Zusammenfassung
Die Strahlentherapie zählt zu einer der drei Säulen in der primären Behandlung von Patientinnen mit einem Mammakarzinom. Für Patientinnen mit einem DCIS ermöglicht die adjuvante Nachbestrahlung nach kompletter Resektion ein brusterhaltendes Vorgehen mit einer deutlichen Verbesserung des ereignisfreien Überlebens. Nach brusterhaltender Operation eines lokal begrenzten invasiven Mammakarzinoms ist die Strahlentherapie obligat und senkt die Rate von Lokalrezidiven ohne das Gesamtüberleben zu beeinflussen. Hochrisiko-Patientinnen profitieren von einer lokoregionären Strahlentherapie, bei einem Einsatz moderner Bestrahlungstechniken ist die resultierende kardiale Morbidität und Mortalität nicht mehr erhöht. Subgruppen, bei denen auf eine Strahlentherapie nach brusterhaltender Operation verzichtet werden kann, sind anhand der Datenlage nicht klar zu definieren. Die optimale Sequenz der adjuvanten Strahlentherapie und Chemotherapie ist derzeit unklar, ein später Einsatz der Strahlentherapie geht mit einer Erhöhung von Lokalrezidiven und ein später Einsatz der Chemotherapie mit einem höheren Fernmetastasierungsrisiko einher.
Summary
Radiotherapy is one of the three modalities used in the primary treatment of breast cancer. For patients with ductal carcinoma in situ after complete resection, adjuvant radiotherapy permits breast-sparing treatment and increases the event-free survival. Radiotherapy is mandatory after breast-sparing excision of localized invasive carcinomas and reduces the rate of local recurrence, albeit without affecting overall survival. Currently the data do not permit identification of subgroups of patients with invasive breast cancer after breast-sparing surgery in whom adjuvant radiotherapy could be declined. High-risk patients benefit from locoregional radiotherapy. Modern radiation techniques are no longer associated with cardiac morbidity and mortality. The optimal sequence of adjuvant radiotherapy and chemotherapy is unclear. Delayed radiotherapy is associated with an increased risk of local recurrence whereas delayed chemotherapy is associated with an increased risk of distant recurrence.
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