Zusammenfassung
Die Therapie des metastasierten Mammakarzinoms erfolgt in der Regel medikamentös,
da auch bei Begrenzung der Metastasen auf ein Organ oder Organsystem eine diffuse
Tumorzelldisseminierung vorliegt, so dass ein lokalisiertes chirurgisches Vorgehen
im Allgemeinen nicht sinnvoll erscheint. Insbesondere bei hepatisch oder pulmonal
metastasierten Mammakarzinomen ist die Indikation zum operativen Vorgehen sehr individualisiert
zu stellen, da die hepatische oder pulmonale Metastasierung in der Regel in einer
Krankheitsphase auftritt, in der zusätzlich extrahepatische oder -pulmonale Metastasen
nachweisbar sind. Einzig bei Mammakarzinompatientinnen mit langem therapiefreien Intervall,
isolierter hepatischer bzw. pulmonaler Metastasierung, gutem Allgemeinzustand und
Möglichkeit der R0-Resektion scheint die hepatische bzw. pulmonale Metastasektomie
in Einzelfällen eine Therapieoption darzustellen.
Abstract
Usually, the therapy of metastatic breast cancer consists of chemotherapy or endocrine
therapy, because even in the case of isolated metastases in one organ, diffuse tumor
cell dissemination exists, so that local surgical treatment does not seem sensible.
Particurlarly in patients with hepatic or pulmonary metastases the indication for
hepatic or pulmonary metastasectomy should be individualized, as hepatic or pulmonary
metastases usually develop during a phase of disease, when extrahepatic or -pulmonary
metastases also can be detected. Only in patients with long disease-free interval,
with isolated hepatic or pulmonary metastases, and the possibility of R0-resection
is hepatic or pulmonary metastasectomy a therapeutic option in selected cases.
Schlüsselwörter
metastasiertes Mammakarzinom - pulmonale Metastasektomie - hepatische Metastasektomie
Key words
metastatic breast cancer - hepatic metastasectomy - pulmonary metastasectomy
Literatur
- 1
Elias D, Lasser P, Spielmann M. et al .
Surgical and chemotherapeutic treatment of hepatic metastases from carcinoma of the
breast.
Surg Gynecol Obstet.
1991;
6
461-464
- 2
Elias D, Lasser P H, Montrucolli D. et al .
Hepatectomy for liver metastases from breast cancer.
Eur J Surg Oncol.
1995;
21
510-513
- 3
Elias D, Cavalcanti de Albuquerque A, Eggenspieler P. et al .
Resection of liver metastases from a noncolorectal primary: indications and results
based on 147 monocentric patients.
J Am Coll Surg.
1998;
5
487-493
- 4
Friedel G, Linder A, Toomes H.
The significance of prognostic factors for the resection of pulmonary metastases of
breast cancer.
Thorac Cardiovasc Surg.
1994;
2
71-75
- 5
Friedel G, Pastorino U, Ginsberg R J. et al .
Results of lung metastasectomy from breast cancer: prognostic criteria on the basis
of 467 cases of the International Registry of Lung metastases.
Eur J Cardiothorac.
2002;
3
335-344
- 6
Kodama K, Doi O, Higashiyama M. et al .
Surgical management of lung metastases.
J Thorac Cardiovasc Surg.
1991;
101
901-908
- 7
Kolodziejski L, Goralcyk J, Dyczek S. et al .
The role of surgery in lung metastases.
Eur J Surg Oncol.
1999;
25
410-417
- 8
Lanza L A, Natarajan G, Roth J A. et al .
Long-term survival after resection of pulmonary metastases from carcinoma of the breast.
Ann Thorac Surg.
1992;
2
244-247
- 9
Lee Y-T N.
Breast carcinoma. Pattern of metastasis at autopsy.
J Surg Oncol.
1985;
23
175-180
- 10
Livartowski A, Chapelier A, Beuzeboc P. et al .
