Zusammenfassung
Eine Metastasierung in das Gehirn ist - unabhängig von der zugrunde liegenden Tumorentität - ein ungünstiger Prognosefaktor. Das Auftreten zerebraler Metastasen variiert unter den Organtumoren sehr stark, bei einigen Tumorentitäten mit ansteigender Tendenz. Hieran hat zum einen die heute präzisere Bildgebungsdiagnostik (MRT, CT) einen wesentlichen Anteil, denn sie hat dazu beigetragen, zerebrale Metastasen besser detektieren zu können. Zum anderen gibt es heute effektivere Chemotherapien, welche die zugrunde liegenden Primärtumore und deren Metastasen beeinflussen, was sich positiv auf die Prognose auswirkt. Drei Viertel aller intrazerebralen Metastasen entstammen von Bronchial- und Mammakarzinomen sowie malignen Melanomen. Bei der interdisziplinär zu erarbeitenden individuellen Therapieentscheidung sind die Anzahl der Hirnmetastasen, ihr Ausmaß und die therapeutische Beeinflussbarkeit von Primärtumor und eventuellen extrazerebralen Manifestationen, ein Ansprechen auf eine initiale Steroidmedikation sowie der Karnofsky-Index die wichtigsten Bewertungskriterien. So sind, je nachdem ob solitäre oder multiple Hirnmetastasen vorliegen, unterschiedliche operative und radiotherapeutische Maßnahmen indiziert. Bei der Behandlung solitärer Hirnmetastasen beispielsweise steht die Kombination von Operation und Bestrahlung im Vordergrund. Letztlich jedoch bestimmen individuelle und logistische Faktoren die Therapieentscheidung.
Summary
Irrespective of the primary tumour entity, metastases in the brain is an unfavourable factor. The risk of cerebral metastasis varies greatly among the primary tumours of various organs, with some showing an increasing tendency. A major role in this latter is played by the currently more accurate diagnostic imaging techniques (MRI, CT), which have helped to considerably improve the detection of cerebral metastases. On the other hand, we now have more effective chemotherapeutic agents which impact on the underlying primary tumours, and thus exercise a positive influence on the prognosis. Three-quarters of all brain metastases stem from carcinomas of the lung or breast, or malignant melanomas. The major evaluation criteria for the interdisciplinary-based choice of treatment include the number of metastasis in the brain, their extent, the responsiveness to treatment of the primary tumour and possible extracerebral manifestations, the response to initial steroid medication, and the Karnofsky score. Thus, depending on whether solitary or multiple brain metastases present, differing surgical and radiotherapeutic measures are indicated. For the treatment of solitary brain metastases, for example, a combination of surgery and radiotherapy is preferred. In the last resort, however, individual and logistic factors will determine the choice of treatment. to therapy
Key Words
cerebral metastasis - diagnosis - prognosis - steroid medication - surgery - radiotherapy
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Anschrift des Verfassers
PD Dr. R. Souchon
Strahlenklinik
Allgemeines Krankenhaus Hagen gGmbH
Grünstr. 35
58095 Hagen
