Zusammenfassung
Die malignen Erkrankungen der Orbita sind vielfältig und bedürfen in der überwiegenden Mehrzahl der Fälle einer interdisziplinären Behandlung. Fortschritte im Bereich der Strahlentherapie, der Operation und Chemotherapie haben insbesondere bei kindlichen Tumoren eine hohe Heilungsrate ermöglicht. Im Erwachsenenalter wird bei diesen Tumoren eine Tumorkontrollrate von fast 90 % erreicht, wobei in den meisten Fällen auch das Auge erhalten werden kann. Die Radiotherapie ist neben der Operation die bisher einzige kurative Therapieoption für solide Tumoren in diesem Bereich. Bei der Therapie von okularen Tumoren und okularen Adnextumoren wird je nach Tumorentität, Tumorausbreitung, Sitz und onkologischer Situation die gesamte Bandbreite der radioonkologischen Therapiemöglichkeiten gefordert. Bei der überwiegenden Anzahl der bösartigen Tumoren (Karzinome der Lider, Tränendrüsen, Orbita, Metastasen, Sarkome) kommt die Radiotherapie als perkutane, fraktionierte Radiotherapie zum Einsatz, ggf. in Kombination mit Operation und/oder Chemotherapie. Speziell für die Therapie der okularen Tumoren stehen als Optionen die Brachytherapie mit offenen oder umschlossenen Radionukliden (z. B. Ruthenium) und an weltweit wenigen Zentren die Protonentherapie zur Verfügung. Als alternatives Therapieverfahren kommt in Zukunft auch die stereotaktische Radiotherapie in Betracht. Insgesamt erlauben die neuen Techniken in der Radiotherapie eine Dosiserhöhung im Tumor und/oder eine Reduzierung der Dosis im gesunden Gewebe. Dadurch lassen sich eine bessere lokale Tumorkontrolle und eine Verringerung von akuten und chronischen Strahlenfolgen erreichen.
Abstract
Malignant diseases of the orbit are multifaceted and require in the majority of the cases an interdisciplinary treatment. Advances in radiotherapy, surgery and chemotherapy make a high cure rate possible, especially in children’s tumors. In adults these tumors reach a tumor control rate of nearly 90 %, even with preservation of the eye in most of the cases. There are only two curative therapy options for tumors in this region: radiotherapy and surgery. The therapy for tumors of the eye and the orbit require the total spectrum of the radiotherapeutic techniques depending on the tumor entity, its spread and localization. In a prevailing number of malignant tumors (tumors of the eyelids, tear glands, orbit, metastases) the application of the radiotherapy as an external, fractionated radiotherapy is standard practice, if necessary in combination with operation and/or chemotherapy. Particularly in the therapy for ocular tumors brachytherapy with radionuclides (e. g., ruthenium) is possible and in a few centers world-wide proton therapy is available. As an alternative procedure in special modalities, stereotactic radiotherapy may be considered. Altogether the new radiotherapy techniques permit a dose increase in the tumor region and/or a reduction of the doses to healthy tissues and lead so to a better local tumor control rate and a decrease in acute and chronic side effects.
Schlüsselwörter
Maligne orbitale Raumforderungen - Radiotherapie - Überblick
Key words
Malignant orbit tumors - radiotherapy - review
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Dr. Thomas Kuhnt
Martin-Luther-Universität Halle-Wittenberg, Universitätsklinik für Strahlentherapie
Dryanderstraße 4
06097 Halle/Saale
Telefon: 03 45/5 57-34 48
Fax: 03 45/5 57-34 44
eMail: thomas.kuhnt@medizin.uni-halle.de
