gms | German Medical Science

27. Deutscher Krebskongress

Deutsche Krebsgesellschaft e. V.

22. - 26.03.2006, Berlin

Interdisciplinary DKG S3 Guidelines for Breast Cancer: Update for Radiotherapy

Meeting Abstract

  • corresponding author presenting/speaker Rainer Souchon - Klinik für Strahlentherapie und Radioonkologie, AKH Hagen, Hagen, Deutschland
  • Rolf Sauer - Strahlenklinik, Universitätsklinikum Erlangen, Erlangen
  • Petra Feyer - Klinik für Strahlentherapie, Radioonkologie und Nuklearmedizin, Vivantes Klinikum Neukölln, Berlin
  • Marie-Luise Sautter-Bihl - Klinik für Strahlentherapie, Städtisches Klinikum Karlsruhe, Karlsruhe
  • Wilfried Budach - Klinik und Poliklinik für Strahlentherapie und radiologische Onkologie, Universitätsklinikum Düsseldorf, Düsseldorf
  • Jürgen Dunst - Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein Campus Lübeck, Lübeck
  • Wulf Haase - Klinik für Strahlentherapie und radiologische Onkologie, St. Vincentius Kliniken Karlsruhe, Karlsruhe
  • Wolfgang Harms - Abt. Radioonkologie und Strahlentherapie, Universitätsklinikum Heidelberg, Heidelberg
  • Frederik Wenz - Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Mannheim, Mannheim

27. Deutscher Krebskongress. Berlin, 22.-26.03.2006. Düsseldorf, Köln: German Medical Science; 2006. DocIS096

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dkk2006/06dkk096.shtml

Veröffentlicht: 20. März 2006

© 2006 Souchon et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Background: In 2004, the German Cancer Society (DKG) published interdisciplinary guidelines for the diagnosis and treatment of breast cancer using the methods and criteria of evidence-based medicine (EBM) (http://www.g-i-n.net/download/files/S3_Diagn_Ther_engl.pdf). Based on the DKG S3 guidelines, the „Breast Cancer Panel" of the German Society of Radiation Oncology (DEGRO) worked out an update of their guidelines for radiation therapy (RT) focusing on specific issues of radiation oncology, such as stage-appropriate treatment selection and RT techniques according to different tumor stages. In 2005, DEGRO presented actualized guidelines for radiation therapy (RT) in this field.

Methods: The DKG Stage 3 guidelines are a statement of interdisciplinary consensus based on currently accepted cross-sectoral approaches to treatment, mainly elaborated from clinical trials which are published up to 06/2004. The updated DEGRO guidelines are based on data from literature research up to summer 2005. The monodisciplinarily conducted guideline formally represents Stage 2 recommendations, while methodologically using same criteria of EBM like S3 guidelines.

Results: The currentDEGRO guidelines routinely includeRT in multimodal combination treatment concepts. New recommendations are given for RT planning and technique in order tominimize treatmentassociated acute toxicity and long term sequelae. Furthermore, the guideline provides more precise stage-adapted indications for RT, more accurate definitions of treatment volumes of RT with special regard to technical improvements such asmodern imaging modalities for determing treatment the treatment volume. - In sequentially combined chemo-/radiotherapy concepts priority should be given to clinically presumed dominant local or systemic risk for relapse favoring RT as a first modality in patientsrepresenting postoperatively consistent „close margin“ or R1/R2 status. Postmastectomy RT should be considered even in pN1-stages with 1-3 nodes in presence of further risk factors („intermediate risk“). RT of ipsilateral supra-/ infraclavicular lymphatics is indicated in case of extensive axillary node involvement, clinically high risk of occult lymphatic spread (e.g. >3 positive axillary nodes, positive node(s) in level III). Even though the data of former and ongoing trials in ductal carcinoma in situ (DCIS) do not yet permit final conclusions, postoperative RT after breast conserving surgery is still regarded as treatment of choice.

Conclusion: The updated DEGRO guidelines for radiotherapy in primary breast cancer treatment are basically consistent with DKG recommendations. They add further detailed informations concerning indications and technique of radiotherapy, thus providing a tool of quality assurance for the clinician with the goal of improving the level of standard care in radiooncological treatment with nationwide implementation in daily RT practice. Statements and recommendations of these DEGRO guidelines should also be a considerable baseline for the recently started new update process of DKG S3 guidelines to define currently accepted approaches to treatment with special regard to radiooncological aspects.

R. Souchon, R. Sauer on behalf of the "Breast Cancer Panel" of the German Society of Radiation Oncology (DEGRO)