Bevölkerungsbezogene Studie über die Anwendung adjuvanter Strahlentherapie bei Patientinnen mit Mammakarzinom

Nagel, Gabriële; Röhrig, Bernd; Hoyer, Heike; Füller, Jürgen; Katenkamp, D.

doi:10.1007/s00066-002-0985-9

Cited by 20 publications

(10 citation statements)

References 22 publications

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“…Several trials were performed lasting several years, and in parallel, thousands of patients were treated according to the "expected results" outside of these trials. Up to 30% of the patients in the respective age group did not receive the proper treatment [10]. However, in none of these prospective trials any subgroup could be identified which did not benefit from WBRT in terms of a reduced rate of IBTR in all age and risk groups.…”

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Accelerated Partial-Breast Irradiation (APBI) – Ready for Prime Time?

et al. 2009

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EditorialBreast cancer has the highest incidence among all cancer types in females with one in every eight to ten women being affected during her lifetime. The 5 year survival rate averaged over all tumor stages is reaching 90% according to the American Cancer Society [3]. Breast cancer therapy has become more and more risk adapted over the last 3 decades and especially the extent of surgery was reduced without compromising outcome. Breast conserving surgery (BCS) and sentinel node biopsy have replaced radical mastectomy and radical axillary resection in appropriately selected patients based on risk factors.There is no doubt, that adjuvant whole breast radiotherapy (WBRT) after BCS decreases the risk of in breast tumor recurrence (IBTR) from about 30-40% after 10 years to about 5-10% and thus improves overall survival by about 5% after 15 years [20,25,29,30]. Moreover, it has been demonstrated in a large randomized trial that a group of patients benefited from an additional focal dose escalation -the tumor bed boost (review in [29]). Although the results were expected founded on theoretical considerations, this change in practice had to be based on a large prospective randomized trial from the EORTC to exactly document risks and benefits.Like every other adjuvant therapy, WBRT after BCS is an overtreatment for some patients and reducing the intensity of WBRT is currently one of the most fervidly and controversially discussed issues with regard to breast cancer therapy [21][22][23][24]. Although the idea of a risk adapted reduction of breast cancer radiotherapy either in radiation dose and/or in treatment volume is intriguing, it is strongly recommended not to base such a fundamental change in clinical practice on theoretical assumptions alone rather than on solid data from properly designed and conducted trials.There are important lessons learned from the history of breast cancer treatment. 15 years ago, it was hypothesized, that there is a certain percentage of patients with so called low risk features (old age, small tumor, receptor positivity, etc.) who would not benefit from WBRT after BCS at all. Several trials were performed lasting several years, and in parallel, thousands of patients were treated according to the "expected results" outside of these trials. Up to 30% of the patients in the respective age group did not receive the proper treatment [10]. However, in none of these prospective trials any subgroup could be identified which did not benefit from WBRT in terms of a reduced rate of IBTR in all age and risk groups. Moreover, it seems important, that the relative risk reduction was almost constant in all patient groups. This experience should remind us that even though hypotheses are a prerequisite for progress in medicine, any such advancement can only Key Words: Breast cancer · Radiotherapy · Breast-conserving therapy · Partial-breast irradiation Schlüsselwörter: Mammakarzinom · Radiotherapie · Brusterhaltende Therapie · Teilbrustbestrahlung

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Accelerated Partial-Breast Irradiation (APBI) – Ready for Prime Time?

et al. 2009

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“…Longitudinally only 1.1% of the women complained at measurement point t6 moderate stress (grade 2) in the course of radiotherapy. Nagel and coworkers [22] confirmed in a field study with breast cancer patients a high rate of adjuvant radiotherapy in addition to breast-conserving surgery of 90.6%. The study documented a very impressive high level of acceptance of adjuvant radiotherapy after breast-conserving surgical care which was in concordance with our results.…”

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Is standard breast-conserving therapy (BCT) in elderly breast cancer patients justified? A prospective measurement of acute toxicity according CTC-classification

et al. 2010

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BackgroundBreast conserving therapy (BCT) is an accepted treatment for early-stage breast cancer. This study aimed to measure prospectively acute radiation-related toxicity and to create a comprehensive data base for long-term temporal analyses of 3D conformal adjuvant radiotherapy. The specific aspect of age has been neglected by traditional research. Therefore, the impact of age on acute BCT toxicity should be also specifically adressed.MethodsToxicity was measured in 109 patients at initiation (t1), during radiotherapy (t2-t7), and 6 weeks after treatment completion (t8) using a new topographic module. Organ systems were recorded in 15 scales and scored according to symptom intensity (grade 0-5) based on CTC (Common Toxicity Criteria) -classification. Radiotherapy was virtually CT-based planned and applied with 6-MeV-photons. Mean total dose was 60.1 Gy. Patients were stratified by age in 3 Groups: <50, 50-60, and >60 years.ResultsRegistered toxicity was generally low. Mean overall-grade climbed from 0.29-0.40 (t1-t7), and dropped to 0.23 (t8). Univariate analyses revealed slightly higher toxicity in older (> 60 years) versus young patients (< 50 years) in 2 scales only: breast-symmetry (p = 0.033), and arm function (p = 0.007). However, in the scale "appetite" toxicity was higher in younger (< 50 years) versus older (> 60 years) patients (p = 0.039). Toxicity differences in all other scales were not significant. Between older (> 60 years) and midaged patients (50-60 years) no significant differences in toxicity were found. This was also true for the comparison between young (< 50 years) versus midaged patient groups (50-60 years).ConclusionThe treatment concept of BCT for breast cancer is generally well tolerated. The toxicity-measurement with the new topographic module is feasible. Not modified standard treatment for BC should be performed in elderly women.

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“…Nagel und Mitarbeiter [7] stellten vor knapp einem Jahrzehnt bei der Gruppe von über 70-Jährigen eine Unterversorgung mit Radiotherapie fest. Das betreffe 30% der über 70-Jährigen im Vergleich zu nur 3-5% der jüngeren Patientinnen.…”

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Nachteile für ältere Patientinnen mit Mammakarzinom durch Untertherapie

Giordano

Wenz

2012

Strahlenther Onkol

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Bevölkerungsbezogene Studie über die Anwendung adjuvanter Strahlentherapie bei Patientinnen mit Mammakarzinom

Cited by 20 publications

References 22 publications

Accelerated Partial-Breast Irradiation (APBI) – Ready for Prime Time?

Accelerated Partial-Breast Irradiation (APBI) – Ready for Prime Time?

Is standard breast-conserving therapy (BCT) in elderly breast cancer patients justified? A prospective measurement of acute toxicity according CTC-classification

Nachteile für ältere Patientinnen mit Mammakarzinom durch Untertherapie

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