Stereotaktische Strahlentherapie für Lebermetastasen

Zusammenfassung

In dieser Übersichtsarbeit wird der aktuelle Stand der stereotaktischen Strahlentherapie im Bereich des Körperstamms (SBRT) als Lokaltherapie für Patienten mit Lebermetastasen im Zustand der Oligometastasierung, Oligoprogression und Oligorekurrenz mit Fokus auf aktuelle Publikationen aus dem deutschsprachigen Raum dargelegt. Moderne SBRT-Techniken umfassen heute neben der präzisen Bildgebung auch Gating- und Tracking-Techniken, welche die Lokaltherapie von Lebermetastasen effektiver gemacht haben. Damit und mit zentralen Tumordosisoptimierungen lassen sich hohe lokale Kontrollraten von langfristig bis über 90% erreichen, die mit minimalen schweren Nebenwirkungsraten von unter 1% und 5-Jahres-Überlebensraten von mehr als 30% in selektionierten (inoperablen) Patientenkollektiven einhergehen. Durch hybride Ultraschall- oder MRT-Bestrahlungssysteme kann zukünftig die teils aktuell technisch erforderliche Fiducial-Marker-Implantation überwunden werden. Die SBRT stellt aufgrund der aktuellen Ergebnislage für Patienten mit Lebermetastasen eine wertvolle Ergänzung des therapeutischen Armamentariums als ebenbürtige Alternative zu minimalinvasiven ablativen Verfahren oder in Kombination mit anderen lokalen oder systemischen Behandlungen im interdisziplinären Kontext dar.

Abstract

In this review, the current state of stereotactic body radiation therapy (SBRT) is presented as a local therapy for patients with oligometastatic, oligoprogressive and oligorecurrent liver metastases – focusing on recent publications from German-speaking countries. In addition to precise imaging, modern SBRT techniques also use gating and tracking techniques that have made local therapy of liver metastases more effective. In combination with optimisation of central tumour dose, local control rates of up to 90% have been achieved with minimal side effects in less than 1% of patients and 5-year survival rates of more than 30% in selected (inoperable) patient populations. In future, hybrid ultrasound or MRI irradiation systems can overcome fiducial marker implantation. Due to the current outcome data, SBRT is a valuable addition to the therapeutic armamentarium for patients with liver metastases and is a true alternative to minimally invasive ablative procedures or can be used in combination with other local or systemic treatments in an interdisciplinary context.

Schlüsselwörter

Lebermetastasen - lokalablative Therapie - Oligometastasierung - stereotaktische Strahlentherapie

Key words

liver metastases - stereotactic body radiation therapy - local ablative therapy - oligometastases

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