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Adjuvante Strahlentherapie beim Mammakarzinom

Adjuvant radiotherapy for breast cancer

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Der Gynäkologe Aims and scope

Zusammenfassung

Die Strahlentherapie beim Mammakarzinom hat sich in den letzten Jahren erheblich gewandelt. Die wichtigste Änderung war die Einführung einer moderaten Hypofraktionierung für die Mehrheit der Patientinnen, eine Hypofraktionierung mit moderater Akzelerierung (15–16 Fraktionen, Gesamtdosis ca. 40–42 Gy, Behandlungszeit ca. 3 Wochen). Für günstige Tumoren ist eine Teilbrustbestrahlung möglich. Die adjuvante Bestrahlung der regionalen Lymphknoten kann vermutlich die Prognose für Subgruppen verbessern, doch die optimale Abstimmung der Behandlungsmodalitäten bleibt eine Herausforderung. Für Patientinnen mit linksseitigen Tumoren haben sich herzschonende Verfahren, z. B. Bestrahlung in tiefer Inspiration mit „breath hold“, etabliert.

Abstract

Adjuvant radiotherapy for breast cancer has undergone significant changes during recent years. The most important modification has been the introduction of moderately hypofractionated radiotherapy for the majority of patients, e.g. a total dose of about 40–42 Gy in 15 or 16 fractions in an overall treatment time of 3 weeks. Partial breast irradiation has become an accepted alternative to whole breast radiotherapy for patients with low-risk tumors. Adjuvant irradiation of regional nodes may improve prognosis in subgroups but the optimal adjustment of treatment modalities remains a challenge. In patients with left-sided tumors, heart-sparing techniques (e.g. deep inspiration breath-hold) have become standard

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Notes

  1. Die strahlenbiologische Erklärung ist ein erstaunlich niedriger α/β-Wert von Mammakarzinomen, der sich von den meisten bekannten α/β-Werten anderer Tumoren unterscheidet. Bei niedrigen α/β-Werten ist eine Hypofraktionierung möglich und sinnvoll. Bis vor wenigen Jahren galt das Dogma, dass bösartige Tumoren generell durch hohe α/β-Werte charakterisiert sind. Große Studien mit unterschiedlichen Fraktionierungen, aus denen man α/β-Werte berechnen kann, gibt es beim Mammakarzinom erst seit wenigen Jahren.

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Authors and Affiliations

  1. Klinik für Strahlentherapie, Christian-Albrechts-Universität zu Kiel, UKSH Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland

    Jürgen Dunst

  2. Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

    Cordula Petersen

  3. Klinik für Frauenheilkunde, Christian-Albrechts-Universität zu Kiel, UKSH Campus Kiel, Kiel, Deutschland

    Nicolai Maass

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  1. Jürgen Dunst
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Correspondence to Jürgen Dunst.

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J. Dunst, C. Petersen und N. Maass geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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N. Maass, Kiel

J. Dunst, Kiel

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Dunst, J., Petersen, C. & Maass, N. Adjuvante Strahlentherapie beim Mammakarzinom . Gynäkologe 52, 896–901 (2019). https://doi.org/10.1007/s00129-019-04532-y

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