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Wöckel A, Festl J, Stüber T, Brust K, Krockenberger M, Heuschmann PU, Jírů-Hillmann S, Albert US, Budach W, Follmann M, Janni W, Kopp I, Kreienberg R, Kühn T, Langer T, Nothacker M, Scharl A, Schreer I, Link H, Engel J, Fehm T, Weis J, Welt A, Steckelberg A, Feyer P, König K, Hahne A, Baumgartner T, Kreipe HH, Knoefel WT, Denkinger M, Brucker S, Lüftner D, Kubisch C, Gerlach C, Lebeau A, Siedentopf F, Petersen C, Bartsch HH, Schulz-Wendtland R, Hahn M, Hanf V, Müller-Schimpfle M, Henscher U, Roncarati R, Katalinic A, Heitmann C, Honegger C, Paradies K, Bjelic-Radisic V, Degenhardt F, Wenz F, Rick O, Hölzel D, Zaiss M, Kemper G, Budach V, Denkert C, Gerber B, Tesch H, Hirsmüller S, Sinn HP, Dunst J, Münstedt K, Bick U, Fallenberg E, Tholen R, Hung R, Baumann F, Beckmann MW, Blohmer J, Fasching P, Lux MP, Harbeck N, Hadji P, Hauner H, Heywang-Köbrunner S, Huober J, Hübner J, Jackisch C, Loibl S, Lück HJ, von Minckwitz G, Möbus V, Müller V, Nöthlings U, Schmidt M, Schmutzler R, Schneeweiss A, Schütz F, Stickeler E, Thomssen C, Untch M, Wesselmann S, Bücker A, Buck A, Stangl S. Interdisciplinary Screening, Diagnosis, Therapy and Follow-up of Breast Cancer. Guideline of the DGGG and the DKG (S3-Level, AWMF Registry Number 032/045OL, December 2017) - Part 2 with Recommendations for the Therapy of Primary, Recurrent and Advanced Breast Cancer. Geburtshilfe Frauenheilkd 2018; 78:1056-1088. [PMID: 30581198 PMCID: PMC6261741 DOI: 10.1055/a-0646-4630] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 06/20/2018] [Indexed: 12/29/2022] Open
Abstract
Purpose The aim of this official guideline coordinated and published by the German Society for Gynecology and Obstetrics (DGGG) and the German Cancer Society (DKG) was to optimize the screening, diagnosis, therapy and follow-up care of breast cancer. Method The process of updating the S3 guideline published in 2012 was based on the adaptation of identified source guidelines. They were combined with reviews of evidence compiled using PICO (Patients/Interventions/Control/Outcome) questions and with the results of a systematic search of literature databases followed by the selection and evaluation of the identified literature. The interdisciplinary working groups took the identified materials as their starting point and used them to develop suggestions for recommendations and statements, which were then modified and graded in a structured consensus process procedure. Recommendations Part 2 of this short version of the guideline presents recommendations for the therapy of primary, recurrent and metastatic breast cancer. Loco-regional therapies are de-escalated in the current guideline. In addition to reducing the safety margins for surgical procedures, the guideline also recommends reducing the radicality of axillary surgery. The choice and extent of systemic therapy depends on the respective tumor biology. New substances are becoming available, particularly to treat metastatic breast cancer.
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Affiliation(s)
- Achim Wöckel
- Universitätsfrauenklinik Würzburg, Universität Würzburg, Würzburg, Germany
| | - Jasmin Festl
- Universitätsfrauenklinik Würzburg, Universität Würzburg, Würzburg, Germany
| | - Tanja Stüber
- Universitätsfrauenklinik Würzburg, Universität Würzburg, Würzburg, Germany
| | - Katharina Brust
- Universitätsfrauenklinik Würzburg, Universität Würzburg, Würzburg, Germany
| | | | - Peter U. Heuschmann
- Institut für Klinische Epidemiologie und Biometrie (IKE-B), Universität Würzburg, Würzburg, Germany
| | - Steffi Jírů-Hillmann
- Institut für Klinische Epidemiologie und Biometrie (IKE-B), Universität Würzburg, Würzburg, Germany
| | | | - Wilfried Budach
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | | | - Ina Kopp
- AWMF-Institut für Medizinisches Wissensmanagement, Marburg, Germany
| | | | - Thorsten Kühn
- Frauenklinik, Klinikum Esslingen, Esslingen, Germany
| | - Thomas Langer
- Office des Leitlinienprogrammes Onkologie, Berlin, Germany
| | - Monika Nothacker
- AWMF-Institut für Medizinisches Wissensmanagement, Marburg, Germany
| | - Anton Scharl
- Frauenklinik, Klinikum St. Marien Amberg, Amberg, Germany
| | | | - Hartmut Link
- Praxis für Hämatologie und Onkologie, Kaiserslautern, Germany
| | - Jutta Engel
- Tumorregister München, Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität München, München, Germany
| | - Tanja Fehm
- Universitätsfrauenklinik Düsseldorf, Düsseldorf, Germany
| | - Joachim Weis
- Stiftungsprofessur Selbsthilfeforschung, Tumorzentrum/CCC Freiburg, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Anja Welt
- Innere Klinik (Tumorforschung), Westdeutsches Tumorzentrum, Universitätsklinikum Essen, Essen, Germany
| | | | - Petra Feyer
- Klinik für Strahlentherapie und Radioonkologie, Vivantes Klinikum, Neukölln Berlin, Germany
