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Laryngorhinootologie 2013; 92(S 01): S199-S204
DOI: 10.1055/s-0032-1333251
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© Georg Thieme Verlag KG Stuttgart · New York

Fehler und Gefahren: Medikamentöse und strahlentherapeutische Behandlung von ­Kopf-Hals-Malignomen

Errors and Hazards in Oncology: Radiation Oncology
T. G. Wendt
1   Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Jena, Jena
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Publication History

Publication Date:
26 April 2013 (online)

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Zusammenfassung

Nebenwirkungen und Gefahren, die aus der Strahlentherapie mit herkömmlichen Techniken (3D-konformale Radiotherapie) und Strahlendosen entstehen können, sind gut bekannt. Dagegen ist das Nebenwirkungssprektrum neuer Methoden wie der intensitätsmodulierter Radiotherapie (IMRT) mit u.U. modifizierten Dosis- und Zielvolumenkonzepten hinsichtlich der Langzeitfolgen wenig erforscht. Da die IMRT die selektive Schonung insbesondere der großen Kopfspeicheldrüsen erlaubt, was die chronische Xerostomie drastisch vermindert und die mittelfristige Lebensqualität erheblich verbessert, ist diese Technik die Methode der Wahl, wenngleich viele Detail prospektiv untersucht werden müssen. Die Kombination von Zytostatika und Strahlentherapie führt bei Hochrisikokonstellationen zu signifikanten Überlebensverbesserungen, allerdings ist die therapieassoziierte Morbidität und Mortalität speziell bei diesen Patienten hoch und bedarf besonderer Expertise und Supportivtherapie. Antikörper gegen EGF-Rezeptoren haben einen festen Platz in der Kombinationstherapie erlangt, wenngleich speziell bei der gleichzeitigen Anwendung mit ionisierender Strahlung akut auftretende Toxizität besondere Aufmerksamkeit erfordert und prospektiv untersucht werden muß.

Abstract

Errors and Hazards in Oncology: Radiation Oncology

Adverse effects and hazards which have their origin from radiation using conventional techniques like 3-D conformal radiotherapy and total radiation doses are well known. However little is known about the sprectum of especially late toxicity after radiation using new technologies like intensity modulated radiotherapy (IMRT) combined with novel target volume and dose concepts. Since IMRT allows for selective protection of the large salivary glands this technique improves the intermediate term quality of life and is the standard of care despite many details need further prospective evaluation. Combining cytotoxic drugs and radiotherapy yield improved survival in well-defined high risk patients. However morbidity and mortality of these protocols are high and deserve special expertise and supportive therapy. EGF-receptor antibodies have gained well defined indications, albeit specific toxicities in combination with irradiation deserve prospective studies and special attention.

Schlüsselwörter

intensitätsmodulierte Radiotherapie - Radiochemotherapie - Nebenwirkungen - epidermaler Wachstumsfaktor Rezeptor - Kopf-Hals-Karzinom

Key words

intensitiy modulated radiotherapy - chemoradiation - adverse events - epidermal growth factor receptor - head and neck cancer
 

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