Der Gynäkologe

, Volume 50, Issue 11, pp 879–884 | Cite as

Strahlentherapie nach brusterhaltender Operation beim Mammakarzinom

Aktuelle Entwicklungen und Studienkonzepte
  • Jürgen Dunst
  • René Baumann
  • Ping Jiang
  • Constanze Walldorf
  • Dirk Bauerschlag
Gynäkologie aktuell
  • 90 Downloads

Zusammenfassung

Die in den 1980er-Jahren etablierte Strahlentherapie bei Brustkrebs hat zahlreiche, relevante Veränderungen erfahren. Die Forschung hat zwar das Verständnis für die Wirkung verbessert, aber gleichzeitig auch Fragen aufgeworfen. Fokussiert wird auf Radiotherapie nach brusterhaltender Operation. Aktuelle bzw. noch laufende Studien, u.a. der ARO, werden vorgestellt. Thematisiert wird auch das Desiderat der notwendigen Skepsis (z.B. Limitationen durch zu kurze Gesamtbestrahlungszeit bei größeren Volumina, Überforderung der Reparaturkapazität gesunden Gewebes) angesichts von Versuchen, die Behandlungszeit noch weiter zu minimieren. Mit Einführung der Hypofraktionierung hat sich der Vorteil der Teilbrustbestrahlung bezüglich der Behandlungszeit verringert; daher wäre ein Trend weg von der Teilbrustbestrahlung plausibel, in den USA etwa ist er schon zu beobachten. Allerdings bleibt sie bei brusterhaltender Operation von Rezidiven nach Radiotherapie die einzig sinnvolle strahlentherapeutische Option.

Schlüsselwörter

Dosis-Hypofraktionierung Brusterhaltende Operation Mastektomie Brachytherapie Lymphknoten 

Radiation therapy after breast-conserving surgery for breast cancer

Current developments and study concepts

Abstract

The radiation therapy for breast cancer established in the 1980s has experienced many relevant modifications. Research has improved the understanding of the mode of action but at the same time has thrown up questions. The focus is on radiation treatment after breast-conserving surgery. Current results and running studies, e.g. the Working Group of Radiation Oncology (ARO) study are presented. Also addressed is the desideratum for the necessary scepsis (e.g. limitations due to a too short total irradiation time for large volumes and excessive demands on the repair capacity of healthy tissue) in view of the attempts to minimize the treatment times even further. With the introduction of hypofractionization, the advantage of partial breast irradiation has been reduced with respect to the treatment time; therefore, a trend away from partial breast irradiation would be plausible and can already be observed in the USA; nevertheless, this remains the only meaningful radiotherapeutic option for breast-conserving operations for recurrences following irradiation.

Keywords

Dose hypofractionation Surgery, breast conserving Mastectomy  Brachytherapy Lymph nodes 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

