DÄ internationalArchive44/2008Guideline-Compatible Treatment of Breast Cancer Patients – The Status Quo in Schleswig-Holstein: Language is the Source of All Misunderstandings

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Guideline-Compatible Treatment of Breast Cancer Patients – The Status Quo in Schleswig-Holstein: Language is the Source of All Misunderstandings

Dtsch Arztebl Int 2008; 105(44): 767. DOI: 10.3238/arztebl.2008.0767a
by Dr. rer. nat. Annika Waldmann, Dr. rer. nat. Ron Pritzkuleit, Prof. Dr. med. Dr. phil. Heiner Raspe, PD Dr. med. Alexander Katalinic in volume 18/2008

Stadler, P

LNSLNS As a radiation oncologist I was horrified to hear that in Schleswig-Holstein, more than 35%—rather than 10%—of patients with breast cancer receive radiotherapy to the axilla. The indication for classic axillary radiotherapy—level I to II; level III is optional—is narrowly defined at the tumor center in Munich (1). It is an option as alternative to axillary dissection in selected cases (2)—after axillary dissection it is justifiable only in case of high risk of local recurrence.

It is possible that the authors are unfamiliar with target volume concepts in breast cancer.

The lymphatic drainage is not defined as a target volume after breast conserving surgery and axillary dissection in patients with N0 status. However, for technical reasons it is regularly inevitable that the ventro-caudal axillary region is included. In patients with pN+ status, if particular conditions are met (1), the adjacent paraclavicular lymphatic drainage should be treated with radiation. For this target volume, parts of the craniomedial axillary drainage area are included, but the operated parts of the axilla (levels I and II) are not subject to radiotherapy.

The authors raised the question of axillary radiation. If they meant therapy of the paraclavicular lymphatic drainage areas then the question was formulated incorrectly because the complete axilla is not included in this target volume. If the question had included each partial concomitant treatment of the axilla, almost all patients might have responded "yes".

As radiation oncologists we are dependent on the trust and benevolence of our referrers more than other physicians are. We could not afford to give inadequate care or, to be exact, the wrong care to 25% of our patients. I therefore seriously doubt the hypothesis of inadequate care. DOI: 10.3238/arztebl.2008.0767a


Dr. med. Peter Stadler
Bunsenstr. 215, 71032 Böblingen, Germany
Peter.Stadler@web.de
1.
Schaffer P, Atavesen B, Herbst M et al.: Radioonkologische Behandlung. In: Janni W (Hrsg): Manual Mammakarzinome, Empfehlungen zur Diagnostik, Therapie und Nachsorge. München, Wien, New York: Zuckschwerdt Verlag 2007; 11 Auflage: 114–27 (verfügbar unter: http://tumorzentrum-muenchen.de).
2.
Stadler P: Die regionale Strahlentherapie ist ebenso effektiv wie die Axilladissektion. Eine vertretbare Alternative zur kompletten Axilladissektion. InFoOnkologie 2008; 11: 94–5.
1. Schaffer P, Atavesen B, Herbst M et al.: Radioonkologische Behandlung. In: Janni W (Hrsg): Manual Mammakarzinome, Empfehlungen zur Diagnostik, Therapie und Nachsorge. München, Wien, New York: Zuckschwerdt Verlag 2007; 11 Auflage: 114–27 (verfügbar unter: http://tumorzentrum-muenchen.de).
2.Stadler P: Die regionale Strahlentherapie ist ebenso effektiv wie die Axilladissektion. Eine vertretbare Alternative zur kompletten Axilladissektion. InFoOnkologie 2008; 11: 94–5.

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