Das sekundäre Angiosarkom der Brust nach brusterhaltender Therapie

Zusammenfassung

Hintergrund: Durch das Mammografie-Screening werden zunehmend kleine Mamma-Carcinome entdeckt, welche mit einer brusterhaltenden Therapie (BET) und anschließender Bestrahlung kurativ behandelt werden können. Aufgrund der Zunahme der Brust Bestrahlungen nach brusterhaltender Therapie häufen sich die Fälle von strahleninduzierten sekundären Neoplasien. Die am häufigsten auftretende sekundäre Neoplasie ist das Angiosarkom. Dies entsteht mit einer Latenz von 4–7 Jahren nach einer Bestrahlungstherapie. Genetische Prädisposition und eine strahleninduzierte Entartung von Endothelzellen werden als auslösender Faktoren beschrieben.

Ziel der Arbeit: In der vorliegenden Arbeit wird auf Grundlage der vorliegenden Literatur und der Erfahrung der Autoren die chirurgische Behandlungsmöglichkeit dargestellt und Anhand einiger Fallbeispiele zur Diskussion gestellt.

Ergebnisse und Diskussion: Eine radikale Exzision des Tumors mit einem ausreichenden Sicherheitsabstand ist die Therapie der Wahl. Durch das lokal destruierende Wachstum des Angiosarkoms stellt dies eine besondere Herausforderung an den Chirurgen dar. Die Defektdeckung des entstandenen Gewebedefizits ist aufgrund des vorbestrahlen Gewebes ebenfalls anspruchsvoll und limitiert die rekonstruktiven Möglichkeiten. Hier sollten individuelle Faktoren, wie Alter der Patientin, lokaler Gefäßstatus und Wunsch nach einer Brust-Rekonstruktion berücksichtigt werden. Trotz kurativer Resektion liegt die 5-Jahres-Überlebensrate bei sekundären Angiosarkomen zwischen 20–30%.

Abstract

Background: Mammography for the detection of early stage breast cancer is widely established. Breast-conserving therapy followed by radiation therapy is the most common therapy for early stage breast cancer. Due to the increasing use of radiation therapy in breast cancer, secondary neoplasia are induced. The most common secondary neoplasia of the breast is the angiosarcoma. It occurs 4–7 years after radiation therapy. Genetic predisposition and a transformation of endothelial cells by radiation therapy are known to lead to angiosarcoma.

Objective: The present paper outlines a concept for treatment on the basis of the current literature and the experience of the authors.

Results and Conclusion: Radical surgical resection of the tumour with a sufficient margin of safety is the treatment of choice for angiosarcoma. Tumour infiltration of the chest wall and other local structures are challenges for the surgeon performing a radical tumour resection. The replacement of the tissue is also demanding for the surgeon. After radiation therapy the reconstructive options are limited. Individual factors such as age, quality of local vessels and the patients demand for breast reconstruction should be considered. Although R0 resection is performed, the 5-year survival rates are 20–30%.

Schlüsselwörter

Mammarekonstruktion - Brustchirurgie - Brust - gestielte Lappenplastiken - Angiosarkom

Key words

breast reconstruction - breast cancer - breast - pedicled flaps - angiosarcoma

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