Intraoperative Strahlentherapie beim Mammakarzinom mit niederenergetischen Röntgenstrahlen

Zusammenfassung

Die intraoperative Strahlentherapie (IORT) im Rahmen der brusterhaltenden Therapie des Mammakarzinoms wird immer häufiger eingesetzt. Neben der Anwendung als Tumorbettboost haben die Ergebnisse der TARGIT-A-Studie gezeigt, dass die alleinige IORT in einem risikoadaptierten Konzept bei einem selektierten Patientinnenkollektiv eine nicht unterlegene Alternative zur konventionellen Ganzbrustradiatio darstellt. Vor dem Hintergrund der aktuellen Daten sollte die Indikation zur Strahlentherapie beim Mammakarzinom, sowie die operative und systemische Behandlung möglichst an das individuelle Rezidivrisiko der Patientin angepasst werden. Neben der Tumorbettaufsättigung, welche bereits als geeignete Alternative zur konventionellen Boostbestrahlung in den S3-Leitlinien zur Diagnostik, Therapie und Nachsorge des Mammakarzinoms verankert ist, kann die intraoperative Strahlentherapie seit dem 2013 publizierten Statement der Deutschen Gesellschaft für Radioonkologie (DEGRO) bei geeigneten Patientinnen auch als alleinige Radiatio angewandt werden. Des Weiteren kann die IORT bei Rezidiven nach einer vorausgegangenen brusterhaltenden Therapie oder bei einem primären Mammakarzinom nach thorakaler Bestrahlung in der Vorgeschichte und dem Wunsch der Patientin nach Brusterhalt nach entsprechender Aufklärung eingesetzt werden. Insbesondere Patientinnen, die ausschließlich eine IORT als Variante der akzelerierten Teilbrustbestrahlung erhalten, profitieren eindeutig im Sinne einer besseren Lebensqualität bei signifikant weniger Langzeittoxizität. Nichtsdestotrotz sind weitere Untersuchungen zur Validierung der bislang verfügbaren Ergebnisse sinnvoll, denn zum jetzigen Zeitpunkt ist das Patientenkollektiv, für das die IORT als alleinige Radiotherapie in Frage kommt, noch nicht abschließend geklärt.

Abstract

Intraoperative radiotherapy (IORT) is increasingly being used as a treatment option in early breast cancer (BC). The results of the TARGIT-A trial, which recruited 3451 patients in 11 countries over a time period of 12 years showed, that in a selected patient collective, IORT as a single dose in a risk adapted concept is non-inferior compared to conventional whole breast radiotherapy (WBRT) with regard to 5 year local recurrence (LR) and overall survival. Furthermore it was shown, that patients who had IORT only have less radiotherapy related complications and a better quality of life after therapy. Thus radiotherapy (RT) for breast cancer should be adapted to the individual risk, as it is the case for surgery and systemic treatment, and the application of IORT is one possibility to do so. The most frequent use of IORT is to deliver the tumor bed boost in addition to WBRT. Since the published 5 year LR is below 2%, this technique has been adopted by several guidelines. Toxicity and cosmesis after IORT boost is not different compared to external boost. Finally IORT is a potential treatment in women, in whom external RT is not an option, such as women with local relapse after breast conserving therapy of BC or women with primary BC after RT of the chest wall for other reasons. Although the published toxicity and efficacy seems to be acceptable, the data for this indications are very limited. Further research to verify the important role of IORT in the risk adapted treatment of early breast cancer is ongoing.

Schlüsselwörter

Intraoperative Strahlentherapie - Mammakarzinom - niederenergetische Röntgenstrahlen

Key words

intraoperative radiotherapy - breast cancer - low energy x-rays

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