Skip to main content
Erschienen in: Im Fokus Onkologie 7-8/2018

10.07.2018 | Mammakarzinom | Gynäkoonkologie

Update der S3-Leitlinie

Aktuelle Therapiestrategien beim primären Mammakarzinom

verfasst von: Dr. med. Jasmin Festl, Prof. Dr. med. Achim Wöckel

Erschienen in: Im Fokus Onkologie | Ausgabe 7-8/2018

Einloggen, um Zugang zu erhalten

Zusammenfassung

In der aktualisierten S3-Leitlinie für die Früherkennung, Diagnostik, Therapie und Nachsorge des Mammakarzinoms von Dezember 2017 haben sich auch Neuerungen für die Behandlung des frühen Brustkrebs’ ergeben. So hat sich vor allem im Hinblick auf das operative Vorgehen die Radikalität verringert. Die erweiterten Möglichkeiten der Bestrahlung und systemischen Therapie in der adjuvanten Situation sind ebenfalls in die neuen Empfehlungen eingegangen.
Literatur
1.
Zurück zum Zitat Robert-Koch-Institut. Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V. (Hrsg). Krebs in Deutschland fur 2013/2014. 2017. 11. Ausg. Berlin, 2017. Robert-Koch-Institut. Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V. (Hrsg). Krebs in Deutschland fur 2013/2014. 2017. 11. Ausg. Berlin, 2017.
3.
Zurück zum Zitat Buchholz TA et al. Margins for breast-conserving surgery with wholebreast irradiation in stage I and II invasive breast cancer: American Society of Clinical Oncology endorsement of the Society of Surgical Oncology/American Society for Radiation Oncology consensus guideline. J Clin Oncol. 2014;32(14):1502–6.CrossRefPubMed Buchholz TA et al. Margins for breast-conserving surgery with wholebreast irradiation in stage I and II invasive breast cancer: American Society of Clinical Oncology endorsement of the Society of Surgical Oncology/American Society for Radiation Oncology consensus guideline. J Clin Oncol. 2014;32(14):1502–6.CrossRefPubMed
4.
Zurück zum Zitat Voogd AC et al. Differences in risk factors for local and distant recurrence after breast-conserving therapy or mastectomy for stage I and II breast cancer: pooled results of two large European randomized trials. J Clin Oncol. 2001;19(6):1688–97.CrossRefPubMed Voogd AC et al. Differences in risk factors for local and distant recurrence after breast-conserving therapy or mastectomy for stage I and II breast cancer: pooled results of two large European randomized trials. J Clin Oncol. 2001;19(6):1688–97.CrossRefPubMed
5.
Zurück zum Zitat Fisher B, Anderson S. Conservative surgery for the management of invasive and noninvasive carcinoma of the breast: NSABP trials. National Surgical Adjuvant Breast and Bowel Project. World J Surg. 1994;18(1):63–9.CrossRefPubMed Fisher B, Anderson S. Conservative surgery for the management of invasive and noninvasive carcinoma of the breast: NSABP trials. National Surgical Adjuvant Breast and Bowel Project. World J Surg. 1994;18(1):63–9.CrossRefPubMed
6.
Zurück zum Zitat De La Cruz L et al. Overall Survival, Disease-Free Survival, Local Recurrence, and Nipple-Areolar Recurrence in the Setting of Nipple-Sparing Mastectomy: A Meta-Analysis and Systematic Review. Ann Surg Oncol. 2015;22(10):3241–9.CrossRef De La Cruz L et al. Overall Survival, Disease-Free Survival, Local Recurrence, and Nipple-Areolar Recurrence in the Setting of Nipple-Sparing Mastectomy: A Meta-Analysis and Systematic Review. Ann Surg Oncol. 2015;22(10):3241–9.CrossRef
7.
Zurück zum Zitat Piper M et al. Total skin-sparing mastectomy: a systematic review of oncologic outcomes and postoperative complications. Ann Plast Surg. 2013;70(4):435–7.CrossRefPubMed Piper M et al. Total skin-sparing mastectomy: a systematic review of oncologic outcomes and postoperative complications. Ann Plast Surg. 2013;70(4):435–7.CrossRefPubMed
