We’re sorry, something doesn't seem to be working properly.

Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Skip to main content
SpringerLink
Log in

Frühes Mammakarzinom

Bestrahlung: Wer, wann, wo, wie lange?

Early-stage breast cancer

Irradiation: who, when, where and how long?

  • Leitthema
  • Published:
Der Onkologe Aims and scope

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Bartelink H, Maingon P, Poortmans P et al (2015) Whole-breast irradiation with or without a boost for patients treated with breast-conserving surgery for early breast cancer: 20-year follow-up of a randomised phase 3 trial. Lancet Oncol 16:47–56

    Article  Google Scholar 

  2. Bellon JR, Come SE, Gelman RS et al (2005) Sequencing of chemotherapy and radiation therapy in early-stage breast cancer: updated results of a prospective randomized trial. J Clin Oncol 23:1934–1940

    Article  Google Scholar 

  3. Bentzen SM, Agrawal RK, Aird EG et al (2008) The UK Standardisation of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet 371:1098–1107

    Article  CAS  Google Scholar 

  4. Bentzen SM, Agrawal RK, Aird EG et al (2008) The UK Standardisation of Breast Radiotherapy (START) Trial A of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet Oncol 9:331–341

    Article  CAS  Google Scholar 

  5. Brunt AM, Haviland JS, Sydenham M et al (2020) Ten-year results of FAST: a randomized controlled trial of 5‑fraction whole-breast radiotherapy for early breast cancer. J Clin Oncol 38:3261–3272

    Article  Google Scholar 

  6. Early Breast Cancer Trialists’ Collaborative G, Darby S, Mcgale P et al (2011) Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet 378:1707–1716

    Article  Google Scholar 

  7. Fastner G, Hauser-Kronberger C, Moder A et al (2016) Survival and local control rates of triple-negative breast cancer patients treated with boost-IOERT during breast-conserving surgery. Strahlenther Onkol 192:1–7

    Article  Google Scholar 

  8. Fastner G, Reitsamer R, Urbanski B et al (2020) Toxicity and cosmetic outcome after hypofractionated whole breast irradiation and boost-IOERT in early stage breast cancer (HIOB): First results of a prospective multicenter trial (NCT01343459). Radiother Oncol 146:136–142

    Article  Google Scholar 

  9. Fastner G, Reitsamer R, Ziegler I et al (2015) IOERT as anticipated tumor bed boost during breast-conserving surgery after neoadjuvant chemotherapy in locally advanced breast cancer—results of a case series after 5‑year follow-up. Int J Cancer 136:1193–1201

    Article  CAS  Google Scholar 

  10. Fastner G, Sedlmayer F, Merz F et al (2013) IORT with electrons as boost strategy during breast conserving therapy in limited stage breast cancer: long term results of an ISIORT pooled analysis. Radiother Oncol 108:279–286

    Article  Google Scholar 

  11. Franceschini D, Loi M, Chiola I, Arculeo S, Marzo M, Fernandes B, Masci G, Torrisi R, Tinterri C, Testori A, Santoro A, Scorsetti M (2021) Preliminary Results of a Randomized Study on Postmenopausal Women With Early Stage Breast Cancer: Adjuvant Hypofractionated Whole Breast Irradiation Versus Accelerated Partial Breast Irradiation (HYPAB Trial). Clin Breast Cancer 21(3):231–238. https://doi.org/10.1016/j.clbc.2020.09.004

    Article  PubMed  Google Scholar 

  12. Group ST, Bentzen SM, Agrawal RK et al (2008) The UK Standardisation of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet 371:1098–1107

    Article  Google Scholar 

  13. Group ST, Bentzen SM, Agrawal RK et al (2008) The UK Standardisation of Breast Radiotherapy (START) Trial A of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet Oncol 9:331–341

    Article  Google Scholar 

  14. Haussmann J, Budach W, Corradini S, Krug D, Tamaskovics B, Bölke E, Djiepmo-Njanang FJ, Simiantonakis I, Kammers K, Matuschek C (2020) No Difference in Overall Survival and Non-Breast Cancer Deaths after Partial Breast Radiotherapy Compared to Whole Breast Radiotherapy–A Meta-Analysis of Randomized Trials. Cancers (Basel) 12(8):2309. https://doi.org/10.3390/cancers12082309

    Article  Google Scholar 

  15. Haussmann J, Budach W, Strnad V, Corradini S, Krug D, Schmidt L, Tamaskovics B, Bölke E, Simiantonakis I, Kammers K, Matuschek C (2021) Comparing Local and Systemic Control between Partial- and Whole-Breast Radiotherapy in Low-Risk Breast Cancer–A Meta-Analysis of Randomized Trials. Cancers (Basel) 13(12):2967. https://doi.org/10.3390/cancers13122967

