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Intraoperative Strahlentherapie beim Mammakarzinom

Intraoperative radiotherapy for breast cancer

  • Leitthema
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Der Gynäkologe Aims and scope

Zusammenfassung

Standard der postoperativen Strahlentherapie des brusterhaltend operierten Mammakarzinoms ist die homogene Bestrahlung der gesamten Brust bis zu einer Gesamtdosis von 50 Gy mit einer anschließenden Aufsättigung des Tumorbettes (Boost). Aus der vermehrten Feststellung von kleinen Mammakarzinomen bei postmenopausalen Patientinnen durch das Mammographiescreening ergibt sich die Notwendigkeit, über mögliche Veränderungen der bisherigen Therapiegewohnheiten nachzudenken. Nachdem der Großteil der Lokalrezidive im Bereich der ehemaligen Tumorhöhle auftritt, wird diskutiert, ob die alleinige Bestrahlung des Tumorbettes die Behandlung der gesamten Restbrust ersetzen kann. Publizierte Ergebnisse von Teilbrustbestrahlungen (sowohl intra- als auch postoperativ) zeigen ein sehr hohes Maß an lokaler Kontrolle bei Nachbeobachtungszeiten von bis zu 11 Jahren. Prospektive und randomisierte Studien untersuchen derzeit, bei welchen Patientinnen eine intraoperative Strahlentherapie (IORT) als alleinige Methode der Strahlenbehandlung nach vorausgegangener Operation ausreichend ist. Gemäß einer aktuellen Stellungnahme der Deutschen Gesellschaft für Radioonkologie (DEGRO) ist die IORT als Boost mit nachfolgender perkutaner Ganzbrustbestrahlung schon jetzt möglich.

Abstract

The standard postoperative radiotherapy after breast-conserving surgery is percutaneous irradiation of the entire breast to a total dose of 50 Gy, usually followed by a tumor bed boost. Due to the increased detection of small breast carcinomas by mammographic screening, it is necessary to consider a possible change of the existing therapeutic practice. Since the majority of local recurrences are close to the former tumor bed, the question arises whether tumor bed irradiation alone might be a therapeutic alternative to total breast irradiation. Published results of partial irradiation of the breast (intra- as well as postoperatively) show a very high degree of local control with follow-ups up to 11 years. Ongoing prospective and randomized studies are investigating which patients are suited to intraoperative radiotherapy as the sole irradiation method following surgery. According to a relevant statement of the DEGRO, intraoperative radiotherapy as a boost preceding percutaneous whole-breast irradiation is already possible.

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Authors and Affiliations

  1. Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland

    D. Bottke, R. Dourdoumas & T. Wiegel

  2. Universitätsfrauenklinik Ulm, Ulm, Deutschland

    R. Kreienberg & G. Sauer

Authors
  1. D. Bottke
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  2. R. Dourdoumas
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  3. T. Wiegel
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  4. R. Kreienberg
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  5. G. Sauer
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Correspondence to D. Bottke.

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Bottke, D., Dourdoumas, R., Wiegel, T. et al. Intraoperative Strahlentherapie beim Mammakarzinom. Gynäkologe 42, 402–408 (2009). https://doi.org/10.1007/s00129-008-2313-7

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  • DOI: https://doi.org/10.1007/s00129-008-2313-7

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