Niedrige Fibroserate bei adäquatem Zeitintervall zwischen intraoperativem Tumorbettboost und perkutaner Nachbestrahlung

Zusammenfassung

Die intraoperative Radiotherapie (IORT) kommt zunehmend als Boost bei Brustkrebspatientinnen zum Einsatz. Wir haben den Einfluss des Zeitintervalls zwischen IORT und der anschließenden perkutanen Mammahomogenbestrahlung (EBRT) auf die Spättoxizität analysiert. Hierzu wurden 91 Patientinnen im Median 24 Monate (= Gruppe 1) und 48 Patientinnen im Median 36 Monate (= Gruppe 2) nachgesorgt. Intraoperativ wurden 20 Gy mit 50 kV Röntgenstrahlen (INTRABEAM, Carl Zeiss Surgical, Oberkochen) und perkutan 46–50 Gy appliziert. Das mediane Zeitintervall zwischen IORT und EBRT betrug 37 Tage in Gruppe 1 und 36 Tage in Gruppe 2. Die Toxizität wurde anhand der modifizierten LENT SOMA Skala ­bewertet. In Gruppe 1 und 2 hatten 54 bzw. ­30 Patientinnen keine höhergradigen Spätfolgen. In Gruppe 1 entwickelten 27 Patientinnen eine höhergradige Fibrose (II–III°), 13 Retraktionen, 8 Schmerzen II°, 8 ein Brustödem und 4 Teleangiektasien. Ein Lymphödem II° und Hyperpigmentierung II° traten einmal auf. In Gruppe 2 hatten 12 Patientinnen Fibrosen (II–III°), 6 Retraktionen, 5 Schmerzen (II–III°), 4 Hyperpigmentierungen, 3 Teleangiektasien und 1 ein Brustödem II°. 2 / 3 der höhergradigen Fibrosen (Gruppe 1: n = 18, Gruppe 2: n = 8) lagen unterhalb des medianen Zeitintervalls zwischen IORT und EBRT. Im Vergleich zeigte sich bei den Patientinnen mit ­Spättoxizität sowohl in Gruppe 1 (n = 37) als auch in Gruppe 2 (n = 18) ein signifikant kürzeres Intervall zwischen IORT und EBRT (Gruppe 1: 34 vs. 40 Tage, p = 0,044; Gruppe 2: 29,5 vs. 39,5 Tage, p = 0,023; Mann-Whitney-U-Test). Bei adäquatem Zeitintervall zwischen IORT und EBRT konnte eine niedrige Fibroserate beobachtet werden. Die EBRT sollte frühestens ca. 5–6 Wochen nach der IORT eingeleitet werden.

Abstract

Intraoperative radiotherapy (IORT) during breast conserving surgery is increasingly used. When ­given as a boost, the sequencing of IORT, systemic therapy and external beam radiotherapy (EBRT) may be of importance to normal tissue damage. We analyzed the influence of the interval be­tween IORT and EBRT on the development of late toxicity in breast cancer patients. No higher grade toxicity was seen in 54 and 30 patients in group 1 and 2, respectively. 91 patients were followed for a median of 24 months (= group 1) and 48 patients for a median of 36 months (= group 2) after IORT and EBRT. 20 Gy IORT were given with 50 kV x-rays (INTRABEAM, Carl Zeiss Surgical, Oberkochen, Germany) followed by 46–50 Gy EBRT with a median interval of 37 days in group 1 and 36 days in group 2. Toxicity was assessed with the modified LENT SOMA score. 27 patients devel­oped a higher grade fibrosis (II–III°). There were 13 patients with retractions, 8 with pain II°, 8 with edema I°, 4 with teleangiectases, 1 with lymphedema II°, and 1 patient with hyperpigmentation II°. In group 2, 12 patients developed fibrosis II–III°, 6 retractions, 5 pain II–III°, 4 hyperpigmentation, 3 teleangiectases and 1 patient had edema II°. In both groups most fibroses II–III° (group 1: n = 18; group 2: n = 8) were noticed ­under the median interval between IORT and EBRT. Finally the interval in patients with higher grade toxicity (group 1: n = 37; group 2: n = 18) was significantly shorter in both groups than in the patients without chronic late effects (group 1: 34 vs. 40 d, p = 0.044; group 2: 29.5 vs. 39.5 d, p = 0.023; Mann-Whitney-U-Test). A low fibrosis rate was seen after delayed initiation of external beam radiotherapy. Starting EBRT about 5–6 weeks after IORT appears safe.

Mammakarzinom - intraoperative ­Bestrahlung - Tumorbettboost - Fibrose - Spätfolgen

breast cancer - intraoperative radiotherapy - tumorbed boost - fibrosis - late effects

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