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Präoperative Bestrahlung mit interstitiellem Radiohyperthermie-Boost bei Mammatumoren ≥3 cm

Preoperative external beam radiotherapy and interstitial radiohyperthermia in breast tumors ≥3 cm. The düsseldorf experience

Düsseldorfer Ergebnisse

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Zusammenfassung

Hintergrund

Untersucht wurde die Brusterhaltungsrate mit und ohne Myokutanlappenunterstützung nach präoperativer Chemotherapie, Radiotherapie und Hyperthermie.

Patienten und Methode

158 Patientinnen im Stadium IIA-IV wurden präoperativ mit Chemotherapic, Radiotherapie und Hyperthermie behandelt. Die Radiotherapie bestand aus einem primären interstitiellen Boost des palpablen Tumors von 10 Gy192Ir-HDR-Afterloading-Therapie sowie einer perkutanen Brustbestrahlung von 50 Gy in einer Fraktionierung von 5 × 2 Gy pro Woche. Die Hyperthermiebehandlung mit 43,5 bis 44,5 °C über 60 Minuten erfolgte unmittelbar vor der interstitiellen Bestrahlung.

Ergebnisse

Es wurden insgesamt 142 Patientinnen einer Sanierungsoperation unterzogen. 74 Patientinnen (52%) wurden brusterhaltend operiert. In 53 Fällen (37%) wurden Myokutanlappen verwendet. Nach einer medianen Beobachtungszeit von 20 Monaten entwickelte eine Patientin ein isoliertes Thoraxwandrezidiv. 14 weitere lokoregionäre Rezidive traten in Kombination mit Fernmetastasen auf.

Schlußfolgerung

Nach der vorgestellten präoperativen Behandlung wurde in mehr als der Hälfte der Fälle die Brust erhalten. Die niedrige isolierte Lokalrezidivrate von 0,6% (1/158) nach 20 Monaten muß durch längere Nachbeobachtung validiert werden.

Abstract

Aim

The aim of this protocol was to investigate breast conservation rates with and without flap-supported surgery after preoperative chemotherapy, radiotherapy and hyperthermia.

Patients and Methods

One hundred and fifty-eight patients with stage IIA-IV breast cancers were initially treated with chemotherapy, radiotherapy and hyperthermia. Radiation treatment consisted of an interstitial boost of 10 Gy192Ir-afterloading therapy and a course of external beam radiotherapy of 50 Gy, using 5 × 2 Gy/week. Local hyperthermia with 43.5–44.5°C over 60 minutes was delivered immediately before interstitial radiotherapy.

Results

One hundred and forty-two patients underwent salvage surgery. A breast-conserving approach was possible in 74 patients (52%). Fifty-three patients (37%) underwent flap-supported surgery. After a median follow-up of 20 months, one patient developed isolated local recurrence. In 14 cases, locoregional recurrences occurred in combination with distant metastases.

Conclusion

In about 50%, breast conservation was achieved by chemotherapy, radiotherapy and hyperthermia. The low isolated local recurrence rate of 0.6% (1/158) has to be substantiated by further follow-up.

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Authors and Affiliations

  1. Klinik für Strahlentherapie und Radioonkologie, Universität Düsseldorf, Niirebstraße 5, D-40225, Düsseldorf, Deutschland

    K. A. Hartmann, U. M. Carl, S. Gripp, K. Muskalla, T. Schnabel, I. Waap & G. Schmitt

  2. Abteilung für Senologie, Krankenhaus Gerresheim, Düsseldorf, Deutschland

    W. Audretsch & M. Rezai

  3. Strahlenklinik Offenbach, Deutschland

    C. Kolotas & N. Zamboglou

Authors
  1. K. A. Hartmann
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  2. W. Audretsch
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  3. U. M. Carl
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  4. S. Gripp
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  5. C. Kolotas
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  6. K. Muskalla
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  7. M. Rezai
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  8. T. Schnabel
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  9. I. Waap
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  10. N. Zamboglou
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  11. G. Schmitt
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Hartmann, K.A., Audretsch, W., Carl, U.M. et al. Präoperative Bestrahlung mit interstitiellem Radiohyperthermie-Boost bei Mammatumoren ≥3 cm. Strahlenther. Onkol. 173, 519–523 (1997). https://doi.org/10.1007/BF03038468

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  • DOI: https://doi.org/10.1007/BF03038468

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