Strahlentherapie

Die Strahlentherapie wird in Kuration und Palliation eingesetzt und stellt eine wichtige Therapiemodalität in der interdisziplinären Tumortherapie dar. Innovative Therapiekonzepte wurden auf dem ASCO 2016 vorgestellt: Die Akzelerierung der postoperativen Bestrahlung kann bei Patienten mit Mundhöhlenkarzinomen, die nicht für eine Chemotherapie mit Cisplatin geeignet sind, den potentiellen Überlebensnachteil kompensieren. Die hyperfraktioniert-akzelerierte Bestrahlung erreicht bei tolerabler Toxizität sehr gute Überlebensraten für Patienten mit kleinzelligen Bronchialkarzinomen im Stadium limited disease. Patienten mit Prostatakarzinomen intermediären Risikos können sicher und effektiv mit einer hypofraktionierten Strahlentherapie behandelt werden. Die stereotaktische Radiochirurgie von residuellen oder rezidivierenden Hirnmetastasen kann Patienten nach Operation von 1–4 Hirnmetastasen anstelle der postoperativen Ganzhirnbestrahlung mit gleichwertigen Überlebensraten bei geringerer Toxizität angeboten werden. Patienten mit Magenkarzinomen profitieren nach neoadjuvanter Chemotherapie und Resektion nicht von einer Eskalation der postoperativen Chemotherapie um eine zusätzliche Bestrahlung; Subgruppenanalysen von nodal positiven, inkomplett resezierten oder Chemotherapie-resistenten Patienten stehen aus. Auch ältere Patienten ≥ 65 Jahre profitieren unabhängig vom Methylierungsstatus des MGMT-Promotors von einer Strahlentherapie mit konkomitanter und adjuvanter Temozolomid-Chemotherapie.

Radiation therapy is administered both in curative and palliative settings, and it displays one of the most important modalities in interdisciplinary treatment regimes. Innovative concepts and developments were presented at ASCO 2016: the acceleration of postoperative radiotherapy can compensate for inferior survival rates in patients with oral cavity tumors not eligible for chemotherapy with cisplatin. Hyperfractionated accelerated radiotherapy achieves high survival rates in patients with limited stage small cell lung cancer at manageable toxicity rates. Patients with intermediate risk prostate cancer are treated safely and effectively with hypofractionated radiation treatment regimes. Stereotactic salvage radiosurgery can be offered to patients following neurosurgical resection of 1-4 brain metastases instead of whole brain radiotherapy, where it achieves equivalent survival rates with lower toxicity. Patients with gastric cancer do not profit from postoperative chemoradiation following preoperative chemotherapy and surgery; the role of postoperative chemoradiation following incomplete resection, in patients with nodal involvement or in non-responders to preoperative chemotherapy remains unclear. Patients aged ≥ 65 years with glioblastomas profit from chemoradiation with concomitant and adjuvant temozolomide chemotherapy independently of their MGMT methylation status.

Key words

Fractionation - acceleration - chemoradiation - radiosurgery

• Literatur

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