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TumorDiagnostik & Therapie 2008; 29(2): 91-95
DOI: 10.1055/s-2008-1027323
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Dilemmas in Therapy of Gestational Breast Cancer: Review of Literature

Dilemma in der Therapie bei Schwangeren mit Brustkrebs: Übersicht der LiteraturJ. Fajdić1 , N. Gotovac2 , Z. Hrgović3
  • 1Department of Surgery, County Hospital, Pozega, Croatia
  • 2Department of Radiology, County Hospital, Pozega, Croatia
  • 3Department of Obstetrics and Gynecology, J. J. Strossmayer University, Clinical Hospital Osijek, Croatia
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Publication Date:
18 April 2008 (online)

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Zusammenfassung

Gegenstand: Unter Verwendung von meist rückblickenden/retrospektiven Studien und diverser anderer verfügbarer Publikationen ist das Ziel dieser Besprechung/dieses Reviews aufzuzeigen, dass es neben den meisten geklärten Problemen noch verschiedene Unklarheiten bezüglich der GBC-Behandlung (Behandlung von Brustkrebs in der Schwangerschaft) gibt. Ergebnisse: Die Mehrheit der verwendeten Publikationen stellen klare Positionen im Hinblick auf die chirurgische Behandlung von GBC dar, wobei eine modifizierte radikale Brustamputation in diesen Präsentationen vorherrscht - unabhängig vom Stadium der Krankheit oder der Schwangerschaft. Aber es gibt Möglichkeiten der Anwendung von brusterhaltenden Eingriffen in Fällen mit einem geringeren Erkrankungsstadium, wenn postoperative Bestrahlung angewendet wird. Soweit die Strahlentherapie bei GBC angewendet wird, hat die Mehrheit der Autorenprotokolle ein klares Verständnis über die Risiken, die die Bestrahlung für den Fötus mit sich bringt und wie das Risiko im Hinblick auf das Stadium der Schwangerschaft bzw. im Hinblick auf die Entwicklung des Fötus zu analysieren ist. Zweifellos sind im ersten Trimester, während der Einnistung in den ersten zehn Tagen und während der Entwicklung der Organe, die zerstörenden Effekte der Bestrahlung am höchsten. Der Erfolg und die eingesetzten Modelle bei der Chemotherapie gegen GBC sind ebenso abhängig vom Stadium der Schwangerschaft. In allen Publikationen ist klar herausgestellt, dass die Chemotherapie im ersten Trimester der Schwangerschaft wegen allen neuro- und kardiotoxischen Effekten und der beträchtlichen Verzögerung des Wachstums des Fötus nicht akzeptabel ist. Wenn die Chemotherapie im dritten Trimester benötigt wird, kann sie auf den Zeitpunkt nach der Entbindung verzögert werden. Es besteht heutzutage Konsens dahingehend, dass der therapeutische Abort vermieden werden sollte - außer in klar definierten Fällen von GBC. Zusammenfassung: Das größte Problem im Hinblick auf die Festlegung der multidisziplinären Behandlung von GBC ist die kleine Anzahl von vorausblickenden/prospektiven Studien, während retrospektive Studien auf lange zeitliche Perioden der Beobachtung nach der Behandlung von GBC sowie der Behandlung durch mehrere Ärzte und der Verwendung von manchmal verschiedenen Behandlungsansätzen basieren. Es bleibt zu sagen, dass die Literatur heutzutage zeigt, dass das Stadium der Schwangerschaft bzw. das Alter des Fetus das grundlegende Kriterium für jegliche Art von Behandlung von GBC ist.

Abstract

Purpose: Goal of this review is, by using data of mostly retrospective studies and other available publications, to point out that besides most of cleared problems, there are several dilemmas in GBC treatment. Patients and methods: Reviewing protocols using Medline database as well as conclusions from meetings specialized on this topic, we found that greatest problems are in chemotherapy and irradiation of patients in I. and II. trimester. Problems in surgical part of treatment are considerably smaller. Results: Majority of used publications bring us clear positions about surgical treatment of GBC where modified radical mastectomy is prevailing, regardless to stage of disease or pregnancy. But, there are possibilities for usage of breast conserving surgery in cases with lower grade of the disease, if postoperative irradiation is used. As far as radiotherapy of GBC is used, majority of protocols consider clear understanding of risks that radiation carries for the fetus, and how the risk is to be analyzed considering stage of pregnancy, or in other words, stage of fetal development. Without doubt, highest level of deletory effects of radiation is in first trimester, during implantation in first ten days, and after, during organogenesis. Success and models used in chemotherapy in GBC is also dependable on stage of the pregnancy. All publications state clearly that chemotherapy is not acceptable in first trimester of pregnancy, due to all neuro and cardio toxic effects and considerable growth retardation. If needed during third trimester, chemotherapy can be delayed after delivery. There is consensus today that therapeutic abortion is to be avoided, except clearly defined cases of GBC. Conclusion: Biggest problem in getting the multidisciplinary treatment of GBC more clear is small number of prospective studies, while retrospective studies are based on tracking the patients after long periods after the treatment of GBC as well as patients treated by several physicians and using sometimes different approaches. It still remains to be said, literature shows today that stage of pregnancy, or in other words, age of fetus, is base criteria for any kind of treatment of GBC.

Schlüsselwörter

Schwangerschaftsbrustkrebs - therapeutische Schwierigkeiten/Dilemma - Literaturangaben

Key words

gestational breast cancer - dilemmas in therapy - review of literature

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