| | - Klaus König
- Berufsverband der Frauenärzte, Steinbach, Germany
| | | | | | - Hans H. Kreipe
- Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Wolfram Trudo Knoefel
- Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Michael Denkinger
- AGAPLESION Bethesda Klinik, Geriatrie der Universität Ulm, Ulm, Germany
| | - Sara Brucker
- Universitätsfrauenklinik Tübingen, Tübingen, Germany
| | - Diana Lüftner
- Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Campus Benjamin Franklin, Universitätsklinikum Charité, Berlin, Germany
| | - Christian Kubisch
- Institut für Humangenetik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Christina Gerlach
- III. Medizinische Klinik und Poliklinik, uct, Interdisziplinäre Abteilung für Palliativmedizin, Universitätsmedizin der Johannes Gutenberg Universität, Mainz, Germany
| | - Annette Lebeau
- Institut für Pathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Cordula Petersen
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Markus Hahn
- Universitätsfrauenklinik Tübingen, Tübingen, Germany
| | - Volker Hanf
- Frauenklinik Nathanstift, Klinikum Fürth, Fürth, Germany
| | | | | | - Renza Roncarati
- Frauenselbsthilfe nach Krebs – Bundesverband e. V., Bonn, Germany
| | - Alexander Katalinic
- Institut für Sozialmedizin und Epidemiologie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Christoph Heitmann
- Ästhetisch plastische und rekonstruktive Chirurgie, Camparihaus München, München, Germany
| | | | - Kerstin Paradies
- Konferenz Onkologischer Kranken- und Kinderkrankenpflege, Hamburg, Germany
| | - Vesna Bjelic-Radisic
- Universitätsfrauenklinik, Abteilung für Gynäkologie, Medizinische Universität Graz, Graz, Austria
| | - Friedrich Degenhardt
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
| | - Frederik Wenz
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Mannheim, Mannheim, Germany
| | - Oliver Rick
- Klinik Reinhardshöhe Bad Wildungen, Bad Wildungen, Germany
| | - Dieter Hölzel
- Tumorregister München, Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität München, München, Germany
| | - Matthias Zaiss
- Praxis für interdisziplinäre Onkologie & Hämatologie, Freiburg, Germany
| | | | - Volker Budach
- Klinik für Radioonkologie und Strahlentherapie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Carsten Denkert
- Institut für Pathologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Gerber
- Universitätsfrauenklinik am Klinikum Südstadt, Rostock, Germany
| | - Hans Tesch
- Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany
| | | | - Hans-Peter Sinn
- Pathologisches Institut, Universität Heidelberg, Heidelberg, Germany
| | - Jürgen Dunst
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Karsten Münstedt
- Frauenklinik Offenburg, Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Germany
| | - Ulrich Bick
- Klinik für Radiologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Eva Fallenberg
- Klinik für Radiologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Reina Tholen
- Deutscher Verband für Physiotherapie, Referat Bildung und Wissenschaft, Köln, Germany
| | - Roswita Hung
- Frauenselbsthilfe nach Krebs, Wolfsburg, Germany
| | - Freerk Baumann
- Centrum für Integrierte Onkologie Köln, Uniklinik Köln, Köln, Germany
| | - Matthias W. Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Jens Blohmer
- Klinik für Gynäkologie incl. Brustzentrum, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Fasching
- Frauenklinik, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Michael P. Lux
- Frauenklinik, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Nadia Harbeck
- Brustzentrum, Frauenklinik, Universität München (LMU), München, Germany
| | - Peyman Hadji
- Klinik für Gynäkologie und Geburtshilfe, Krankenhaus Nordwest, Frankfurt, Germany
| | - Hans Hauner
- Lehrstuhl für Ernährungsmedizin, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | | | | | - Jutta Hübner
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Christian Jackisch
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach, Offenbach, Germany
| | | | | | | | - Volker Möbus
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Frankfurt Höchst, Frankfurt, Germany
| | - Volkmar Müller
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Ute Nöthlings
- Institut für Ernährungs- und Lebensmittelwissenschaften, Rheinische Friedrich-Wilhelms Universität Bonn, Bonn, Germany
| | - Marcus Schmidt
- Klinik und Poliklinik für Geburtshilfe und Frauengesundheit, Universitätsmedizin der Johannes Gutenberg-Universität Mai, Germany nz, Mainz
| | - Rita Schmutzler
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum Köln, Köln, Germany
| | - Andreas Schneeweiss
- Nationales Centrum für Tumorerkrankungen, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Florian Schütz
