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Duktales Carcinoma in situ

Ductal carcinoma in situ

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Zusammenfassung

Beim duktalen Carcinoma in situ (DCIS) handelt es sich um eine heterogene Gruppe von Läsionen, deren Klassifikation und Therapie derzeit Gegenstand vieler Diskussionen ist. War bis vor wenigen Jahrzehnten noch die Mastektomie die Standardtherapie, wird heute in Analogie zum invasiven Mammakarzinom zunehmend die brusterhaltende Behandlung angestrebt. Studien belegten, dass eine adjuvante Strahlentherapie das DCIS-Lokalrezidivrisiko um 40–60% senkt. Patientinnen mit einem erhöhten Risiko (Frauen <50 Jahre, positiver Resektionsrand, hoher Anteil an Komedonekrosen) profitieren besonders von dieser. Ungeklärt ist nach wie vor, welche Patientinnen auf adjuvante Radiatio verzichten können. Die adjuvante Tamoxifentherapie reduziert die Lokalrezidivrate. Aufgrund des Nebenwirkungsprofils ist jedoch der Einsatz von Tamoxifen besonders bei komorbiden Patienten sorgfältig zu bedenken. Um ein optimales Therapiemanagement beim DCIS durchführen zu können, ist es unerlässlich, weitere Prognosefaktoren zu ermitteln. Auch im Hinblick auf eine Prävention des invasiven Mammakarzinoms ist die adäquate Behandlung des DCIS von entscheidender Bedeutung.

Abstract

Ductal carcinoma in situ (DCIS) is a heterogeneous group of lesions, and their classification and treatment is currently the subject of intense discussion. While mastectomy was the standard treatment up to only a few decades ago, as in the case of invasive carcinoma of the breast efforts are now made to save the breast. Studies have documented that adjuvant radiotherapy lowers the risk of a local recurrence of DCIS by 40–60%. Patients with an elevated risk (women under 50 years of age, positive resection margins, high proportion of comedo necroses) in particular benefit from this. It is still not known in which patients it is safe not to perform radiotherapy. Adjuvant tamoxifen also reduces the local recurrence rate. In view of the side effects of tamoxifen, however, the use of this adjuvant therapy should be considered very carefully, especially in the case of patients with comorbidities. Optimal management of therapy for DCIS is impossible without the ascertainment of further prognostic factors. Adequate treatment of DCIS is also of decisive importance from the aspect of preventing invasive carcinoma of the breast.

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Authors and Affiliations

  1. Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck

    T. Meyners & J. Dunst

  2. Klinik für Radiologe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck

    B. Stöckelhuber

  3. Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck

    M. Friedrich

  4. Institut für Pathologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck

    F. Noack

  5. Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 , Lübeck

    T. Meyners

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  1. T. Meyners
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  3. M. Friedrich
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  5. J. Dunst
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Correspondence to T. Meyners.

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Meyners, T., Stöckelhuber, B., Friedrich, M. et al. Duktales Carcinoma in situ. Onkologe 11, 993–1004 (2005). https://doi.org/10.1007/s00761-005-0952-z

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