PET-basierte Bestrahlungsplanung

Die Strahlentherapie ist fest in der Behandlung von Kopf-Hals-Tumoren verankert, und die [¹⁸F]-FDG-PET hat als PET/CT und PET/MRT einen zunehmenden Stellenwert in der personalisierten Therapie bei Kopf-Hals-Tumoren. Der Beitrag thematisiert die elementare Bedeutung einer Erfassung der genauen Tumorausdehnung und der daraus resultierenden Bestimmung der Tumorvolumina in der bildbasierten Strahlentherapieplanung als Grundlage für die erfolgreiche Bestrahlung.

Abstract

Head and neck tumours are associated with high morbidity and mortality. Radiotherapy is an integral part of the treatment of these tumours and [¹⁸F]-FDG-PET/CT or PET/MRI is becoming increasingly important in the personalised treatment of head and neck cancer. Advanced tumour stage radiotherapy is combined with chemotherapy and/or surgery. The paper deals with the elementary importance of measuring the exact tumour extent and the resulting determination of the tumour volumes in image-based radiotherapy planning as the basis for successful irradiation. The PET/CT-based target volume definition results in target volume reduction with consecutive protection of risk organs and healthy tissue. Increased glucose metabolism and hypoxic states of cancerous lesions allows PET/CT to correctly identify tumour regions and thereby helps in potential dose escalation for tumour control. PET/MRI shows promising results in the diagnosis of relapses after radiotherapy, but requires further evaluation in larger studies. The [¹⁸F]-FDG-PET/CT is ideally suited for therapy evaluation and recurrence diagnosis and has found its way into the ambulatory reimbursement system with some indications due to randomised studies with the highest level of evidence. In addition, the increasing use of machine learning in radiation therapy is emphasised.

Kernaussagen

• Kopf-Hals-Tumoren sind mit einer hohen Morbidität und Mortalität assoziiert. Die Strahlentherapie ist fest in der Behandlung dieser Tumoren verankert.

• Die [¹⁸F]-FDG-PET als PET/CT und PET/MRT gewinnt zunehmend an Bedeutung in der personalisierten Therapie bei Kopf-Hals-Tumoren.

• Im fortgeschrittenen Tumorstadium findet die Behandlung als Kombination aus Strahlentherapie und Systemtherapie und/oder Operation statt.

• Die vorliegende Arbeit geht auf die elementare Bedeutung der Erfassung der genauen Tumorausdehnung und die daraus resultierende Bestimmung der Tumorvolumina in der bildbasierten Strahlentherapieplanung als Grundlage für die erfolgreiche Bestrahlung ein.

• Die PET/CT-basierte Zielvolumendefinition führt zu einer Zielvolumenreduktion mit konsekutiver Schonung von Risikoorganen und gesundem Gewebe. Sie kann aufgrund des erhöhten FDG-Metabolismus und unter Einsatz von Hypoxietracern Tumorregionen identifizieren, die eine potenzielle Dosiseskalation zur Tumorkontrolle benötigen.

• Die PET/MRT zeigt vielversprechende Ergebnisse u. a. in der Rezidivdiagnostik nach Radiotherapie, bedarf aber einer weiteren Evaluierung in größeren Studien.

• Die [¹⁸F]-FDG-PET/CT ist hervorragend für die Therapieevaluation und Rezidivdiagnostik geeignet und fand aufgrund von randomisierten Studien mit höchstem Evidenzniveau mit einigen Indikationen Einzug in die vertragsärztliche Versorgung.

• Das maschinelle Lernen in der Strahlentherapie gewinnt zunehmend an Bedeutung.

Schlüsselwörter

PET/CT - Bestrahlungsplanung - IMRT - Strahlentherapie - Kopf-Hals-Tumoren

Keywords

PET/CT - radiotherapy planning - IMRT - head and neck cancer

Publication History

Article published online:
28 May 2020

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