R. Baumann, P. Jiang, C. Walldorf, D. Bauerschlag und J. Dunst geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Aly MMOM, Abo-Madyan Y, Jahnke L, Wenz F, Glatting G (2016) Comparison of breast sequential and simultaneous integrated boost using the biologically effective dose volume histogram (BEDVH). Radiat Oncol 11:16CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Bantema-Joppe EJ, Vredeveld EJ, de Bock GH, Busz DM, Woltman-van Iersel M, Dolsma WV, van der Laan HP, Langendijk JA, Maduro JH (2013) Five year outcomes of hypofractionated simultaneous integrated boost irradiation in breast conserving therapy; patterns of recurrence. Radiother Oncol 108:269–272CrossRefPubMedGoogle Scholar
  3. 3.
    Budach W, Boelke E, Kammers K, Matuschek C, Gerber PA, Nestle-Kraemling C (2015) Adjuvant radiotherapy of regional lymph nodes in breast cancer – a meta-analysis of randomized trials – an update. Radiat Oncol 10:258CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Chadha M, Vongtama D, Friedmann P, Parris C, Boolbol SK, Woode R, Harrison LB (2012) Comparative acute toxicity from whole breast irradiation using 3‑week accelerated schedule with concomitant boost and the 6.5-week conventional schedule with sequential boost for early-stage breast cancer. Clin Breast Cancer 12:57–62CrossRefPubMedGoogle Scholar
  5. 5.
    Dellas K, Vonthein R, Zimmer J, Dinges S, Boicev AD, Andreas P, Fischer D, Winkler C, Ziegler A, Dunst J, ARO Study Group. (2014) Hypofractionation with simultaneous integrated boost for early breast cancer. Results of the German multicentre phase II trial (ARO-2010-01). Strahlenther Onkol 190:646–653CrossRefPubMedGoogle Scholar
  6. 6.
    Giuliano AE, Hunt KK, Ballman KV et al (2011) Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA 305:569–575CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Haviland JS, Owen JR, Dewar JA, Agrawal RK, Barrett J, Barrett-Lee PJ, Dobbs HJ, Hopwood P, Lawton PA, Magee BJ, Mills J, Simmons S, Sydenham MA, Venables K, Bliss JM, Yarnold JR, START Trialists’ Group. (2013) The UK Standardisation of BreastRadiotherapy (START) trials of radiotherapy hypofractionation for treatment ofearly breast cancer: 10-year follow-up results of two randomised controlled trials. Lancet Oncol 14(11):1086–1094CrossRefPubMedGoogle Scholar
  8. 8.
    Hennequin C, Bossard N, Servagi-Vernat S, Maingon P, Dubois JB, Datchary J, Carrie C, Roullet B, Suchaud JP, Teissier E, Lucardi A, Gerard JP, Belot A, Iwaz J, Ecochard R, Romestaing P (2013) Ten-year survival results of a randomized trial of irradiation of internal mammary nodes after mastectomy. Int J Radiat Oncol Biol Phys 86:860–866CrossRefPubMedGoogle Scholar
  9. 9.
    Owen JR, Ashton A, Bliss JM, Homewood J, Harper C, Hanson J, Haviland J, Bentzen SM, Yarnold JR (2006) Effect of radiotherapy fraction size on tumour control in patients with early-stage breast cancer after local tumour excision: long-term results of a randomized trial. Lancet Oncol 7:467–471CrossRefPubMedGoogle Scholar
  10. 10.
    Poortmans PM, Collette S, Kirkove C et al (2015) Internal mammary and medial supraclavicular irradiation in breast cancer. N Engl J Med 373:317–327CrossRefPubMedGoogle Scholar
  11. 11.
    Sedlmayer F, Sautter-Bihl ML, Budach W, Dunst J, Fastner G, Feyer P, Fietkau R, Haase W, Harms W, Souchon R, Wenz F, Sauer R, Breast Cancer Expert Panel of the German Society of Radiation Oncology (DEGRO) (2013) DEGRO practical guidelines: radiotherapy of breast cancer I. Radiotherapy following breast conserving therapy for invasive breast cancer. Strahlenther Onkol 189:825–833CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    START Trialists’ Group, Bentzen SM, Agrawal RK, Aird EG, Barrett JM, Barrett-Lee PJ, Bliss JM, Brown J, Dewar JA, Dobbs HJ, Haviland JS, Hoskin PJ, Hopwood P, Lawton PA, Magee BJ, Mills J, Morgan DA, Owen JR, Simmons S, Sumo G, Sydenham MA, Venables K, Yarnold JR (2008) The UK Standardization of Breast Radiotherapy (START) Trial A of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet Oncol 9:331–341CrossRefGoogle Scholar
  13. 13.
    START Trialists’ Group, Bentzen SM, Agrawal RK, Aird EG, Barrett JM, Barrett-Lee PJ, Bentzen SM, Bliss JM, Brown J, Dewar JA, Dobbs HJ, Haviland JS, Hoskin PJ, Hopwood P, Lawton PA, Magee BJ, Mills J, Morgan DA, Owen JR, Simmons S, Sumo G, Sydenham MA, Venables K, Yarnold JR, The UK Standardization of Breast Radiotherapy (START) (2008) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet 371:1098–1107CrossRefGoogle Scholar
  14. 14.
    Groupe Européen de Curiethérapie of European Society for Radiotherapy and Oncology (GEC-ESTRO), Strnad V, Ott OJ, Hildebrandt G et al (2016) 5‑year results of accelerated partial breast irradiation using sole interstitial multicatheter brachytherapy versus whole-breast irradiation with boost after breast-conserving surgery for low-risk invasive and in-situ carcinoma of the female breast: a randomised, phase 3, non-inferiority trial. Lancet 387(10015):229–238CrossRefGoogle Scholar
  15. 15.
    Thorsen LB, Offersen BV, Dano H et al (2016) DBCG-IMN: a population-based cohort study on the effect of internal mammary node irradiation in early node-positive breast cancer. J Clin Oncol 34(4):314–320CrossRefPubMedGoogle Scholar
  16. 16.
    Twyman-Saint Victor C, Rech AJ, Maity A et al (2015) Radiation and dual checkpoint blockade activate non-redundant immune mechanisms in cancer. Nature 520:373–377CrossRefPubMedGoogle Scholar
  17. 17.
    Van Parijs H, Miedema G, Vinh-Hung V, Verbanck S, Adriaenssens N, Kerkhove D, Reynders T, Schuermans D, Leysen K, Hanon S, Van Camp G, Vincken W, Storme G, Verellen D, De Ridder M (2012) Short course radiotherapy with simultaneous integrated boost for stage I–II breast cancer, early toxicities of a randomized clinical trial. Radiat Oncol 7:80CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Van Parijs H, Reynders T, Heuninckx K, Verellen D, Storme G, De Ridder M (2014) Breast conserving treatment for breast cancer: dosimetric comparison of sequential versus simultaneous integrated photon boost. Biomed Res Int.  https://doi.org/10.1155/2014/827475 PubMedPubMedCentralGoogle Scholar
  19. 19.
    Whelan TJ, Pignol JP, Levine MN, Julian JA, MacKenzie R, Parpia S, Shelley W, Grimard L, Bowen J, Lukka H, Perera F, Fyles A, Schneider K, Gulavita S, Freeman C (2010) Longterm results of hypofractionated radiation therapy for breast cancer. N Engl J Med 362:513–520CrossRefPubMedGoogle Scholar
  20. 20.
    Whelan T, Olivotto IA, Parulekar WR et al (2015) Regional nodal irradiation in early stage breast cancer. N Engl J Med 373:307–316CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Sedlmayer F, Sautter-Bihl ML, Budach W, Dunst J, Fastner G, Feyer P, Fietkau R, Haase W, Harms W, Souchon R, Wenz F, Sauer R, Breast Cancer Expert Panel of the German Society of Radiation Oncology (DEGRO) (2013) Is the simultaneously integrated boost (SIB) technique for early breast cancer ready to be adopted for routine adjuvant radiotherapy? Statement of the German and the Austrian Societies of Radiooncology (DEGRO/ÖGRO). Strahlenther Onkol 189:193–196CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH 2017

Authors and Affiliations

  • Jürgen Dunst
    • 1
  • René Baumann
    • 1
  • Ping Jiang
    • 1
  • Constanze Walldorf
    • 1
  • Dirk Bauerschlag
    • 2
  1. 1.Klinik für StrahlentherapieChristian-Albrechts-Universität zu KielKielDeutschland
  2. 2.Klinik für Strahlentherapie und Klinik für FrauenheilkundeChristian-Albrechts-Universität zu KielKielDeutschland

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