Zusammenfassung
Tumorhypoxie ist ein wesentlicher prognostischer Faktor bei der Strahlentherapie von verschiedenen malignen Tumoren. Zur nichtinvasiven Bildgebung einer Tumorhypoxie wurden in den letzten Jahren mehrere viel versprechende Tracer für die Positronen-Emissions-Tomografie (PET) entwickelt, die die invasiven Messungen mittels pO2-Histografen ersetzen sollen. Bis jetzt hat sich jedoch keiner dieser Tracer für die klinische Routine der Bestrahlungsplanung durchsetzen können, obwohl die Datenlage eine Eignung dieser Tracer zur Darstellung von Gewebehypoxie nahe legt. Die bisher mangelnde Akzeptanz der Hypoxie-PET ist sicher bedingt durch ein im Vergleich zu anderen PET-Tracern eher ungünstiges Verhältnis des Tumor- zu Hintergrundsignals, was eine Abgrenzung von Tumoren und eine Einbindung in eine Bestrahlungsplanung erschwert. Zudem ist noch unklar, inwieweit verschiedene Hypoxiephasen (akut bei temporärer Gefäßokklusion oder chronisch durch Diffusionsdistanz) mit welchen diagnostischen Schritten abgebildet werden und welche therapeutischen Konsequenzen sie erfordern. Neue methodische Ansätze wurden entwickelt, die eine Integration von differenziert akquirierten PET-Daten in eine intensitätsmodulierte Strahlentherapie (IMRT) ermöglichen.
Abstract
Tumor hypoxia is an important prognostic factor for radiotherapy of various malignant tumors. Several promising PET tracers for non-invasive imaging of tumor hypoxia have been developed in the past years which were meant to replace invasive measurements by pO2-histography. However, none of these tracers has been introduced into clinical routine radiotherapy planning though throughout the literature the potential of these tracers for imaging of hypoxia could be proven. One reason for this lack of acceptance of hypoxia PET may be the non-optimal tumor-to background-relation which makes tumor delineation and integration of PET information into treatment planning difficult. Furthermore, the meaning of different phases of hypoxia (acute vessel occlusion or chronic diffusion distance), their measurement and integration into radiotherapy remain unknown. New methods for integration of differentiately acquired PET information into intensity modulated radiotherapy planning (IMRT) have been developed meanwhile.
Schlüsselwörter
PET / CT - Strahlentherapie - Bestrahlungsplanung - Hypoxie
Key words
PET / CT - irradiation treatment - irradiation planning - hypoxia
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Dr. S. M. Eschmann
Abteilung Nuklearmedizin · Marienhospital Stuttgart
Böheimstr. 37
70199 Stuttgart
Email: susanneeschmann@vinzenz.de
