Hirnmetastasen und Meningeosis carcinomatosa solider Tumoren

Zerebrale Metastasen oder eine Meningeosis neoplastica treten im Verlauf einer Tumorerkrankung relativ häufig auf und gehen auch heute noch mit einer relevanten Morbidität und Mortalität einher. Insbesondere die Therapierbarkeit zerebraler Metastasen hat sich allerdings in den letzten 20 Jahren erheblich verbessert. Der Artikel fasst die wichtigen Entwicklungen in der Diagnostik und Therapie zerebraler Metastasen und der Meningeosis neoplastica zusammen.

Kernaussagen

• Die Therapierbarkeit zerebraler Metastasen hat sich in den vergangenen 2 Dekaden grundlegend verbessert.

• Die Radiochirurgie sowie die Therapie mit Immuncheckpointinhibitoren haben die Behandlung revolutioniert.

• Die molekulare Charakterisierung des Gewebes macht heute die Anwendung von „targeted Therapies“ möglich.

• Eine zerebrale Metastasierung ist heute kein Ausschlusskriterium mehr für die Teilnahme an klinischen Studien.

• Die operative Resektion einer großen Raumforderung kann auch bei multipler Metastasierung sinnvoll sein.

• Therapieoptionen bei Meningeosis carcinomatosa sind eine systemische Therapie, eine Bestrahlung oder eine intrathekale Chemotherapie.

• Mangels prospektiver Daten erfolgt die systemische Therapie der Meningeosis carcinomatosa (konventionelle Chemotherapie/targeted therapies/Immuntherapien) oft analog der Therapie bei zerebralen Metastasen der jeweiligen Tumoren.

• Therapieentscheidungen sollen interdisziplinär getroffen werden.

Schlüsselwörter

Hirnmetastasen - metastasierte Tumorerkrankung - Meningeosis neoplastica - Ganzhirnbestrahlung - zerebrale Metastasen

Publication History

Article published online:
21 September 2023

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