Risk, III.

Background: Breast cancer in men is an uncommon disease. Little is known about its etiology, clinical behavior, treatment, and outcome. Retrospective data indicate that stage- and age-matched male and female breast cancer is similar in presentation. The aim is to find an adequate treatment for male breast cancer, which is not just extrapolated from its female counterpart. Case Report: We present the history of a 41-year-old man who was diagnosed with pT2 (3 cm) breast cancer in 2001. After mastectomy without axillary dissection, 4 cycles of adjuvant epirubicin and cyclophosphamide and radiation therapy were performed followed by hormonal treatment with tamoxifen until 2003. In 2003, 2004, 2005, and 2006, there were relapses with skin metastases, treated with several courses of chemotherapy. In 2006, an inflammatory carcinoma in the contralateral breast was revealed during the course of epirubicin chemotherapy. In May 2007, the patient passed away from extensive tumor progression despite numerous attempts of local and systemic chemotherapeutic treatment. Conclusion: Here, an unusual case of male breast cancer is reported. It was first diagnosed at the age of 41 years, which is relatively young for male breast cancer. Although the treatment was started at an early stage, several relapses and contralateral breast cancer occurred within 5 years and could no be controlled.

112 Background: Intraoperative boost irradiation as part of breast-conserving therapy is a perfect method to adequately capture the high risk tumor relapse area. The most homogeneous dose distribution is achieved with electrons. Intraoperative radiotherapy (IOERT) as a boost for breast cancer releases a high single dose of radiation to the breast tissue; therefore acute toxicity is of particular attention. To date there is only inadequate information available on breast cancer patients treated with IORT using electrons applied as a boost. We therefore analyzed the acute toxicity after radiotherapy with 10 Gy as a boost with a minimum follow-up of 3 months. Methods: A total of 69 patients treated with IOERT (10Gy with 5, 7 and 9 MeV electrons) with a dedicated robotic linac (NOVAC 7, New Radiant Technology, Aprilia, Italy) to the tumor bed during breast-conserving surgery as a boost followed by whole-breast radiotherapy (WBRT, 50.4 Gy; 1.8 Gy per fraction) were included in this study. All patients underwent a retrospective follow-up (median, 8 months; range 1-17 months) regarding acute side effects within the first three months. Toxicities were documented using the common toxicity criteria (CTC 4.0 of the European Organization for Research and Treatment of Cancer). Results: The IOERT was well tolerated. As a side effect there was one patient with seroma. Two patients developed chronic pain in the irradiated breast. Two patients developed a secondary wound healing. The remaining patients did not develop any grade 3 or 4 side effects. The observed toxicity rates were not influenced by age, tubus size, electron energy or systemic therapy. Conclusions: After IOERT of the breast using electrons we did not find any unexpected acute toxicity rates.

