas Hehr
    • 9
  • Marc D. Piroth
    • 10
  • Felix Sedlmayer
    • 11
  • Rainer Souchon
    • 12
  • Frederik Wenz
    • 13
  • Rolf Sauer
    • 6
  1. 1.Department of Radiation OncologyUniversity Hospital HeidelbergHeidelbergGermany
  2. 2.Heidelberg Institute for Radiation Oncology (HIRO)National Center for Radiation Research in Oncology (NCRO)HeidelbergGermany
  3. 3.University Hospital Schleswig-HolsteinKielGermany
  4. 4.Heinrich-Heine-UniversityDuesseldorfGermany
  5. 5.Vivantes Hospital NeukoellnBerlinGermany
  6. 6.University Hospital ErlangenErlangenGermany
  7. 7.Formerly St.-Vincentius-HospitalKarlsruheGermany
  8. 8.St. ClaraspitalBaselSwitzerland
  9. 9.Department of Radiation OncologyMarienhospital StuttgartStuttgartGermany
  10. 10.HELIOS-Hospital WuppertalWitten/Herdecke UniversityWuppertalGermany
  11. 11.Paracelsus Medical University HospitalSalzburgAustria
  12. 12.Formerly University Hospital TuebingenTuebingenGermany
  13. 13.Universitätsmedizin Mannheim, Medizinische Fakultät MannheimUniversität HeidelbergMannheimGermany

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