9.
Zurück zum Zitat Hoffmann J, Wallwiener D. Classifying breast cancer surgery: a novel, complexity-based system for oncological, oncoplastic and reconstructive procedures, and proof of principle by analysis of 1225 operations in 1166 patients. BMC Cancer. 2009;9:108.CrossRefPubMedPubMedCentral Hoffmann J, Wallwiener D. Classifying breast cancer surgery: a novel, complexity-based system for oncological, oncoplastic and reconstructive procedures, and proof of principle by analysis of 1225 operations in 1166 patients. BMC Cancer. 2009;9:108.CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat Andersson Y. et al. Axillary recurrence rate 5 years after negative sentinel node biopsy for breast cancer. Br J Surg. 2012;99(2):226–31.CrossRefPubMed Andersson Y. et al. Axillary recurrence rate 5 years after negative sentinel node biopsy for breast cancer. Br J Surg. 2012;99(2):226–31.CrossRefPubMed
11.
Zurück zum Zitat Giuliano AE et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011;305(6):569–75.CrossRefPubMedPubMedCentral Giuliano AE et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011;305(6):569–75.CrossRefPubMedPubMedCentral
12.
Zurück zum Zitat Giuliano AE et al. Locoregional Recurrence After Sentinel Lymph Node Dissection With or Without Axillary Dissection in Patients With Sentinel Lymph Node Metastases: Long-term Follow-up From the American College of Surgeons Oncology Group (Alliance) ACOSOG Z0011 Randomized Trial. Ann Surg. 2016;264(3):413–20.CrossRefPubMed Giuliano AE et al. Locoregional Recurrence After Sentinel Lymph Node Dissection With or Without Axillary Dissection in Patients With Sentinel Lymph Node Metastases: Long-term Follow-up From the American College of Surgeons Oncology Group (Alliance) ACOSOG Z0011 Randomized Trial. Ann Surg. 2016;264(3):413–20.CrossRefPubMed
13.
Zurück zum Zitat Classe JM et al. Sentinel lymph node biopsy after neoadjuvant chemotherapy for advanced breast cancer: results of Ganglion Sentinelle et Chimiotherapie Neoadjuvante, a French prospective multicentric study. J Clin Oncol. 2009;27(5):726–32.CrossRefPubMed Classe JM et al. Sentinel lymph node biopsy after neoadjuvant chemotherapy for advanced breast cancer: results of Ganglion Sentinelle et Chimiotherapie Neoadjuvante, a French prospective multicentric study. J Clin Oncol. 2009;27(5):726–32.CrossRefPubMed
14.
Zurück zum Zitat Boughey JC et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA. 2013;310(14):1455–61.CrossRefPubMedPubMedCentral Boughey JC et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA. 2013;310(14):1455–61.CrossRefPubMedPubMedCentral
15.
Zurück zum Zitat Kuehn T et al. Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentre cohort study. Lancet Oncol. 2013;14(7):609–18.CrossRefPubMed Kuehn T et al. Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentre cohort study. Lancet Oncol. 2013;14(7):609–18.CrossRefPubMed
16.
Zurück zum Zitat Trentin C et al. Predictors of invasive breast cancer and lymph node involvement in ductal carcinoma in situ initially diagnosed by vacuum-assisted breast biopsy: experience of 733 cases. Breast. 2012;21(5):635–40.CrossRefPubMed Trentin C et al. Predictors of invasive breast cancer and lymph node involvement in ductal carcinoma in situ initially diagnosed by vacuum-assisted breast biopsy: experience of 733 cases. Breast. 2012;21(5):635–40.CrossRefPubMed
17.
