Radiotherapie im Konzept der primären ("neoadjuvanten") systemischen Behandlung des Mammakarzinoms

Background: The indications for primary ("neoadjuvant") systemic treatment (PST) for breast cancer have evolved over the last few years. PST is not only used in patients with locally advanced breast cancer (LABC) and inoperable tumors but also plays a role for operable tumors aiming at breast conservation and higher complete remission rates (ypCR). The contribution of radiotherapy and the optimal sequencing of chemotherapy, surgery and radiotherapy still have to be defined. Material and Methods: Objectives and results of PST for inflammatory, locally advanced and operable breast cancer were analyzed according to tumor stage. Results: Radiotherapy following PST and surgery is the standard of care for inflammatory breast cancer, LABC and nonresectable lesions. Comparable results are achieved for good responders after PST receiving radiotherapy or surgery. The evaluation of a preoperative radiotherapeutic approach is complicated by different chemo- and radiotherapy regimens, continuation of chemotherapy after surgery and heterogeneous patient groups. Conclusion: For LABC and inflammatory breast cancer the role of PST is well defined. For operable lesions, however, the value of preoperative radiotherapy still has to be established. This should be assessed within the framework of a clinical trial using standardized parameters for applying chemotherapy as well as radiation therapy.