Exerese chirurgicale de metastases pulmonaires de cancer du sein: a propos de 40 patientes.
Bull Cancer.
1998;
9
799-802
- 11
Maksan S M, Lehnert T, Bastert G. et al .
Curative liver resection for metastatic breast cancer.
Eur J Surg Oncol.
2000;
26
209-212
- 12
Marincola F M, Mark J BD.
Selection factors resulting in improved survival after surgical resection of tumors
metastatic to the lungs.
Arch Surg.
1990;
125
1387-1393
- 13
McCormack P, Baines M S, Beattie E J. et al .
Pulmonary resection in metastatic carcinoma.
Chest.
1978;
73
163-166
- 14
McDonald M L, Deschamps C, Ilstrup D M. et al .
Pulmonary resection for metastatic breast cancer.
Ann Thorac Surg.
1994;
6
1599-1602
- 15
Morrow C E, Vassilopoulos P P, Grage T B.
Surgical resection for neoplasms of the lung: experience at the University of Minnesota
Hospitals.
Cancer.
1980;
45
2981-2985
- 16
Mountain C F, McMurtrey M J, Hermes K E.
Surgery for pulmonary metastases: a 20-year experience.
Ann Thorac Surg.
1984;
4
323-330
- 17
Pocard M, Salmon R J.
Resection hepatique pour metastase du cancer du sein. Le concepte de chirurgie adjuvante.
Bull Cancer.
1997;
1
47-50
- 18
Raab R, Nussbaum K T, Behrend M. et al .
Liver metastases of breast cancer: result of liver resection.
Anticancer Res.
1998;
18
2231-2234
- 19
Salat A, Murabito M, Groeger A. et al .
Significant extension of survival by complete resection of isolated lung metastases
after breast carcinoma.
Chirurg.
1998;
7
735-740
- 20
Schneebaum S, Walker M J, Young D. et al .
The regional treatment of liver metastases from breast cancer.
J Surg Oncol.
1994;
55
26-32
- 21
Selzner M, Morse M, Vredenburg J J. et al .
The regional treatment of tumor metastases: general considerations and results.
Surg Today.
1995;
25
1-10
- 22
Silber R, Engelmaier S, Elert O.
Einfluss von so genannten prognostischen Faktoren auf die Überlebensrate in der operativen
Entfernung von Lungenmetastasen.
Z Herz Thorax Gefäßchirugie.
1991;
5
115-122
- 23
Simpson R, Kennedy C, Carmalt H, McCaughan B, Gillet D.
Pulmonaryresection for metastatic breast cancer.
Aust N Z J Surg.
1997;
67
717-719
- 24
Staren E D, Salerno C, Rongione A. et al .
Pulmonary resection for metastatic breast cancer.
Arch Surg.
1992;
11
1282-1284
- 25
Takita H, Edgerton F, Karakousis C. et al .
Surgical management of metastases to the lung.
Surg Gynecol Obstet.
1981;
152
191-194
- 26
Vogt-Moykopf I, Krysa S, Bülzebruck. et al .
Surgery for pulmonary metastases.
Curr Persp Thor Surg.
1994;
4
85-112
- 27
Wilkins E W, Head J M, Burke J F.
Pulmonary resection for metastatic neoplasms in the lung.
Am J Surg.
1979;
135
480-483
- 28
Wright J O, Brandt B, Ehrenhaft J L.
Results of pulmonary resection for metastatic lesions.
J Thorac Cardiovasc Surg.
1982;
83
94-99
- 29
Yoshimoto M, Tada T, Saito M. et al .
Surgical treatment of hepatic metastases from breast cancer.
Breast Cancer Res Treat.
2000;
59
177-184
Priv.-Doz. Dr. med. M. Friedrich
Universitätsklinikum Schleswig-Holstein · Campus Lübeck · Klinik für Frauenheilkunde
und Geburtshilfe
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