Zurück zum Zitat Chin-Lenn L et al. Predictors of treatment with mastectomy, use of sentinel lymph node biopsy and upstaging to invasive cancer in patients diagnosed with breast ductal carcinoma in situ (DCIS) on core biopsy. Ann Surg Oncol. 2014;21(1):66–73.CrossRefPubMed Chin-Lenn L et al. Predictors of treatment with mastectomy, use of sentinel lymph node biopsy and upstaging to invasive cancer in patients diagnosed with breast ductal carcinoma in situ (DCIS) on core biopsy. Ann Surg Oncol. 2014;21(1):66–73.CrossRefPubMed
18.
Zurück zum Zitat Virnig BA et al. Ductal carcinoma in situ of the breast: a systematic review of incidence, treatment, and outcomes. J Natl Cancer Inst. 2010;102(3):170–8.CrossRefPubMed Virnig BA et al. Ductal carcinoma in situ of the breast: a systematic review of incidence, treatment, and outcomes. J Natl Cancer Inst. 2010;102(3):170–8.CrossRefPubMed
19.
Zurück zum Zitat Narod SA et al. Breast Cancer Mortality After a Diagnosis of Ductal Carcinoma In Situ. JAMA Oncol. 2015; 1(7):888–96.CrossRefPubMed Narod SA et al. Breast Cancer Mortality After a Diagnosis of Ductal Carcinoma In Situ. JAMA Oncol. 2015; 1(7):888–96.CrossRefPubMed
20.
Zurück zum Zitat Shamliyan T et al. Association between patient and tumor characteristics with clinical outcomes in women with ductal carcinoma in situ. J Natl Cancer Inst Monogr. 2010;2010(41):121–9.CrossRefPubMedPubMedCentral Shamliyan T et al. Association between patient and tumor characteristics with clinical outcomes in women with ductal carcinoma in situ. J Natl Cancer Inst Monogr. 2010;2010(41):121–9.CrossRefPubMedPubMedCentral
21.
Zurück zum Zitat Marinovich ML et al. The Association of Surgical Margins and Local Recurrence in Women with Ductal Carcinoma In Situ Treated with Breast-Conserving Therapy: A Meta-Analysis. Ann Surg Oncol. 2016;23(12):3811–21.CrossRefPubMedPubMedCentral Marinovich ML et al. The Association of Surgical Margins and Local Recurrence in Women with Ductal Carcinoma In Situ Treated with Breast-Conserving Therapy: A Meta-Analysis. Ann Surg Oncol. 2016;23(12):3811–21.CrossRefPubMedPubMedCentral
22.
Zurück zum Zitat Rudloff U et al. The influence of margin width and volume of disease near margin on benefit of radiation therapy for women with DCIS treated with breast-conserving therapy. Ann Surg. 2010;251(4):583–91.CrossRefPubMed Rudloff U et al. The influence of margin width and volume of disease near margin on benefit of radiation therapy for women with DCIS treated with breast-conserving therapy. Ann Surg. 2010;251(4):583–91.CrossRefPubMed
23.
Zurück zum Zitat Lyman GH et al. Sentinel lymph node biopsy for patients with earlystage breast cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2014;32(13):1365–83.CrossRefPubMed Lyman GH et al. Sentinel lymph node biopsy for patients with earlystage breast cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2014;32(13):1365–83.CrossRefPubMed
24.
Zurück zum Zitat Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2011;378(9804):1707–16.CrossRef Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2011;378(9804):1707–16.CrossRef
25.
Zurück zum Zitat Haviland JS et al. The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomised controlled trials. Lancet Oncol. 2013;14(11):1086–94.CrossRefPubMed Haviland JS et al. The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomised controlled trials. Lancet Oncol. 2013;14(11):1086–94.CrossRefPubMed
26.
Zurück zum Zitat Whelan TJ et al. Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med. 2010;362(6):513–20.CrossRefPubMed Whelan TJ et al. Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med. 2010;362(6):513–20.CrossRefPubMed
27.
