Background: We recently published 2-year results of the prospective, randomized IMRT-MC2 trial, showing non-inferior local control and cosmesis in breast cancer patients after conventionally fractionated intensity-modulated radiotherapy with simultaneously integrated boost (IMRT-SIB), compared to 3D conformal radiotherapy with sequential boost (3D-CRT-seqB). Here, we report on 2-year quality of life results. Patients and Methods: 502 patients were enrolled and randomized to IMRT-SIB (50.4 Gy in 1.8 Gy fractions with a 64.4 Gy SIB to the tumor bed) or to 3D-CRT-seqB (50.4 Gy in 1.8 Gy fractions, followed by a sequential boost of 16 Gy in 2 Gy fractions). For quality of life (QoL) assessment, patients completed the QLQ-C30 and QLQ-BR23 questionnaires at baseline, 6 weeks and 2 years after radiotherapy. Results: Significant differences between treatment arms were seen 6 weeks after radiotherapy for pain (22.3 points for IMRT vs. 27.0 points for 3D-CRT-seqB; p = 0.033) and arm symptoms (18.1 points for IMRT vs. 23.6 points for 3D-CRT-seqB; p = 0.013), both favoring IMRT-SIB. Compared to baseline values, both arms showed significant improvement in global score (IMRT: p = 0.009; 3D-CRT: p = 0.001) after 2 years, with slight deterioration on the role (IMRT: p = 0.008; 3-D CRT: p = 0.001) and social functioning (IMRT: p = 0.013, 3D-CRT: p = 0.001) as well as the future perspectives scale (IMRT: p = 0.003; 3D-CRT: p = 0.0034). Conclusion: This is the first randomized phase III trial demonstrating that IMRT-SIB was associated with slightly superior QoL compared to 3-D-CRT-seqB. These findings further support the clinical implementation of SIB in adjuvant breast cancer treatment. (c) 2021 Elsevier B.V. All rights reserved. Radiotherapy and Oncology 163 (2021) 165-176

Adjuvant breast radiotherapy with risk-adapted boost irradiation continues to be the gold standard in primary treatment of breast cancer patients. During the last years, technical innovations and the possibility to shorten treatment times have paved the way for simultaneous integrated boost irradiation in breast radiotherapy. However, to our knowledge, there are no randomized studies supporting the non-inferiority of this treatment approach. The IMRT-M2 study is a prospective, multicenter, randomized phase-III-trial (NCT 01322854, Askoxylakis et al., BMC Cancer 2011) analyzing non-inferiority of intensity-modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB) (50.4 Gy/64.4 Gy in 28 fractions) to 3D-conformal radiotherapy with consecutive boost (3D-CRT) (50.4 Gy + 16 Gy in 36 fractions) for patients with breast cancer following breast-conserving therapy (BCT). 502 eligible patients (≤ 70 years or >70 years with risk factors (>T2, multifocal disease, L1, EIC, resection margin ≤ 3mm)) treated with breast conserving therapy (BCT) were enrolled between March 2011 and August 2015. Systemic therapy and regional nodal irradiation were performed in accordance to guideline recommendations. The primary outcomes were the local control rate measured at 2 and 5 years as well as the cosmetic results 6 weeks and 2 years post radiotherapy. The cosmetic results were evaluated via photo documentation calculating the relative breast retraction assessment (pBRA) score according to Vrieling et al. with the BCCT.core software. After a median follow-up of 5.11 years, 2-year local control was 99.56% in the IMRT with SIB arm and 99.55% in the 3D-CRT with consecutive boost arm (HR 0.602, 95%-CI 0.123-2.452, p = 0.487). There were no significant differences between the groups for the cosmetic results with a median pBRA of 9.1 and 10.3 following IMRT with SIB and 3-D-CRT with consecutive boost after both 6 weeks and 2 years after radiotherapy (95%-CI 0.183-0.516, p = 0.349). The pBRA score after radiotherapy significantly correlated with the initial pBRA score before radiotherapy (p<0.001) and with patient age (p = 0.046). Furthermore, no significant differences were detected in the cosmetic assessment according to the Harvard criteria by both the patient and the treating physician. Estimated overall survival and progression-free survival rates were 99.57% versus 99.56% (HR 3.281, 95%-CI 0.748-22.585, p = 0.148) and 99.12% versus 98.65% (HR 0.789; 95%-CI 0.301-2.00; p = 0.617) for IMRT with SIB and 3-D-CRT with consecutive boost, respectively. This is the first prospective trial reporting that normofractionated intensity modulated radiotherapy with simultaneous integrated boost is non-inferior to 3-D-conformal radiotherapy with consecutive boost in respect to cosmesis and local control after 2 years.

