Teilbrustbestrahlung beim Mammakarzinom mit günstigen prognostischen Faktoren: 3-Jahres-Ergebnisse der deutsch-österreichischen Phase II-Studie

Zusammenfassung

Ziel: Evaluierung von perioperativer Morbidität, Akut- und Spättoxizität sowie des kosmetischen Ergebnisses nach alleiniger interstitieller PDR- oder HDR-Brachytherapie des Tumorbetts nach brusterhaltender Operation. Material und Methoden: Zwischen November 2000 und November 2004 erhielten 240 Frauen nach brusterhaltender Operation wegen Mammafrühkarzinom eine alleinige PDR- oder HDR-Brachytherapie des Tumorbetts (Teilbrustbestrahlung). Wir präsentieren Ergebnisse der ersten 51 Patientinnen bezüglich Morbidität, Toxizität und Kosmetik. Die minimale bzw. mediane Nachbeobachtungszeit betrug 30 bzw. 36 Monate. Ergebnisse: Perioperative Morbidität: bakterielle Infektion des Implantats: 2 % (1/51); Akuttoxizität: Radiodermatitis Grad 1: 4 % (2/51); Spättoxizität: Brustschmerz Grad 1: 8 % (4/51), Grad 2: 2 % (1/51); Dyspigmentation Grad 1: 8 % (4/51); Fibrosierung Grad 1: 4 % (2/51), Grad 2: 8 % (4/51); Teleangiektasien Grad 1: 10 % (5/51), Grad 2: 4 % (2/51); kosmetisches Ergebnis: sehr gut und gut bei 94 % (48/51) der Patientinnen. Schlussfolgerung: Die Analyse zeigt, dass die interstitielle PDR-/HDR-Multikatheter-Brachytherapie des Tumorbetts (Teilbrustbestrahlung) allein nach brusterhaltender Operation mit niedriger perioperativer Komplikationsrate durchführbar, die Akuttoxizität niedrig und die Spättoxizität bei einer medianen Nachbeobachtungszeit von 36 Monaten mild war. Das kosmetische Ergebnis wurde bislang nicht signifikant beeinflusst.

Abstract

Purpose: To evaluate perioperative morbidity, toxicity and cosmetic outcome in patients treated with interstitial brachytherapy to the tumor bed as the sole radiation modality after breast conserving surgery. Materials and Methods: From 11/2000 to 11/2004, 240 women with early stage breast cancer participated in a protocol of tumor bed irradiation alone using pulsed dose rate (PDR) or high dose rate (HDR) interstitial multi-catheter implants (partial breast irradiation). Perioperative morbidity, acute and late toxicity as well as cosmetic outcome were assessed. Of the first 51 patients treated in this multicenter trial, we present interim findings after a median follow-up of 36 months. Results: Perioperative Morbidity: Bacterial infection of the implant: 2 % (1/51). Acute toxicity: radiodermatitis Grade 1: 4 % (2/51). Late toxicity: breast pain Grade 1: 8 % (4/51), Grade 2: 2 % (1/51); dyspigmentation Grade 1: 8 % (4/51); fibrosis Grade 1: 4 % (2/51), Grade 2: 8 % (4/51); telangiectasia Grade 1: 10 % (5/51), Grade 2: 4 % (2/51). Cosmetic results: Excellent and good in 94 % (48/51) of the patients. Conclusion: This analysis indicates that accelerated partial breast irradiation with 192-iridium interstitial multicatheter PDR-/HDR-implants (partial breast irradiation) is feasible with low perioperative morbidity, low acute and mild late toxicity at a median follow-up of 36 months. The cosmetic result is not significantly affected.

Key words

Accelerated partial breast irradiation - radiotherapy - pulsed dose rate brachytherapy - early breast cancer - cosmetic results

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