Was gibt es Neues in der Neuroonkologie

Zusammenfassung

Wegweisende, häufig von Neurologen koordinierte Studien erlauben einen vorsichtig optimistischen Ausblick auf die Entwicklung der Neuroonkologie. Erkenntnisse wurden dabei im Bereich der anaplastischen Gliome, der primären ZNS-Lymphome sowie der Hirnmetastasen durch die Beantwortung von Therapieoptimierungsfragen zur Rolle der Radiotherapie gewonnen. Weitere Neuerungen betreffen die gemeinsam mit den Neuropathologen verfolgte Einführung molekularer Faktoren in die Entwicklung von Studien bei anaplastischen Gliomen und Glioblastomen und in die Klassifikation der Hirntumoren. Diese Fortschritte wurde durch die Durchführung kontrollierter Studien und die konsequente molekulare Auswertung von Tumorgeweben erzielt. Im Gegensatz dazu hinterlassen viele vermeintlich innovative, aber unkontrollierte und wegen fehlenden Biobankings auch nicht nachhaltig angelegte Studien mehr Fragen als Antworten, sowie ein Strohfeuer anstelle rationaler akademischer Therapieentwicklung. Zusammenfassend wurde dadurch Fortschritt erzielt, dass grundsätzliche Studienfragen gestellt und nicht nur Substanzen getestet wurden. Die relevanten Studien sind kontrolliert und beinhalten verpflichtende zentrale Strukturen wie eine Referenzpathologie, -radiologie und Gewebebanken.

Abstract

Several clinical trials that were mainly coordinated by neurologists allow a careful but optimistic view on the future of neurooncology. New insights have been gained particularly in anaplastic glioma, primary CNS lymphoma as well as brain metastases by answering the basic question about the optimal place for radiotherapy in the treatment of these diseases. Another important development concerns the introduction of molecular factors into the inclusion criteria of clinical trials as well as possibly into the so far merely histopathological WHO classification of brain tumours. These advances are attributed to the conduct of controlled trials and systematic evaluation of tumour tissue for molecular parameters. In contrast, many seemingly innovative but uncontrolled trials produce more questions than answers and are regarded as short-lived opportunities rather than a rational academic drug development. The lack of biobanking in most of these trials will also not allow future insights with increasing knowledge about the molecular pathology of the disease. Hence, important lessons learned in neurooncology are to dare to pose real questions rather than to merely test compounds, to appreciate the value of controls and the to accept the necessity of central structures, including, but not limited to central pathology, radiology and biobanking.

Schlüsselwörter

Glioblastom - primäres ZNS-Lymphom - Hirnmetastasen

Keywords

glioblastoma - primary CNS lymphoma - brain metastases

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