Brustkrebspatientinnen leiden während und nach der Strahlentherapie häufig unter krebs- oder therapiebedingter Fatigue, die die Lebensqualität stark einschränken kann. Körperliches Training scheint Fatigue zu reduzieren und das Wohlbefinden zu verbessern. Jedoch wurden entsprechende Interventionen bei Brustkrebspatientinnen unter Strahlentherapie, insbesondere Krafttraining, noch wenig erforscht. Darum untersuchten wir die Effekte eines 12-wöchigen progressiven Krafttrainings bei Brustkrebspatientinnen parallel zur Strahlentherapie in einer randomisierten kontrollierten Studie.

Cosmetic results have a significant impact on quality of life in breast cancer survivors. Several trials have shown that simple forward-planned intensity-modulated radiotherapy can improve cosmetic results in terms of global cosmetic outcome, reduced hyperpigmentation and a reduced risk of moist desquamation.

Aims: Local ablative therapies such as stereotactically guided single-dose radiotherapy or helical intensity-modulated radiotherapy (tomotherapy) with high single-doses are successfully applied in many centers in patients with liver metastasis not suitable for surgical resection. This study presents results from more than 10 years of clinical experience and evaluates long-term outcome and efficacy of this therapeutic approach.

Up to 50 % of all cancer patients require psychosocial support during the course of their disease. However, only a proportion of these patients make use of the existing services. This is partly because patients are unaware that psychosocial support services are available to them. We investigated whether systematically providing printed information concerning psychosocial support can increase the knowledge and usage of these services, as well as health-related self-efficacy. In a controlled trial, 108 breast cancer patients were assigned alternately to either an intervention- or a control group. At two predefined time points before and during radiotherapy, patients in the intervention group received correspondence informing them about psychosocial services (psycho-oncology, clinical social work and the Cancer Information Service).The control group received no systematic information. Using a standardized questionnaire, all patients were subsequently questioned about their knowledge of psychosocial support services, their perceived self-efficacy and their use of psychosocial support services. We found that systematic provision of information had a positive effect on the knowledge of psychosocial support services (p = 0.042; d = 0.45) and self-efficacy (p = 0.047; d = 0.42). However, no increase in the actual usage of these services was observed (p = 0.661; d = 0.10). The systematic provision of information in the form of written correspondence can easily be implemented into clinical routine and is an effective way to increase cancer patients' knowledge of psychosocial support services. Furthermore, providing information about the services had a positive impact on patients' perceived self-efficacy. However, simply making this information available did not increase the usage of psychosocial support services.

Bis zu 50 % aller Krebspatienten benötigen im Verlauf der Erkrankung psychosoziale Unterstützung. Jedoch nimmt nur ein Teil dieser Patienten bestehende Angebote in Anspruch. Dies hängt unter anderem mit dem fehlenden Kenntnisstand über die Möglichkeit der Inanspruchnahme psychosozialer Angebote zusammen. Wir untersuchten, ob durch die systematische Bereitstellung von schriftlichen Informationen über psychosoziale Angebote die Kenntnis, Selbstwirksamkeit und Inanspruchnahme derselben gesteigert werden kann.

Vorgestellt wird eine 45-jährige perimenopausale Patientin, I-Gravida I-Para. Die Patientin hatte selbst seit Monaten einen größenpersistenten Knoten in der rechten Brust getastet, der seit wenigen Wochen schmerzhaft geworden sei. Daher erfolgte nun eine Abklärung über unser Brustzentrum. Bei der Familienanamnese gab es kein Vorkommen von Mamma- und / oder Ovarialkarzinomen. Die Patientin war gesund und hatte keinerlei internistische Nebendiagnosen. Die Frau war 165 cm groß bei einem Gewicht von 55 kg, die Brustgröße wurde mit Cup B angegeben.