Extrakranielle stereotaktische Bestrahlung bei Lungenrundherden

Zusammenfassung

Der Begriff der stereotaktischen „Body“-Strahlentherapie (SBRT) beschreibt eine Methode zur hochpräzisen perkutanen Radiotherapie, die es ermöglicht, ein extrakranielles Target präzise mit hohen Bestrahlungsdosen in wenigen Fraktionen zu behandeln. Sie hat sich wegen der exzellenten lokalen Kontrollraten in den letzten Jahren bei kleinen Lungentumoren gut etabliert. Bei internistisch inoperablen Patienten ist sie hierbei die Methode der Wahl, bei High-Risk-Patienten und Patienten, die eine Operation ablehnen, belegt die aktuelle Literatur die SBRT ebenfalls als sinnvolle Therapieoption. Nach einer Analyse der AG Stereotaxie der deutschen Gesellschaft für Radioonkologie sind die Therapieergebnisse in Deutschland international gut vergleichbar und im universitären Multicenter-Setting reproduzierbar; wenn adäquate Behandlungsdosen angewendet wurden, dann resultierten sehr gute Therapieergebnisse bei minimaler Toxizität. Die Grenzen der Methode liegen in der Behandlung von Tumoren in der Nachbarschaft sogenannter „serieller“ Risikoorgane wie Ösophagus oder zentralen Bronchien. Hier besteht das Risiko schwerer Strahlenspätfolgen, weshalb eine SBRT bei solchen Patienten, idealerweise innerhalb klinischer Studien, erfahrenen Zentren vorbehalten sein sollte.

Abstract

Stereotactic body radiotherapy (SBRT) is a method for the highly precise application of percutaneous high dose radiotherapy of extracranial targets in a limited number of treatment fractions. Due to the excellent local control rates, SBRT is now well established in limited stage lung tumours. In medically inoperable patients SBRT is the method of choice, in high-risk patients and patients who refuse resection, the current literature recommends SBRT as a reasonable therapeutic option. An analysis of the SBRT working group of the German Society for Radiation Oncology showed that the treatment results in Germany are well comparable to international data. The limitations of SBRT lie in the treatment of tumours in the direct neighbourhood of so-called “serial” normal tissues, which is due to the risk of severe late effects of high dose radiation. Therefore these patients should be treated by SBRT, if at all, in the context of respective clinical studies.

Schlüsselwörter

Radiotherapie - stereotaktische Strahlentherapie - Lungentumoren - stereotaktische Body-Strahlentherapie (SBRT)

Key words

radiotherapy - stereotactic radiotherapy - lung tumours - stereotactic body radiotherapy (SBRT)

• Literatur

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