It is currently unclear whether patients with low risk breast cancer receiving adjuvant endocrine therapy need adjuvant radiation therapy after breast conserving surgery. The data of randomized trials are available. In a database search 5 randomized trials including in total 3766 mostly elderly patients with early stage breast cancer treated either with adjuvant endocrine therapy or with endocrine therapy and additional whole breast radiation after breast conserving surgery were identified. Published hazard ratios for time to local recurrence were the basis of our meta-analysis. Meta-analysis of the effect sizes on local recurrence was performed using a random effects model based on parameter estimates of log hazard ratios in Cox models and their standard errors. Furthermore, overall survival was examined. Adjuvant hormone therapy alone in mostly older patients with low risk breast cancer resulted in significantly shorter time to local relapse compared to radiation therapy combined with hormone therapy (Hazard Ratio: 6.8, 95% CI: 4.23–10.93, p < 0.0001) . There was no significant difference for overall survival. Additional radiation therapy to hormone therapy did improve local relapse in breast cancer patients but did not show significant impact on overall survival.

Neoadjuvant chemotherapy enables close monitoring of tumor response in patients with breast cancer. Being able to assess tumor response during treatment provides an opportunity to evaluate new therapeutic strategies. Thus, for triple-negative breast tumors, it was demonstrated that additional immunotherapy could improve prognosis compared with chemotherapy alone. Furthermore, adjuvant therapy can be escalated or de-escalated correspondingly. The CREATE-X trial randomly assigned HER2-negative patients with residual tumor after neoadjuvant therapy to either observation or capecitabine. In HER2-negative patients with positive BRCA testing, the OlympiA study randomly assigned patients to either observation or olaparib. HER2-positive patients without pathologic remission were randomly assigned to trastuzumab or trastuzumab–emtansine within the KATHERINE study. These studies were all able to show an improvement in oncologic outcome associated with the escalation of therapy in patients presenting with residual tumor after neoadjuvant treatment. On the other hand, this individualization of therapy may also offer the possibility to de-escalate treatment, and thereby reduce morbidity. Among WSG-ADAPT HER2+/HR-, HER2-positive patients achieved comparable results without chemotherapy after complete remission following neoadjuvant treatment. In summary, the concept of post-neoadjuvant therapy constitutes a great opportunity for individualized cancer treatment, potentially improving outcome. In this review, the most important trials of post-neoadjuvant therapy are compiled and discussed.

Background: The question of how to deal with B3 lesions is of emerging interest. Methods: In the breast diagnostics of 192 patients between 2009 and 2016, a minimally invasive biopsy revealed a B3 lesion with subsequent resection. This study investigates the malignancy rate of different B3 subgroups and the risk factors that play a role in obtaining a malignant finding. Results: The distribution of B3 lesions after minimally invasive biopsy was as follows: atypical ductal hyperplasia (ADH), 7.3%; flat epithelial atypia (FEA), 7.8%; lobular neoplasia (LN), 7.8%; papilloma (Pa), 49.5%; phylloidal tumour (PT), 8.9%; radial sclerosing scar (RS), 3.1%; mixed findings, 10.4%; and other B3 lesions, 5.2%. Most B3 lesions were detected by stereotactic vacuum-assisted biopsy (44.3%), 36.5% by ultrasound-assisted biopsy, and 19.3% by magnetic resonance imaging-assisted biopsy. Most B3 lesions (55.2%) were verified by surgical resection, whereas 30.7% were downgraded to a benign lesion. About 14.1% of the cases were upgraded to malignant lesions, 9.4% to ductal carcinoma in situ and 4.7% to invasive carcinoma. In relation to individual B3 lesions, the following malignancy rates were found: 28.6% (ADH), 13.3% (FEA), 33.3% (LN), 12.6% (Pa), 5.9% (PT), and 0% (RS). The most important risk factor was increasing age. Postmenopausal status was considered an increased risk for an upgrade (p = 0.015). A known malignancy in the ipsilateral breast was a significant risk factor for a malignant upgrade (p = 0.003). Conclusion: Increasing knowledge about B3 lesions allows us to develop a “lesion-specific” therapy approach in the heterogeneous group of B3 lesions, with follow-up imaging for some lesions with less malignant potential and concordance with imaging or further surgical resection in cases of disconcordance with imaging or higher malignant potential.