Zurück zum Zitat Bartelink H et al. Whole-breast irradiation with or without a boost for patients treated with breast-conserving surgery for early breast cancer: 20-year follow-up of a randomised phase 3 trial. Lancet Oncol. 2015;16(1):47–56.CrossRefPubMed Bartelink H et al. Whole-breast irradiation with or without a boost for patients treated with breast-conserving surgery for early breast cancer: 20-year follow-up of a randomised phase 3 trial. Lancet Oncol. 2015;16(1):47–56.CrossRefPubMed
28.
Zurück zum Zitat Warnberg F et al. Effect of radiotherapy after breast-conserving surgery for ductal carcinoma in situ: 20 years follow-up in the randomized SweDCIS Trial. J Clin Oncol. 2014;32(32):3613–8.CrossRefPubMed Warnberg F et al. Effect of radiotherapy after breast-conserving surgery for ductal carcinoma in situ: 20 years follow-up in the randomized SweDCIS Trial. J Clin Oncol. 2014;32(32):3613–8.CrossRefPubMed
29.
Zurück zum Zitat Goodwin A et al. Post-operative radiotherapy for ductal carcinoma in situ of the breast. Cochrane Database Syst Rev. 2013;(11):CD000563. Goodwin A et al. Post-operative radiotherapy for ductal carcinoma in situ of the breast. Cochrane Database Syst Rev. 2013;(11):CD000563.
30.
Zurück zum Zitat Goldhirsch A et al. Strategies for subtypes—dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer. Ann Oncol. 2011;22(8):1736–47.CrossRefPubMedPubMedCentral Goldhirsch A et al. Strategies for subtypes—dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer. Ann Oncol. 2011;22(8):1736–47.CrossRefPubMedPubMedCentral
32.
Zurück zum Zitat Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;365(9472):1687–717.CrossRef Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;365(9472):1687–717.CrossRef
33.
Zurück zum Zitat Sparano JA et al. Long-Term Follow-Up of the E1199 Phase III Trial Evaluating the Role of Taxane and Schedule in Operable Breast Cancer. J Clin Oncol. 2015;33(21):2353–60.CrossRefPubMedPubMedCentral Sparano JA et al. Long-Term Follow-Up of the E1199 Phase III Trial Evaluating the Role of Taxane and Schedule in Operable Breast Cancer. J Clin Oncol. 2015;33(21):2353–60.CrossRefPubMedPubMedCentral
34.
Zurück zum Zitat Bria E et al. Benefit of taxanes as adjuvant chemotherapy for early breast cancer: pooled analysis of 15,500 patients. Cancer. 2006;106(11):2337–44.CrossRefPubMed Bria E et al. Benefit of taxanes as adjuvant chemotherapy for early breast cancer: pooled analysis of 15,500 patients. Cancer. 2006;106(11):2337–44.CrossRefPubMed
35.
Zurück zum Zitat Martin M et al. Randomized phase 3 trial of fluorouracil, epirubicin, and cyclophosphamide alone or followed by Paclitaxel for early breast cancer. J Natl Cancer Inst. 2008;100(11):805–14.CrossRefPubMed Martin M et al. Randomized phase 3 trial of fluorouracil, epirubicin, and cyclophosphamide alone or followed by Paclitaxel for early breast cancer. J Natl Cancer Inst. 2008;100(11):805–14.CrossRefPubMed
36.
Zurück zum Zitat Moebus V et al. Intense dose-dense sequential chemotherapy with epirubicin, paclitaxel, and cyclophosphamide compared with conventionally scheduled chemotherapy in high-risk primary breast cancer: mature results of an AGO phase III study. J Clin Oncol. 2010;28(17):2874–80.CrossRefPubMed Moebus V et al. Intense dose-dense sequential chemotherapy with epirubicin, paclitaxel, and cyclophosphamide compared with conventionally scheduled chemotherapy in high-risk primary breast cancer: mature results of an AGO phase III study. J Clin Oncol. 2010;28(17):2874–80.CrossRefPubMed
37.
Zurück zum Zitat Jones S et al. Docetaxel With Cyclophosphamide Is Associated With an Overall Survival Benefit Compared With Doxorubicin and Cyclophosphamide: 7-Year Follow-Up of US Oncology Research Trial 9735. J Clin Oncol.2009;27(8):1177–83.CrossRefPubMed Jones S et al. Docetaxel With Cyclophosphamide Is Associated With an Overall Survival Benefit Compared With Doxorubicin and Cyclophosphamide: 7-Year Follow-Up of US Oncology Research Trial 9735. J Clin Oncol.2009;27(8):1177–83.CrossRefPubMed
