Modern radiotherapy for breast cancer: Update and new developments

Eva Meixner; Jürgen Debus

doi:10.1055/a-2289-0436

Senologie - Zeitschrift für Mammadiagnostik und -therapie, Table of Contents

CC BY-NC-ND 4.0 · Senologie - Zeitschrift für Mammadiagnostik und -therapie 2024; 21(04): 273-281
DOI: 10.1055/a-2289-0436

Review

Moderne Strahlentherapie beim Mammakarzinom: Update und neue Entwicklungen

Article in several languages: English | deutsch

Authors

Eva Meixner

¹Abteilung für RadioOnkologie und Strahlentherapie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

²Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Deutschland

³National Center for Tumor diseases (NCT), Heidelberg, Deutschland

⁴Heidelberger Ionenstrahl-Therapiezentrum (HIT), Heidelberg, Deutschland
Jürgen Debus

¹Abteilung für RadioOnkologie und Strahlentherapie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

²Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Deutschland

³National Center for Tumor diseases (NCT), Heidelberg, Deutschland

⁴Heidelberger Ionenstrahl-Therapiezentrum (HIT), Heidelberg, Deutschland

⁵Clinical Cooperation Unit Radiation Oncology, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland

Abstract

Zusammenfassung

Die Durchführung der Strahlentherapie beim Mammakarzinom hat sich im Laufe der Jahre deutlich weiterentwickelt. Ziel dieser Übersichtsarbeit ist es, einige wichtige Entwicklungen und aktuelle Konzepte aufzuzeigen. Die postoperative perkutane, hypofraktionierte 3D-konformale oder intensitätsmodulierte Photonen-Bestrahlung stellt weiterhin die Standardapplikation nach brusterhaltender Operation zur Verbesserung der Lokalkontrolle dar. Neue Therapietechniken in tiefer Inspiration oder physikalisch-biologische Vorteile einer Protonentherapie bieten in Hinblick auf die Schonung des Normalgewebes und reduzierter Kardiotoxizität innovative Therapieverfahren. Ultra-hypofraktionierte Therapiekonzepte sowie die Integration eines simultan integrierten Boosts auch in hypofraktionierte Therapiekonzepte ermöglichen, die Behandlungsdauer auf wenige Tage bis Wochen zu reduzieren. Bei Niedrigrisiko-Konstellationen kann zudem das Bestrahlungsvolumen auf eine Teilbrustbestrahlung deeskaliert, bei gleichzeitig stark eingeschränkter Lebenserwartung potenziell auch der vollständige Verzicht auf eine adjuvante Radiotherapie kritisch diskutiert werden. Der onkologische Benefit durch die Bestrahlung der regionären Lymphabflusswege bestätigt sich weiterhin bei lokal fortgeschrittenen, nodal-positiven Karzinomen und ermöglicht mit geringer Morbidität in individualisierte Therapieansätze den Verzicht auf eine operative axilläre Lymphknotendissektion.

Schlüsselwörter

tiefe Atemanhaltetechnik - Protonentherapie - Kardiotoxizität - Teilbrustbestrahlung - RT-Verzicht

Full Text

References

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