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Hirnmetastasen

Prophylaxe und Therapie

Brain metastases

Prophylaxis and therapy

  • Leitthema
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Der Onkologe Aims and scope

Zusammenfassung

Hirnmetastasen stellen eine häufige Komplikation solider Tumorerkrankungen dar. Durch eine verbesserte Primärtumortherapie mit verlängertem Überleben der Patienten und eine verbesserte neuroradiologische Diagnostik beobachten wir eine scheinbare Zunahme der Inzidenz. Nach Induktion einer kompletten Remission beim kleinzelligen Lungenkarzinom liegt die Inzidenz von Hirnmetastasen bei ca. 30%. Durch eine prophylaktische Ganzhirnbestrahlung kann das Risiko auf ca. 5% reduziert werden. Darüber hinaus konnte ein absoluter Überlebensvorteil von 5,4% gezeigt werden. Moderate Strahlendosen von 30 Gy in 3 Wochen sind ein etabliertes Schema mit nur geringer Neurotoxizität. Bei manifesten Hirnmetastasen steht die Palliation im Vordergrund. Die klinische Symptomatik und damit die Lebensqualität kann durch die therapeutische Ganzhirnbestrahlung in über 80% der Fälle gebessert werden, auch das Gesamtüberleben wird positiv beeinflusst. Neue Therapiestrategien zur Verbesserung der noch enttäuschenden Ergebnisse sind dringend erforderlich und stellen möglicherweise die Kombination aus Strahlentherapie und Chemotherapie dar.

Abstract

Brain metastases are a frequent complication in solid tumors with a major worsening of the prognosis. With improved treatment of the primary tumor site and improved neuroradiological diagnosis, the incidence is apparently increasing. The incidence of brain metastases after complete remission in small cell lung cancer is reported to be approximately 30%. After prophylactic cranial irradiation the incidence is reduced to approximately 5%. Furthermore, there is an absolute increase in overall survival of 5.4%. An accepted moderate fractionation scheme with minimal morbidity is 30 Gy in 3 weeks. The therapeutic aim in patients with brain metastases is palliation. Symptomatic response rates of 80% are reported after therapeutic cranial irradiation and overall survival could be prolonged. New strategies to improve the still discouraging results are urgently needed. One candidate may be the combination of radiotherapy and chemotherapy.

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  1. Abt. Radioonkologie und Strahlentherapie, Klinische Radiologie und Poliklinik, Universitätsklinikum Heidelberg

    A. Zabel & J. Debus

  2. Abt. Radioonkologie und Strahlentherapie, Klinische Radiologie und Poliklinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg

    A. Zabel

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  2. J. Debus
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Correspondence to A. Zabel.

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Zabel, A., Debus, J. Hirnmetastasen. Onkologe 11, 747–752 (2005). https://doi.org/10.1007/s00761-005-0884-7

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  • DOI: https://doi.org/10.1007/s00761-005-0884-7

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