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Nach heutigem Kenntnisstand wird die Mammakarzinomerkrankung nicht als eine Entität verstanden und in mehrere Subgruppen unterteilt.Durch Genexpressionsanalysen lässt sich Brustkrebs in 5 Subtypen [1, 2] mit deutlich unterschiedlichem biologischen und klinischen Verhalten unterscheiden. TNMC sind immunhistochemisch durch das Fehlen von Östrogen(ER)-und Progesteronrezeptoren (PR) sowie fehlender Her2-neu-Expression gekennzeichnet [3]. Häufig wird das TNMC vereinfacht mit Tumoren des Basalzelltyps gleich gesetzt, welches nur begrenzt richtig ist. TNMC weisen zwar zu 90 % das molekulare Profil des Basal-Typs auf, jedoch besteht zwischen ihnen eine Diskordanz von bis zu 30 % [4]. Bisher gibt es keine Übereinstim-mung über die genaue immunhistochemische Definition dieses Subtyps. Bisher werden zur Identifizierung des Basalzelltyps ER, Her2, CK5/6 und EGFR mit hoher Spezifität (100 %) und Sensitivität (76 %) beschrieben [3]. Dieser Subtyp zeichnet sich durch unterschiedliche Defekte bestimmter DNA-Reparatur-Gene wie z.B. p53, BRCA1 sowie durch Veränderungen im MAP-K-/Akt-/ PARP-Pathway aus [1]. Besonders P53-und BRCA1-Gene sind verantwortlich für die genetische Stabilität im gesunden Gewebe und an der Transkription und Zellzykluskontrolle wesentlich beteiligt [5]. BRCA/BRCAness ▼ Bis zu 80 % der Mammakarzinome mit einer BRCA1-Mutation sind triple-negativ und zeigen immunhistochemisch einen Basalzelltyp [1]. Jedoch weisen die meisten basal-like Tumore keine BRCA1-Mutation auf. In der Literatur werden etwa 11 % der TNMC mit einer BRCA1-Mutation beschrieben und nach Altersselektion (< 50. Lebensjahr) 11-29 % [6]. Triple-negative und basalzellige Karzinome zeigen Defekte genetischer Reparaturmechanismen für DNA-Doppelstrangbrüche, welche charakteristisch auch für Tumoren mit Mutationen des BRCA1-Gens sind [8]. Sie werden auch als BRCAness bezeichnet. BRCA-defiziente Karzinomzellen sowie Tumorzellen ohne BRCA-Mutationen zeichnen sich durch alternative Reparaturmechanismen zur genetischen Stabili sierung der Tumorzellen aus. Der therapeutische Ansatz liegt in der Hemmung dieser Reparaturmechanismen, in dem es durch gezielten Einsatz von PARP1-Inhibitoren zur Zerstörung der Tumorzelle kommt [7]. Epidemiologie und Charakteristika ▼ Das Auftreten der TNMC variiert zwischen 11-20 % aller Brustkrebsfälle [8-11]. Über 90 % der TNMC sowie Mammakarzinome vom Basalzelltyp sind invasiv-duktale Karzinome. Sie sind gekennzeichnet durch eine erhöhte Aggressivität mit einem frühen Rezidivrisiko, einem hohen Risiko für Fernmetastasierung (vor allem viszeral und zerebral) sowie einem schlechteren Überleben mit insgesamt schlechter Prognose [12-16]. Dent et al. konnten anhand einer großen Kohortenstudie die klinischen Merkmale der triple-negativen Karzinome verdeutlichen: das mediane Alter bei Erstdiagnose war signifikant jünger bei Frauen mit TNMC als non-TMNC (53 vs.57,7 Jahre, p < 0,0001). Signifikant häufiger zeigten sie ein hohen Malignitätsgrad (G3) (66 % vs. 28 %; p = 0,0001) und die mediane Tumorgröße war größer als in anderen Grupp...

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94 Background: Intraoperative boost irradiation as part of breast-conserving therapy is a perfect method to adequately capture the high risk tumor relapse area. The most homogeneous dose distribution is achieved with electrons. Intraoperative radiotherapy (IOERT) as a boost for breast cancer releases a high single dose of radiation to the breast tissue; therefore acute toxicity is of particular attention. To date there is only inadequate information available on breast cancer patients treated with IORT using electrons applied as a boost. We therefore analyzed the acute toxicity and late side effects after radiotherapy with 10 Gy as a boost with a minimum follow-up of 3 months. Methods: A total of 385 patients treated with IOERT (10 Gy with 5, 7 and 9 MeV electrons) with a dedicated robotic linac (NOVAC 7, New Radiant Technology, Aprilia, Italy) to the tumor bed during breast-conserving surgery as a boost followed by whole-breast radiotherapy (WBRT,50- 50.4 Gy; 1.8-2 Gy per fraction) were included in this study. All patients underwent a retrospective follow-up regarding acute and late side effects. Toxicities were documented using the common toxicity criteria (CTC 4.0 of the European Organization for Research and Treatment of Cancer). Results: The IOERT was well tolerated and the cosmetic results were good. As a side effect there were five patients with seroma. Two patients developed a secondary wound healing. Two patients developed chronic pain in the irradiated breast. Ten patients developed a grade 2 fibrosis. The remaining patients did not develop any grade 3 or 4 side effects. The observed toxicity rates were not influenced by age, tubus size, electron energy or systemic therapy. 80 patients had a follow up longer than 5 years. Three of them developed distant metastasis and one patient died. Conclusions: After IOERT of the breast using electrons we did not find any unexpected acute and late toxicity rates.