Intraoperative Radiotherapie (IORT) des Mammakarzinoms mit Elektronen – eigene Erfahrungen, aktuelle Aspekte und Literaturübersicht

Zusammenfassung

Fragestellung: Ist eine Boost-Bestrahlung im Rahmen der Radiotherapie des Mammakarzinoms indiziert, stellt die intraoperative Radiotherapie (IORT) eine Alternative zur perkutanen Boost-Bestrahlung dar. Material und Methodik: Insgesamt 54 Patientinnen mit Mammakarzinom wurden von 1/2006–2/2009 im Rahmen einer BET einer Boost-IORT zugeführt. Die IORT wurde mittels dediziertem mobilem Linearbeschleuniger (NOVAC7®) durchgeführt. Das Follow-up beträgt bisher 25 (6–56) Monate. Die Boost-IORT-Indikation wurde bei einem Alter ≤ 50 Jahre und/oder einer bildgebenden Tumorgröße von ≥ 2 cm gestellt. Nach Tumorresektion erfolgte eine Mobilisierung und Approximation des Gewebes. Anschließend erfolgte unter direkter visueller Kontrolle die Tubusplatzierung im Situs. Die Boost-Dosis betrug 10 Gray. Im Anschluss an die Boost-IORT folgte postoperativ die perkutane Ganzbrustbestrahlung. Ergebnisse: Bisher trat 1 lokales Rezidiv auf. Das lokalrezidivfreie bzw. Gesamtüberleben liegt bei 98,2 bzw. 96,3 %. Es trat keine Grad-III/IV-Toxizität auf. Leichtgradige Erytheme, Hyperpigmentierungen, Teleangiektasien oder Fibrosierungen zeigten sich bei 70,4, 7,4, 5,6 oder 25,9 % der Patientinnen. Das kosmetische Ergebnis wurde von 90,7 % der Patientinnen und 94,4 % der Ärzte als sehr gut oder gut beurteilt. Eine Boost-IORT würden, wenn nötig, 96,9 % der Patientinnen wieder durchführen lassen. Schlussfolgerung: Die Boost-IORT ist mit einer geringen Teleangiektasie-, Hyperpigmentierungs- sowie sukutanen Fibroserate assoziiert. Die Gefahr eines „geographical miss“, bedingt durch postoperative Wundbettveränderungen, onkoplastische Gewebsverlagerungen oder Migration gesetzter Markierungsclips, ist bei der Boost-IORT ausgeschlossen. Die Ergebnisse unserer Analyse zeigen vergleichbar mit den Daten der Literatur eine hohe lokale Effizienz, geringe Nebenwirkungsrate und hohe Patientenakzeptanz der Boost-IORT.

Abstract

Purpose: If boost irradiation is indicated as a radiotherapy for breast cancer, intraoperative radiotherapy (IORT) can be an alternative to a percutaneous boost. Materials and Methods: A total of 54 patients with breast cancer were treated with IORT boost as part of a breast conserving therapy from 1/2006–2/2009, using the dedicated mobile linear accelerator NOVAC7®. Mean follow-up time was 25 (range: 6–56) months. The indications for IORT boost were age ≤ 50 years and/or tumor size ≥ 2 cm in preoperative imaging. After tumor resection the tissue was mobilized and approximated. The irradiation tube was placed into the situs under direct visual control. The boost dose was 10 Gy. Percutaneous whole breast irradiation was performed subsequently to the IORT boost. Results: One local relapse was seen to date. Freedom from local relapse and overall survival rates are 98.2 and 96.3 %, respectively. No patient suffered grade III/IV toxicity. Mild erythema, hyperpigmentation, telangiectasia or fibrosis occurred in 70.4, 7.4, 5.6 and 25.9 % of patients. The cosmetic result was assessed as very good or good by 90.7 % of patients and 94.4 % of physicians. Overall, 96.9 % of the patients would undergo boost IORT again, if necessary. Conclusion: Boost IORT is associated with a low rate of telangiectasia, hyperpigmentation and subcutaneous fibrosis. The risk of a “geographical miss” due to postoperative tissue changes, oncoplastic shifts or migration of clip markers is excluded. The results of our analysis are comparable to those reported in the literature and show a high local efficiency, low toxicity and high patient acceptance of IORT boost.

Schlüsselwörter

intraoperative Radiotherapie - IORT - Mammakarzinom - Boost‐Bestrahlung

Key words

intraoperative radiotherapy - IORT - breast cancer - boost irradiation

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