Brustkrebs Behandlung: Zwei neue wissenschaftliche Studien zeigen, dass die alleinige Entfernung eines Knotens aus der Brust  (Lumpektomie) - zumindest bei kleineren Brustkrebsen - die gleichen guten Überlebenschancen eröffnet wie die Entfernung der ganzen Brust (Mastektomie).  Es zeigte sich weiter, dass in der erkrankten Brust zurückgebliebene "Nester von Krebszellen"  nicht häufiger zu Neuerkrankungen führen als bei Patientinnen, denen vorsichtshalber die ganze Brust entfernt wurde. Die Wahrscheinlichkeit der Entwicklung eines Zweitumors in der gleichen Brust liegt nach Lumpektomie bei 40%. Wird die operative Brust aber bestrahlt, sinkt diese Wahrscheinlichkeit auf nur noch 14%.

News

Lumpectomy is as effective as mastectomy for breast cancer

Scott Gottlieb, New York

Lumpectomy is just as effective as mastectomy for treating small breast cancers, conclude two studies from Italy and the United States.

Researchers from the University of Pittsburgh studied 1851 women with tumours up to 4 cm in diameter. In more than a third of cases the cancer had spread to the axillary lymph nodes (New England Journal of Medicine 2002; 347:1233-41) .

The women were randomly assigned to one of three treatments: a mastectomy, a lumpectomy alone, or a lumpectomy followed by radiation. The women were monitored for 20 years as part of the national surgical adjuvant breast and bowel project.

The women had the same chance of being alive after 20 yearswith or without cancerregardless of whether the breast had been removed or they had received a lumpectomy.

But radiation treatment significantly reduced the chance of another cancer arising in the same breast, sparing many women a mastectomythe usual treatment for a second cancer. The risk of a second cancer developing in the same breast was about 40% in women who had a lumpectomy without radiation and 14% in women who also had radiotherapy.

"It is time to declare the case against breast conserving therapy closed and focus our efforts on new strategies for the prevention and cure of breast cancer," writes Dr Monica Morrow of Northwestern University's Feinberg School of Medicine, Chicago, in an accompanying editorial. The findings, she writes, "should convince even the most determined sceptics."

In a second study, from the European Institute of Oncology in Milan, Italy, doctors excised a little more of the breast than a lumpectomy and only compared women whose tumours were 2cm or less in diameter (New England Journal of Medicine 2002;347:1227-32) .

From 1973 to 1980 the researchers monitored 701 women and found that the 20 year death rate from breast cancer was 24.3% in the 349 women who had a mastectomy and 26.1% in the 352 women who underwent less radical surgery.

After 1976, patients in both groups whose tumour had spread to the axillary nodes also received adjuvant chemotherapy with cyclophosphamide, methotrexate, and fluorouracil.

"Breast-conserving surgery is therefore the treatment of choice for women with relatively small breast cancers," conclude the authors.

Tiny clusters of cancer cells, which occur in 16% to 37% of women with breast cancer, can be detected with ultrasonography or magnetic resonance imaging. In such cases doctors often advise a mastectomy, as a lumpectomy cannot remove these clusters.

But Dr Morrow and other experts said the two studies indicated that it made no difference whether tiny clusters of cancer cells were removed or left behind.

"Subjecting women to a mastectomy because we now have a technique that is sensitive enough to detect microscopic foci is not a step forward," she writes.

Link zum Volltext New England Journal of Medicine
 

Link zum 2. Volltext New England Journal of Medicine