Purpose: This study seeks to evaluate MR imaging morphological factors and other covariates that influence the presence of residual glandular tissue after risk-reducing mastectomy in patients with a familial predisposition. Methods: We analyzed women of a high-risk collective with pathogenic mutation (BRCA1 (n = 49), BRCA2 (n = 24), or further mutation (n = 9)). A total of 117 breasts were analyzed, 63 left and 54 right, from a cohort of 81 patients, who were on average 40 years old. The mean follow-up was 63 months (range 12–180 months, SD = 39.67). Retrospective analysis of MR imaging data from 2006–2022 of patients of a high-risk collective (all carriers of a pathogenic mutation) with contralateral (RRCM) or bilateral risk-reducing mastectomy (RRBM) was performed. In the image data the remaining skin flap thickness by distance measurements at eight equally distributed, clockwise points and the retromamillary area, as well as by volumetry of each breast, was elected. Residual glandular tissue was also volumetrized. In addition, patient-related covariates were recorded and their influence on postoperative residual glandular tissue and skin flap thickness was analyzed by uni- and multivariate regressions. Results: A significant association with postoperative residual glandular tissue was shown in multivariate analysis for the independent variables breast density, skin flap mean, and surgical method (all p-values < 0.01). A negatively significant association could be seen for the variables preoperative breast volume (p-values < 0.01) and surgeon experience (most p-values < 0.05–<0.1). Conclusion: Postoperative residual glandular tissue is an important tool for quantifying the risk of developing breast cancer after risk-reducing mastectomy. Different effects on residual glandular tissue were shown for the independent variables breast density, skin flap, surgical method, preoperative breast volume, and surgeon experience, so these should be considered in future surgical procedures preoperatively as well as postoperatively. Breast MRI has proven to be a suitable method to analyze the skin flap as well as the RGT.

Fragestellung: In der gynäkologischen Onkologie wird ein verstärktes Interesse an „komplementären und alternativen Methoden“ (CAM) sowie deren Nutzung von an Krebs erkrankten Frauen beobachtet. Ausreichende Untersuchungen zu möglichen Nebenwirkungen angebotener Produkte fehlen ebenso wie der Nachweis eines Überlebensvorteils. Daraus ergab sich die Fragestellung zur Motivation der Nutzung und der subjektiven Erwartung an die Wirkungsweise von CAM. Material und Methoden: 1030 Frauen mit einem Mammakarzinom, Endometriumkarzinom, Zervixkarzinom oder Ovarialkarzinom im Alter von 20 bis 92 Jahren wurden in einer Interview-gestützten Fragebogenstudie befragt. Der Fragebogen setzte sich aus zwei Teilen, 1. Socio-Economic Satisfaction-Questionnaire (SES-Qol) und 2. Complementary and Alternative Medicine Module (CAM-Module), zusammen. Die Therapiegruppen wurden mit den von den Patientinnen genannten Motivationen auf einen Zusammenhang (χ²-Test) überprüft. Ergebnisse: Eine CAM-Nutzung im Gesamtkollektiv wurde von 48,7 % (n = 502) angegeben. 50,1 % der Mammakarzinompatientinnen und 44 % der Frauen mit einem Genitalkarzinom setzten CAM ein. Am häufigsten wird die Misteltherapie (72,9 %) und am seltensten werden psychologische Methoden (19,1 %) genutzt. 434 Frauen nannten die „Stärkung des Immunsystems“ als häufigste und die „Eigeninitiative, selbst etwas gegen die Krebserkrankung bewirken zu wollen“ mit 68 Nennungen als seltenste Motivation. Die stärksten Assoziationen zwischen den Erwartungen an die Wirkungsweise und der tatsächlich gewählten CAM-Art zeigten sich bei der physikalischen Therapie. Schlussfolgerung: Trotz fehlenden Nachweises eines Überlebensvorteils und nicht ausreichend untersuchter Nebenwirkungen sollte aufgrund des ausgeprägten Patientinneninteresses für Transparenz hinsichtlich der CAM-Arten und der Anwendungsmethoden gesorgt werden. Durch eine vergleichende Informationsvermittlung von herkömmlichen Standardtherapien und CAM sollten Erwartungen von Patientinnen an die Wirkungsweise von CAM erörtert werden. Purpose: In recent years there has been an increased interest in gynecological oncology in the use of “complementary and alternative methods” (CAM). The lack of data on side effects and the fact that the posited survival advantage is still unproven appear to have no influence on the decision on whether to use CAM or not. This was the basis for our interest in the motivation and goals of women who use CAM and led us also to inquire which specific CAM are used for which purposes. Material and Methods: 1030 women between the ages of 20 - 92 years and diagnosed with either breast, endometrial, cervical or ovarian cancer were asked to participate in this study which consisted of a questionnaire and a personal interview. The case reports were comprised of two parts: 1. a socio-economic satisfaction questionnaire (SES-QoL), and 2. a complementary and alternative medicine module (CAM-module). Therapy groups were statistically compared using the motives named by patients to search for possible associations (χ²-test). Results: Out of the entire group of women 48.7 % (n = 502) used CAM. 50.1 % of breast cancer patients stated that they used CAM, as did 44.0 % of women with gynaecological cancer. Mistletoe use was widespread (72.9 %) and psychological methods were only seldom used (19.1 %). In the statements “a strengthening of the immune system” was given as the most common motivation (n = 434), whereas the motivation of “doing something oneself to combat the disease” (n = 68) was least often mentioned. The strongest association between the patient's expectations and the CAM used was demonstrated in the evaluation of physiotherapy. Conclusions: Although the proof of a survival advantage is lacking and studies on undesirable side effects are inadequate, there is a marked interest in such treatment methods as shown by the prevalence of CAM usage. Transparency of the CAM types and methods of application should be assured. Patient-oriented information comparing standard therapies with complementary, alternative methods (CAM) should be made generously available and the patient's expectations with respect to the effects of CAM use should be discussed between the physician and the patient.