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DOI: 10.1055/s-2008-1027341
© Georg Thieme Verlag KG Stuttgart · New York
Dilemmas in the Diagnosis and Therapy of Gestational Breast Cancer: Review of Literature
Schwierigkeiten in der Diagnose und Therapie von Brustkrebs in der SchwangerschaftPublication History
Publication Date:
11 June 2008 (online)
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Zusammenfassung
Ziel:Trotz des allgemeinen Konsenses zu diesem Thema sollen die wichtigsten Dilemmas, die bei diesem Thema von multidisziplinärem Interesse sind, hervorgehoben werden und aktuelle Konzepte, wie man eine optimale Diagnose und ein therapeutisches Resultat erreicht, bewertet werden. Ergebnisse: Die letzten Literaturdaten zeigen eine Rate von Brustkrebs in der Schwangerschaft gemäß den meisten Protokollen in einer Range von 0,2 % bis 3,8 %. Gemäß Definition ist die klinische Erscheinungsform dieses Typs von Karzinoms, dass sie in der Schwangerschaft oder innerhalb eines Jahres nach der Entbindung auftritt. Die Art und Weise der Behandlung und Prognose ist identisch zu der bei Frauen mit Brustkarzinom jenseits der Schwangerschaft, mit Ausnahme der Strahlentherapie, welche nicht in der Schwangerschaft angewendet wird und des gezielten Einsatzes von Zytostatika in der Polychemotherapie während des ersten Trimesters. Die einzige Ausnahme zu dieser Vorgehensweise wird bei Frauen angewendet, die aufgrund einer verspäteten Diagnose in einem fortgeschrittenen Stadium der Krankheit sind. Ergebnisse von großen Studien zeigen auf, dass die Therapie für Brustkrebs keinen nachteiligen Effekt für die Prognose von zukünftigen Schwangerschaften hat. Methoden: Aktuelle und ältere veröffentlichte Arbeiten von Autoren wurden reviewed, die gebräuchliche und akzeptable Behandlungsmethoden verwenden, genauso wie Meinungen und Daten, die von mehr zitierten Autoren im Hinblick auf größte Erfahrung in der Behandlung von Brustkrebs in der Schwangerschaft veröffentlicht wurden. Öffentliche Datenbanken und andere relevante veröffentlichte Literatur wurde verwendet. Fazit/Schlussfolgerung: Die Einschätzung/Bewertung und das Management von Frauen mit Brustkrebs in der Schwangerschaft bedürfen eines multidisziplinären Ansatzes. Eine chemotherapeutische Kur sollte individualisiert angewendet werden, um dadurch das Risiko zu reduzieren, wenn sie im zweiten oder dritten Trimester der Schwangerschaft angewendet wird. Eine chirurgische Therapie kann Brustamputation und sparing operative procedures beinhalten. Die Überwachung der Knotenbiopsie sollte bei Patienten mit negativem Knoten betrachtet werden. Die Strahlentherapie sollte bis nach der Geburt hinausgezögert werden.
Abstract
Aim: In spite of the general consensus on the issue, to point to major dilemmas encountered in this entity of multidisciplinary interest, and to review current concepts on how to achieve optimal diagnostic and therapeutic outcome. Results: Recent literature data show the rate of gestational breast cancer according to most protocols to range from 0.2 to 3.8 %. By definition, clinical manifestation of this type of carcinoma is expected to occur during pregnancy or within one year of delivery. The mode of treatment and prognosis are identical to those in women with breast carcinoma beyond pregnancy, except for radiotherapy which is not indicated during pregnancy and selective use of cytostatics in polychemotherapy during the first trimester. The only exception to this practice are women with advanced stage of the disease due to delayed diagnosis. Results of large studies indicate that therapy for breast cancer has no adverse effect on the prognosis of subsequent pregnancy. Methods: Recent and older published work available to authors has been reviewed by having in mind common and acceptable methods of treatment used today as well as opinions and data published by more cited authors having in mind institutions with biggest experience in treatment of gestational breast cancer. Public databases and other relevant published literature were used. Conclusion: The evaluation and management of women with gestational breast cancer require a multidisciplinary approach. Chemotherapeutic regimen should be individualized to maximally reduce the risk if administered in the second and third trimester. Surgical therapy may include mastectomy and sparing operative procedures. Sentinel node biopsy should be considered in node negative patients. Radiotherapy should be postponed to the postpartum period.
Schlüsselwörter
Brustkrebs - Schwangerschaft - Diagnose - Management
Key words
breast cancer - pregnancy - diagnosis - management
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