Indikation zur prä-, post- und intraoperativen Strahlentherapie von Liposarkomen des Erwachsenenalters

Zusammenfassung

Radiotherapie ist ein integraler Bestandteil der Behandlung von Weichteilsarkomen des Erwachsenen. Während die Indikationsstellung zur additiven Radiotherapie bisher im Wesentlichen auf den bekannten allgemeinen Prognosefaktoren wie Tumorgröße, Lokalisation, Grading und (antizipiertem) Resektionsrand basierte, rückt der histologische Subtyp jetzt zunehmend in den Vordergrund. Außerdem haben sich die radiotherapeutischen Techniken deutlich weiterentwickelt, sodass eine adäquate Therapie in einigen Lokalisationen überhaupt erst möglich geworden ist. Diese Übersichtsarbeit fasst daher zunächst die allgemeinen radioonkologischen Therapieprinzipien für alle Weichteilsarkome, getrennt für die Hauptlokalisationen Extremitäten/Körperstamm und Retroperitoneum, zusammen. Dabei werden sowohl die vorliegende Evidenz für eine additive Radiotherapie per se als auch das optimale Timing (prä- vs. postoperativ) sowie grundlegende technische Prinzipien einschl. alternativer Boostverfahren wie der intraoperativen Radiotherapie erörtert. Weiterhin liegt ein besonderer Schwerpunkt auf der Indikation und Durchführung einer additiven Radiotherapie bei Liposarkomen. Hierzu werden sowohl die grundlegenden Unterschiede zwischen Liposarkomen und anderen Weichteilsarkomen als auch zwischen den einzelnen Subgruppen der Liposarkome (gut differenziert, dedifferenziert, myxoid und pleomorph) dargestellt und ihre Implikationen auf Indikationsstellung und Durchführung einer additiven Radiotherapie mit dem Ziel einer übersichtlichen Orientierungshilfe erörtert.

Abstract

Radiation therapy is an integral part of the treatment of soft tissue sarcomas in adults. The indication for additional radiation therapy has usually been based on known general prognostic factors, such as tumour size, localisation, grading and (anticipated) resection margin. Increasing attention has recently been paid to the role of the histological subtype. Moreover, radiation therapy techniques have distinctly improved, so that in some localisations adequate treatment has become possible for the first time. This review firstly summarises general treatment principles of radiation therapy in soft tissue sarcomas – separately for the extremities and trunk and the retroperitoneum. We discuss the available evidence for the administration of additional radiation per se, the preferred timing (pre- vs. postoperative) and fundamental technical principles, including alternative boosting techniques like intraoperative radiation therapy. Moreover, we provide a detailed discussion of the indication and procedure for additional radiation therapy in liposarcomas. We describe fundamental differences between liposarcomas and other soft tissue sarcomas as well as between the subgroups of liposarcoma (well differentiated, dedifferentiated, myxoid, pleomorphic), and how this affects the indication and procedure for additional radiation therapy, in order to provide a panoramic aid to orientation.

Schlüsselwörter

Strahlentherapie - Sarkom - Liposarkom

Key words

radiation therapy - sarcoma - liposarcoma

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