38.
Zurück zum Zitat von Minckwitz G et al. Impact of treatment characteristics on response of different breast cancer phenotypes: pooled analysis of the German neo-adjuvant chemotherapy trials. Breast Cancer Res Treat. 2011;125(1):145–56.CrossRef von Minckwitz G et al. Impact of treatment characteristics on response of different breast cancer phenotypes: pooled analysis of the German neo-adjuvant chemotherapy trials. Breast Cancer Res Treat. 2011;125(1):145–56.CrossRef
39.
Zurück zum Zitat Cortazar P et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet. 2014;384(9938):164–72.CrossRefPubMed Cortazar P et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet. 2014;384(9938):164–72.CrossRefPubMed
40.
Zurück zum Zitat Romond EH et al. Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. N Engl J Med. 2005;353(16):1673–84.CrossRefPubMed Romond EH et al. Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. N Engl J Med. 2005;353(16):1673–84.CrossRefPubMed
41.
Zurück zum Zitat Moja L et al. Trastuzumab containing regimens for early breast cancer. Cochrane Database Syst Rev. 2012;(4):CD006243. Moja L et al. Trastuzumab containing regimens for early breast cancer. Cochrane Database Syst Rev. 2012;(4):CD006243.
42.
Zurück zum Zitat Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials. Lancet. 2011;378(9793):771–84.CrossRef Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials. Lancet. 2011;378(9793):771–84.CrossRef
43.
Zurück zum Zitat Colleoni M et al. Extended adjuvant intermittent letrozole versus continuous letrozole in postmenopausal women with breast cancer (SOLE): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol. 2018;19(1):127–38.CrossRefPubMed Colleoni M et al. Extended adjuvant intermittent letrozole versus continuous letrozole in postmenopausal women with breast cancer (SOLE): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol. 2018;19(1):127–38.CrossRefPubMed
44.
Zurück zum Zitat Davies C et al. Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial. Lancet. 2013;381(9869):805–16.CrossRefPubMedPubMedCentral Davies C et al. Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial. Lancet. 2013;381(9869):805–16.CrossRefPubMedPubMedCentral
45.
Zurück zum Zitat Burstein HJ et al. Adjuvant endocrine therapy for women with hormone receptor-positive breast cancer: american society of clinical oncology clinical practice guideline focused update. J Clin Oncol. 2014;32(21):2255–69.CrossRefPubMedPubMedCentral Burstein HJ et al. Adjuvant endocrine therapy for women with hormone receptor-positive breast cancer: american society of clinical oncology clinical practice guideline focused update. J Clin Oncol. 2014;32(21):2255–69.CrossRefPubMedPubMedCentral
47.
Zurück zum Zitat Blok EJ et al. Optimal Duration of Extended Adjuvant Endocrine Therapy for Early Breast Cancer; Results of the IDEAL Trial (BOOG 2006-05). J Natl Cancer Inst. 2018;110(1). Blok EJ et al. Optimal Duration of Extended Adjuvant Endocrine Therapy for Early Breast Cancer; Results of the IDEAL Trial (BOOG 2006-05). J Natl Cancer Inst. 2018;110(1).
Metadaten
Titel
Update der S3-Leitlinie
Aktuelle Therapiestrategien beim primären Mammakarzinom
verfasst von
Dr. med. Jasmin Festl
Prof. Dr. med. Achim Wöckel
Publikationsdatum
10.07.2018
Verlag
Springer Medizin
Erschienen in
Im Fokus Onkologie / Ausgabe 7-8/2018
Print ISSN: 1435-7402
Elektronische ISSN: 2192-5674
DOI
https://doi.org/10.1007/s15015-018-3605-y

Weitere Artikel der Ausgabe 7-8/2018

Im Fokus Onkologie 7-8/2018 Zur Ausgabe