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Stereotaktische Radiochirurgie und Radiotherapie bei Akustikusneurinomen

Stereotactic radiosurgery and fractionated stereotactic radiotherapy of acoustic neuromas

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Zusammenfassung

Die stereotaktische Radiochirurgie (SRS) ist ein neurochirurgischer Arbeitsbereich, der zunehmend in der Behandlung von Akustikusneurinomen genutzt wird. Radiochirurgische Methoden sind das Gamma-Knife, die sog. LINAC-Technologie und das Cyberknife. Die Gamma-Knife-Radiochirurgie (GKRS) weist die größte Genauigkeit auf und wird seit Jahrzehnten bei Akustikusneurinomen eingesetzt (>18.000 Patienten). Im Unterschied zu chirurgischen Verfahren ist das Ziel der SRS eine Langzeitarretierung des Tumorwachstums bei Erhalt der neurologischen Funktion. Strahlenbedingte Neuropathien treten sehr selten auf. Die seit einigen Jahren verwendete fraktionierte stereotaktische Radiotherapie (FSR) weist wesentliche Unterschiede zur einzeitigen SRS bei radiobiologischer Wirksamkeit und Anwendung auf. Die SRS ist zumeist ambulant möglich. Neurinome bis zu 3 cm Größe sind mögliche Indikationen für SRS oder FSR. Größere Tumoren, Zysten und Neurinome mit Hirnstammkompression sollten wie bisher in erfahrenen Zentren (HNO oder Neurochirurgie) mikrochirurgisch reseziert werden. SRS (und FSR) sind ggf. als Option bei Patienten mit Tumorwachstum nach subtotaler Resektion oder Rezidivtumoren zu erwägen oder bei Patienten, die nicht operationstauglich oder -willig sind.

Abstract

Stereotactic radiosurgery (SRS) is a neurosurgical field that has become increasingly important in the treatment of acoustic neuromas. Radiosurgical treatment modalities include the Gamma knife, the linear accelerator (LINAC), and the CyberKnife. Gamma knife radiosurgery (GKRS) is still unsurpassed in terms of the spatial accuracy of radiation delivery and has been used for decades in acoustic neuromas (>18000 patients). In contrast to surgical resection, the goal of SRS is long-term prevention of tumour growth with preservation of neurological function. Radiation-induced neuropathies rarely occur. However, there are essential differences between SRS and fractionated stereotactic radiotherapy (FSR) in terms of both their radiobiological effects and their modes of application. SRS can be performed in an outpatient setting. Neuromas of up to 3 cm in diameter represent potential candidates for SRS or FSR. For larger tumours, cystic lesions and neuromas with brain stem compression, microsurgical resection in experienced neurosurgical centres is still the preferred option. SRS (and FSR) are possible options for patients with tumour progression after subtotal surgery or tumour recurrence, or for patients unable or unwilling to undergo surgery.

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Danksagung

Abb. 1, Abb. 2 und Abb. 3 wurden freundlicherweise zur Verfügung gestellt von Elekta AB, Stockholm, Schweden. Die Autoren danken Frau Elfriede Meier für die Hilfe bei der Erstellung des Manuskripts.

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Authors and Affiliations

  1. Universitätsklinik für Neurochirurgie, Medizinische Universität Graz, Auenbruggerplatz 29, 8036, Graz, Österreich

    F. Unger & K. Haselsberger

  2. Universitätsklinik für Strahlentherapie-Radioonkologie, Medizinische Universität Graz, Graz, Österreich

    K. Dominikus

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  1. F. Unger
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  2. K. Dominikus
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Correspondence to F. Unger.

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Unger, F., Dominikus, K. & Haselsberger, K. Stereotaktische Radiochirurgie und Radiotherapie bei Akustikusneurinomen. HNO 59, 31–37 (2011). https://doi.org/10.1007/s00106-010-2191-x

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