Einfluss der prognostischen Faktoren auf die Therapie des duktalen Carcinoma in situ der Brust

Zusammenfassung

Fragestellung: Nach heutigem Kenntnisstand wird das duktale Carcinoma in situ (DCIS) wie ein obligater Präkursor oder eine Vorstufe des invasiven Mammakarzinoms behandelt. Unabhängig von der Tumorbiologie gelten für alle Patientinnen die gleichen Therapieempfehlungen. Verlässliche prognostische Faktoren sollen uns in der Zukunft helfen, das individuelle Risiko besser einschätzen zu können und somit die Therapie maßgeschneidert zu gestalten (tailored therapy). Material und Methodik: Selektive Literaturrecherche. Ergebnisse: Offensichtlich werden heutzutage zahlreiche Patientinnen durch die übliche operative Therapie mit anschließender Bestrahlung übertherapiert. Leider fehlen uns bisher verlässliche prognostische Parameter, mit deren Hilfe Patientinnen mit niedrigem Risiko eindeutig identifiziert werden könnten. Einige klinische sowie histologische Prognosefaktoren werden zwar anerkannt, führen aber nach den aktuellen Leitlinien nicht zur Individualisierung der Therapie. Eine ganze Reihe von Biomarkern wurde mit der Fragestellung untersucht, ob durch den Nachweis im Tumorgewebe das Risikoprofil der jeweiligen Patientin besser definiert werden könnte. Bei manchen Markern wurde tatsächlich belegt, dass ihre Überexpression mit einem erhöhten Rezidivrisiko einhergeht. Leider wurden diese Experimente oft an einer sehr geringen Patientenzahl durchgeführt. Auch die Behandlungsmodalitäten weisen in einzelnen Studien Unterschiede auf. Dies erschwert die Auswertung der Ergebnisse. Prospektive Studien fehlen ganz. Schlussfolgerung: Die Therapie des DCIS wird sich zukünftig neben der Berücksichtigung der klassischen Kriterien auch an neuen Biomarkern orientieren müssen. Diese sind an großen Patientenkollektiven möglichst prospektiv auf ihre prognostische Bedeutung zu untersuchen.

Abstract

Purpose: According to current knowledge we treat ductal carcinoma in situ (DCIS) as an obligate precursor of invasive breast cancer. The same guidelines are applied to each patient irrespective of the characteristics of the neoplasm. In future, reliable prognostic factors should help us to assess individual risk better and tailor the therapy accordingly. Material und Methods: A review was done of the relevant literature. Results: We have been trying to individualize the therapy of DCIS for many years. Obviously we do overtreat some patients by performing surgery with adjuvant radiotherapy. Our knowledge of reliable prognostic factors for identifying low-risk patients is still inadequate. But while some clinical and histological criteria are accepted, they still do not have any influence on therapy according to the current guidelines. Dozens of biological markers were evaluated in order to find out whether their expression determines individual risk. As a matter of fact, there are markers indicating an increased risk of recurrence if detected in cancer tissue. Unfortunately the studies often included only a very small number of patients and the treatment approaches varied. This makes evaluation of the results quite difficult. No prospective studies were identified at all. Conclusion: In future, we should evaluate a combination of traditional criteria and novel biological markers prospectively in a large number of patients.

Schlüsselwörter

duktales Carcinoma in situ - Prognosefaktor - Biomarker

Key words

ductal carcinoma in situ - prognostic factor - biomarker

Literatur

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