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Frühes Mammakarzinom

Bestrahlung: Wer, wann, wo, wie lange?

Early-stage breast cancer

Irradiation: who, when, where and how long?

Zusammenfassung

Hintergrund

Beim frühen Mammakarzinom wird in der Regel eine brusterhaltende Therapie durchgeführt. Diese beinhaltet auch eine adjuvante Strahlentherapie. Die adjuvante Strahlentherapie wurde jahrzehntelang über einen Zeitraum von 5–7 Wochen mit werktäglicher Bestrahlung durchgeführt. Standard war eine Ganzbrustbestrahlung mit oder ohne Boost.

Fragestellung

Evidenzbasierter Review zur Klärung der Frage, wer, wann, wo und wie lange bestrahlt werden sollte.

Material und Methode

Mittels systematischer Literaturrecherche in PubMed und manueller Suche wurden relevante Publikationen zwischen 2004 und 2021 untersucht.

Ergebnisse

Nach brusterhaltender Operation führt eine Nachbestrahlung der Brust zu einer Reduktion der Lokalrezidivrate. Das aktuelle Bestrahlungskonzept ist moderat hypofraktioniert. Bei sehr niedrigem Rezidivrisiko und/oder höherem Lebensalter können auch Teilbrustbestrahlungen oder, in ausgewählten Subgruppen als individuelles Konzept, ultrafraktionierte Bestrahlungskonzepte angewendet werden. Bei höherem Risiko kann zur Senkung des Lokalrezidivrisikos ein Boost appliziert werden.

Schlussfolgerungen

Grundsätzlich handelt es sich bei der adjuvanten Strahlentherapie nach brusterhaltender Operation um eine gut untersuchte, nebenwirkungsarme Therapie mit der Möglichkeit, das Lokalrezidivrisiko um den Faktor 3 zu senken. Es stehen inzwischen verschiedene Konzepte und Techniken für die individualisierte Therapie zur Verfügung. Insgesamt ist ein Trend zur Deeskalation der Strahlentherapie beim frühen Mammakarzinom zu verzeichnen.

Abstract

Background

In early-stage breast cancer, breast-conserving surgery is usually performed. This also includes an adjuvant radiotherapy, which for decades was administered daily over a period of 5–7 weeks. Whole-breast irradiation with or without a boost was standard practice.

Objective

An evidence-based review to determine who should be irradiated, when, where and for how long.

Material and methods

A systematic literature review of the relevant articles published in PubMed and in other databases between 2004 and 2021 was performed.

Results

After breast-conserving surgery, adjuvant radiotherapy of the breast results in a significantly reduced local recurrence rate. The current irradiation concept is moderately hypofractionated. In the case of very low recurrence risk and/or old age, partial breast irradiation or in selected subgroups ultra-hypofractionated irradiation schedules can be used. Otherwise, a boost can be administered to reduce the risk of local recurrence in higher risk patients.

Conclusion

Essentially, adjuvant radiotherapy after breast-conserving surgery is a well-studied technique with few side effects, which can reduce the risk of local recurrence by a factor of 3. Various concepts and techniques are available for individualized treatment. Overall, there is a trend towards de-escalation of radiotherapy in early-stage breast cancer.

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Correspondence to Christiane Matuschek.

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Interessenkonflikt

C. Matuschek: Mitglied der DEGRO. W. Budach: Mitglied der AGO Mamma-Gruppe, S3-Leitlinienkommission Mamma, DEGRO.

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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Matuschek, C., Budach, W. Frühes Mammakarzinom. Onkologe (2021). https://doi.org/10.1007/s00761-021-01057-9

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Schlüsselwörter

  • Brusterhaltende Therapie
  • Adjuvante Strahlentherapie
  • Brustkrebs
  • Moderate Hypofraktionierung
  • Radioonkologie

Keywords

  • Breast-conserving therapy
  • Radiotherapy, adjuvant
  • Breast cancer
  • Moderate hypofractionation
  • Radiation oncology