Radiotherapie der Lymphabflusswege bei Mammakarzinom: Zeit für eine Neubewertung

Zusammenfassung

Hintergrund Die Therapie der regionalen Lymphknoten hat sich in den letzten Jahren dramatisch gewandelt. Auch bezüglich der Strahlentherapie hat sich die Evidenzlage wesentlich verbessert, und eine Neubewertung ist erforderlich.

Material und Ergebnisse Randomisierte Studien existieren zur Frage einer Axilla-OP versus Strahlentherapie (AMAROS), Verzicht auf Axilladissektion nach positivem SN bei geplanter Strahlentherapie (ACOSOG Z0011) sowie zur adjuvanten Radiotherapie der regionalen LK. ACOSOG Z0011 zeigt, dass ein Verzicht auf die Axilladissektion auch bei 1 – 2 positiven Sentinel-Lymphnoten möglich ist. Die Studien zur adjuvanten Radiotherapie der regionalen LK (EORTC-Studie, kanadische Studie, französische Studie) zeigen in der Metaanalyse einen signifikanten Überlebensvorteil durch die Strahlentherapie; eine dänische Kohortenstudie bestätigt dieses Ergebnis. Die Reduktion der brustkrebsspezifischen Mortalität beruhte in diesen Studien zum Teil auf einem „systemischen“ Effekt der regionalen Radiotherapie mit einer Reduktion der Rate an Fernmetastasen.

Schlussfolgerungen Für die operative Therapie der Axilla gilt: „Weniger ist nicht schlechter.“ Für die Strahlentherapie der regionalen Lymphknoten gilt dagegen: „Mehr kann unter Umständen vorteilhaft sein.“ Eine eindeutige Erklärung für die Diskrepanz dieser Befunde gibt es noch nicht. Ein immunologischer Effekt (durch immunogenen Zelltod nach Bestrahlung) wird diskutiert. Welche Patientinnen heutzutage von einer regionalen Bestrahlung profitieren, muss noch besser erforscht werden.

Schlüsselwörter

Brustkrebs - Radiotherapie - Regionäre Lymphabflussbestrahlung

Key words

breast cancer - radiotherapy - regional lymphatic radiotherapy

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