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Der Klinikarzt 2004; 33(5): 142-146
DOI: 10.1055/s-2004-828638
In diesem Monat

© Georg Thieme Verlag Stuttgart · New York

Radikaloperation oder Strahlentherapie? - Stand der modernen Strahlentherapie bei der Behandlung des Prostatakarzinoms

Radical Prostatectomy or Radiotherapy? - State of the Art in Irradiation of Prostate CarcinomaP.M. Messer1 , E. Schneider1 , N.M. Blumstein2 , H.-W. Gottfried3
  • 1Abteilung Strahlentherapie, Radiologische Universitäts- und Poliklinik Ulm (Direktor: Prof. Dr. E.M. Röttinger)
  • 2Abteilung Nuklearmedizin, Universitätsklinikum Ulm (Direktor: Prof. Dr. S.N. Reske)
  • 3Abt. Urologie und Kinderurologie, Urologische Universitätsklinik Ulm (Direktor: Prof. Dr. R. Hautmann)
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Publication History

Publication Date:
09 June 2004 (online)

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Zusammenfassung

Die Strahlentherapie des Prostatakarzinoms hat in den letzten Jahren bedeutende Fortschritte erzielt: Sowohl die Planung der Bestrahlung als auch die Bestrahlungstechniken sind heute besser und effizienter. In Abhängigkeit des jeweiligen Tumorstadiums stehen mit der perkutanen Strahlentherapie und der Brachytherapie verschiedene Optionen zur Verfügung, die in der Langzeitbeobachtung ähnlich gute Ergebnisse erreichen wie die radikale Operation. Die Verwendung dreidimensionaler Planungssysteme erlaubt eine immer größere Dosiseskalation am Tumor, wobei gleichzeitig die Akut- und die Spättoxizität vermieden bzw. zumindest reduziert werden können. Weisen die Patienten bereits ein fortgeschrittenes Prostatakarzinom auf bzw. haben sie ein hohes Risiko für eine mögliche Lymphknotenmetastasierung, kann über die Kombination beider Verfahren eine gute lokale Kontrolle erzielt werden. Auch eine zusätzliche antiandrogene Therapie kann bei diesen Patienten das krankheitsspezifische Überleben verbessern. Ein Rezidiv nach radikaler Operation oder definitiver Strahlentherapie kann nach Ausschluss einer möglichen Metastasierung erneut in kurativer Intension strahlentherapeutisch behandelt werden. In der interdisziplinären Behandlung hat die Strahlentherapie demnach heute ihren festen Platz, sie setzt jedoch einen uneingeschränkten Dialog zwischen Urologen und Strahlentherapeuten voraus.

Summary

Radiotherapy of prostate cancer has gained great progress during the last years - 3 d planning and irradiation techniques are more efficient today. Depending on tumour stage external beam irradiation (EBRT) and brachytherapy offer different options for primary treatment achieving equal results in long term follow up compared to surgery. The use of 3d treatment planning systems allows a progressive dose escalation at the tumour site omitting or reducing acute and late toxicity. In patients with advanced carcinoma or at high risk of lymph node metastasis a combination of EBRT and brachytherapy is able to achieve good local control. An additional antiandrogen therapy can improve disease specific survival. Even tumour relapse after radical prostatectomy or definitive irradiation can be treated with irradiation in curative intension after exclusion of distant metastases. Today radiotherapy is well established in interdisciplinary treatment of prostate cancer but requires an unrestricted dialogue between urologists and radiotherapists.

Key Words

prostate cancer - radiotherapy - external beam irradiation (ERBT) - brachytherapy - 3d treatment planning - antiandrogen therapy

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1 american society for therapeutic radiology and oncology

2 radiation therapy oncology group

Anschrift für die Verfasser

Dr. Peter M. Messer

Abteilung Strahlentherapie, Universitätsklinikum Ulm

Robert-Koch-Str. 6

89070 Ulm