- Nationales Centrum für Tumorerkrankungen, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Elmar Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Uniklinik RWTH Aachen, Aachen, Germany
| | | | - Michael Untch
- Klinik für Geburtshilfe und Gynäkologie, Helios Klinikum Berlin-Buch, Berlin, Germany
| | | | - Arno Bücker
- Klinik für Diagnostische und Interventionelle Radiologie am UKS, Universität des Saarlandes, Homburg, Germany
| | - Andreas Buck
- Nuklearmedizinische Klinik und Poliklinik des Universitätsklinikums Würzburg, Würzburg, Germany
| | - Stephanie Stangl
- Institut für Klinische Epidemiologie und Biometrie (IKE-B), Universität Würzburg, Würzburg, Germany
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Minami CA, Bilimoria KY, Hansen NM, Strauss JB, Hayes JP, Feinglass JM, Bethke KP, Rydzewski NR, Winchester DP, Palis BE, Yang AD. National Evaluation of the New Commission on Cancer Quality Measure for Postmastectomy Radiation Treatment for Breast Cancer. Ann Surg Oncol 2016; 23:2446-55. [PMID: 27169774 DOI: 10.1245/s10434-016-5257-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Current guidelines recommend postmastectomy radiotherapy (PMRT) for patients with ≥4 positive lymph nodes and suggest strong consideration of PMRT in those with 1-3 positive nodes. These recommendations were incorporated into a Commission on Cancer quality measure in 2014. However, national adherence with these recommendations is unknown. Our objectives were to describe PMRT use in the United States in patients with stage I to III invasive breast cancer and to examine possible factors associated with the omission of PMRT. METHODS From the National Cancer Data Base, 753,536 mastectomies at 1123 hospitals were identified from 1998 to 2011. PMRT use over time was examined using random effects logistic regression analyses, adjusting for patient, tumor, and hospital characteristics. Analyses were stratified by nodal status (≥4 nodes positive, 1-3 nodes positive, node negative). RESULTS The proportion of patients receiving PMRT increased from 1998 to 2011 (>4 positive nodes: 56.2 to 66.6 %; 1-3 positive nodes: 28.0 to 39.1 %; node-negative: 8.3 to 10.0 %, p < 0.001 for all). In adjusted analyses, patients with ≥4 positive nodes were more likely to have PMRT omitted if they had smaller tumors. Patients with 1-3 positive nodes were more likely to have PMRT omitted if they had lower grade or smaller tumors. Irrespective of patients' nodal status, PMRT utilization rates decreased as age increased. CONCLUSIONS Though PMRT rates increased over time in patients with ≥4 and 1-3 positive nodes, PMRT in patients with ≥4 positive nodes remains underutilized. Feedback to hospitals using the new Commission on Cancer PMRT measure may help to improve adherence rates.
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Affiliation(s)
- Christina A Minami
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University and Northwestern Memorial Hospital, Chicago, IL, USA. .,Robert H. Lurie Comprehensive Cancer Center, Northwestern Institute for Comparative Effectiveness Research in Oncology, Northwestern University and Northwestern Memorial Hospital, Chicago, IL, USA. .,Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Karl Y Bilimoria
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University and Northwestern Memorial Hospital, Chicago, IL, USA.,Robert H. Lurie Comprehensive Cancer Center, Northwestern Institute for Comparative Effectiveness Research in Oncology, Northwestern University and Northwestern Memorial Hospital, Chicago, IL, USA.,Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Nora M Hansen
- Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, IL, USA.,Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jonathan B Strauss
- Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, IL, USA.,Department of Radiation Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - John P Hayes
- Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, IL, USA.,Department of Radiation Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Joe M Feinglass
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kevin P Bethke
- Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, IL, USA.,Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - David P Winchester
- National Cancer Data Base, American College of Surgeons, Chicago, IL, USA
| | - Brian E Palis
- National Cancer Data Base, American College of Surgeons, Chicago, IL, USA
| | - Anthony D Yang
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University and Northwestern Memorial Hospital, Chicago, IL, USA.,Robert H. Lurie Comprehensive Cancer Center, Northwestern Institute for Comparative Effectiveness Research in Oncology, Northwestern University and Northwestern Memorial Hospital, Chicago, IL, USA.,Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, IL, USA.,Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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