Radioonkologische Entwicklungen und Behandlungskonzepte neuroonkologischer Tumorerkrankungen

Zusammenfassung

In den vergangenen Jahren haben technologische Weiterentwicklungen die Radioonkologie sehr stark verändert und erlauben es nun, hohe Therapiedosen zielgenau zu applizieren und gleichzeitig das gesunde Gewebe maximal zu schonen. Daneben hat das bessere Verständnis von radiobiologischen Zusammenhängen dazu geführt, dass sich in den letzten Jahren die kombinierte Radiochemotherapie bei vielen Tumorerkrankungen fest etabliert hat und dass „zielgerichtete” systemische Therapiestrategien in Kombination mit einer Strahlentherapie verstärkt in klinischen Studien zum Einsatz kommen. Somit repräsentiert die Radiotherapie eine wichtige Therapieoption in der Behandlung der heterogenen Gruppe der neuroonkologischen Tumorerkrankungen. Zur Behandlung dieser Erkrankungen eignen sich moderne Therapieverfahren wie die stereotaktische Radiochirurgie (SRS), die intensitätsmodulierte Radiotherapie (IMRT) sowie die bildgestützte Radiotherapie (IGRT). Zusätzlich hat sich, insbesondere in Deutschland, die Teilchentherapie mit Protonen und Schwerionen stark weiterentwickelt. Daneben konnte die Strahlentherapie erfolgreich mit systemischen Therapieansätzen im Rahmen multimodaler Konzepte in der Behandlung von neuroonkologischen Tumoren angewendet werden. Gleichzeitig wurden für das Glioblastom verschiedene prädiktive molekulare Marker gefunden, die gerade klinisch verifiziert und verstärkt in die Therapieentscheidung mit einbezogen werden. Im Rahmen dieser Übersichtsarbeit sollen die aktuellen Entwicklungen in der Radioonkologie zur Behandlung neuroonkologischer Tumore vorgestellt und die Anwendung der Strahlentherapie im Rahmen multimodaler Therapieansätze bei wichtigen Indikationen diskutiert werden.

Summary

Technological advancements have changed radiation oncology strongly and permit now the precise and conformal use of high dose radiotherapy and protect excellent at the same time the surrounding normal tissue. A better understanding and examination of the radiobiology has lead to the use of radiochemotherapy in many clinical indications. Furthermore the combination of “targeted” systemic approaches, like antibodies or small molecules with radiotherapy is now under investigation in several clinical studies and in some indications already used clinically. Thus radiotherapy represents an important therapeutic option in the treatment of the heterogeneous group of neurooncological tumors. In the treatment of these illnesses in are particular modern treatment techniques like stereotactic radiosurgery (SRS), intensity-modulated radiotherapy (IMRT) as well as image-guided radiotherapy (IGRT) suitable to be integrated. In particular in Germany a strong clinical development of particle therapy with protons and heavy ions is seen. Besides this, radiotherapy is also successfully integrated in multimodal treatment concepts of neurooncological tumors. Especially for glioblastoma different predictive molecular markers were found, which are under verification in studies and are currently incorporated more strongly in the clinical decision-making process. In the context of this review the developments in radiation oncology for the treatment of neurooncological tumors will be introduced and the application of radiotherapy in a multidisciplinary treatment approach for the major clinical indications discussed.

Schlüsselwörter

Radiotherapie - Hirntumore - IMRT - Teilchentherapie - stereotaktische Radiotherapie

Keywords

Radiotherapy - brain tumors - IMRT - particle therapy - stereotactic radiosurgery

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