    Article  Google Scholar 

  16. Haviland JS, Owen JR, Dewar JA et al (2013) The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomised controlled trials. Lancet Oncol 14:1086–1094

    Article  Google Scholar 

  17. Krug D, Baumann R, Krockenberger K, Vonthein R, Schreiber A, Boicev A, Würschmidt F, Weinstrauch E, Eilf K, Andreas P, Höller U, Dinges S, Piefel K, Zimmer J, Dellas K, Dunst J (2021) Adjuvant hypofractionated radiotherapy with simultaneous integrated boost after breast-conserving surgery: results of a prospective trial. Strahlenther Onkol 197(1):48–55. https://doi.org/10.1007/s00066-020-01689-7

    Article  PubMed  Google Scholar 

  18. Krug D, Koder C, Hafner MF et al (2020) Acute toxicity of normofractionated intensity modulated radiotherapy with simultaneous integrated boost compared to three-dimensional conformal radiotherapy with sequential boost in the adjuvant treatment of breast cancer. Radiat Oncol 15:235

    Article  CAS  Google Scholar 

  19. Matuschek C, Bölke E, Haussmann J, Mohrmann S, Nestle-Krämling C, Gerber PA, Corradini S, Orth K, Kammers K, Budach W (2017) The benefit of adjuvant radiotherapy after breast conserving surgery in older patients with low risk breast cancer–a meta-analysis of randomized trials. Radiat Oncol 12(1):60. https://doi.org/10.1186/s13014-017-0796-x

    Article  PubMed  PubMed Central  Google Scholar 

  20. Murray Brunt A, Haviland JS, Wheatley DA et al (2020) Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5‑year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial. Lancet 395:1613–1626

    Article  Google Scholar 

  21. Offersen BV, Alsner J, Nielsen HM et al (2020) Hypofractionated versus standard fractionated radiotherapy in patients with early breast cancer or ductal carcinoma in situ in a randomized phase III trial: the DBCG HYPO trial. J Clin Oncol 38:3615–3625

    Article  Google Scholar 

  22. Polgar C, Janvary L, Major T et al (2010) The role of high-dose-rate brachytherapy boost in breast-conserving therapy: Long-term results of the Hungarian National Institute of Oncology. Rep Pract Oncol Radiother 15:1–7

    Article  Google Scholar 

  23. Recht A, Come SE, Henderson IC et al (1996) The sequencing of chemotherapy and radiation therapy after conservative surgery for early-stage breast cancer. N Engl J Med 334:1356–1361

    Article  CAS  Google Scholar 

  24. Sauer R, Sautter-Bihl ML, Budach W et al (2007) Accelerated partial breast irradiation: consensus statement of 3 German Oncology societies. Cancer 110:1187–1194

    Article  Google Scholar 

  25. Swanick CW, Lei X, Shaitelman SF et al (2016) Longitudinal analysis of patient-reported outcomes and cosmesis in a randomized trial of conventionally fractionated versus hypofractionated whole-breast irradiation. Cancer 122:2886–2894

    Article  Google Scholar 

  26. Vaidya JS, Baum M, Tobias JS et al (2006) Targeted intraoperative radiotherapy (TARGIT) yields very low recurrence rates when given as a boost. Int J Radiat Oncol Biol Phys 66:1335–1338

    Article  Google Scholar 

  27. Vaidya JS, Joseph DJ, Tobias JS, Bulsara M, Wenz F, Saunders C, Alvarado M, Flyger HL, Massarut S, Eiermann W, Keshtgar M, Dewar J, Kraus-Tiefenbacher U, Sütterlin M, Esserman L, Holtveg HM, Roncadin M, Pigorsch S, Metaxas M, Falzon M, Matthews A, Corica T, Williams NR, Baum M (2010) Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial): an international, prospective, randomised, non-inferiority phase 3 trial. Lancet 376(9735):91–102. https://doi.org/10.1016/S0140-6736(10)60837-9. Erratum in: Lancet 376(9735):90

    Article  PubMed  Google Scholar 

  28. Vassilis K, Ioannis G, Anna Z et al (2017) A unique hypofractionated radiotherapy schedule with 51.3 Gy in 18 fractions three times per week for early breast cancer: outcomes including local control, acute and late skin toxicity. Breast Cancer 24:263–270

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medizinische Fakultät, Klinik für Strahlentherapie und Radioonkologie, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland

    Christiane Matuschek &  Wilfried Budach

Authors
  1. Christiane Matuschek
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wilfried Budach
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christiane Matuschek.

Ethics declarations

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.

Additional information

figure qr

QR-Code scannen & Beitrag online lesen

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Matuschek, C., Budach, W. Frühes Mammakarzinom. Onkologe 27, 1220–1227 (2021). https://doi.org/10.1007/s00761-021-01057-9

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00761-021-01057-9

Schlüsselwörter

Keywords

Search

Navigation