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Nebenwirkungen der Therapie von Hirntumoren

Side effects of treatment for brain tumors

  • Leitthema
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

In der Behandlung von Hirntumoren kommen Operation, Strahlentherapie und Chemotherapie zum Einsatz. Zur Auswahl der Therapie mit einem sinnvollen Verhältnis von Nutzen und Risiko für den Patienten müssen die therapieinduzierten Komplikationen und Nebenwirkungen der einzelnen Behandlungsmodalitäten sowie ihrer Kombination und deren Auswirkung auf die Lebensqualität der Patienten möglichst genau abgeschätzt werden.

Hirntumoroperationen sind Routineeingriffe. Die Operationsmortalität sowie das Risiko für Nachblutungen und lokale Infektionen ist gering. Die Rate persistierender, neuer postoperativer Neurodefizite wird v. a. von der Tumorlokalisation bestimmt und mit 13–26% angegeben. Der Einsatz neuer, intraoperativer Technologien soll helfen, postoperative neurologische Ausfälle zu vermeiden.

Strahlentherapie ist unter Vermeidung großer Bestrahlungsvolumina und hoher Einzeldosen ein sicheres Behandlungsverfahren mit abschätzbarem Risiko. Neben akuten und subakuten Nebenwirkungen ist besonders die Spättoxizität in Form von Nekrose und Enzephalopathie von klinischer Bedeutung. Unter Beachtung der Toleranzgrenzen des gesunden Gehirngewebes und Einsatz moderner Bestrahlungstechniken ist das Risiko für radiogene Spätschäden aber als gering einzustufen.

Behandlung mit systemischer Chemotherapie bringt systemische Nebenwirkungen wie Übelkeit und Erbrechen sowie gelegentlich Therapie limitierende Myelosuppression mit sich. Neben allgemeiner Toxizität einer systemischen Chemotherapie findet sich oft eine toxische Wirkung auf das zentrale und periphere Nervensystem. Kombination von Chemo- mit Strahlentherapie kann zur Verstärkung und Verschiebung der Nebenwirkungen gegenüber der Monotherapie führen.

Abstract

Surgery, radiotherapy, and chemotherapy are current treatment modalities for brain tumors. In order to choose the therapy with an optimized benefit-to-risk ratio, therapy-induced complications and side effects of single modalities as well as their combination must be estimated and weighed accurately against their effect on the quality of life of the patients.

Brain tumor resection is clinical routine. Mortality as well as risk for bleeding and local infections are low. The rate of new persistent postsurgical neurological deficits is determined mainly by the tumor localization and is estimated at 13–26%. The application of new intraoperative technologies should help to avoid postsurgical neurological failures.

Radiotherapy is generally safe and with limited risk, if large volumes and high single fractions are avoided. Acute and early delayed side effects have a good prognosis. However, late toxicity in the form of necrosis and encephalopathy is of clinical relevance. Considering the tolerance of the normal cerebral tissue under modern radiotherapy, the risk for radiation-induced late damage is low, when appropriate single fractions and total dose limitations are kept in mind.

Treatment with systemic chemotherapy generates systemic side effects in the form of nausea and vomiting as well as rare therapy-limiting myelosuppression. Toxicity to the central and peripheral nervous system is often relevant in addition to the general toxicity of systemic chemotherapy. Combination of chemotherapy with radiotherapy can lead to aggravation and alteration of these side effects compared with monotherapy.

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Authors and Affiliations

  1. Klinik für Radioonkolgie, Universitätsklinik Tübingen, Hoppe-Seyler-Straße 3, 72076 , Tübingen

    G. Henke

  2. Zentrum für Bildgebende Diagnostik und Intervention, Klinik und Poliklinik für Neuroradiologie, Universitätsklinikum Hamburg-Eppendorf

    T. Kucinski

  3. Neurochirurgische Klinik, Rheinische Friedrich-Wilhelms-Universität Bonn

    M. Simon

  4. Neurologische Klinik, Universitätsklinik Tübingen

    U. Herrlinger

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Henke, G., Kucinski, T., Simon, M. et al. Nebenwirkungen der Therapie von Hirntumoren. Onkologe 12, 546–555 (2006). https://doi.org/10.1007/s00761-006-1053-3

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