Zusammenfassung
In dieser Übersicht werden die Möglichkeiten der palliativen Strahlentherapie beim metastasierten Nierenzellkarzinom dargestellt. Während sich über viele Jahre die Tatsache erhärtet hat, dass ein adjuvanter, neoadjuvanter oder gar definitver Einsatz beim Primärtumor keinen Benefit bringt, ist die Strahlentherapie eine wichtige Stütze in der Palliation der disseminierten Erkrankung. Lokale Schmerzen bei Knochenmetastasen können zu über 70% gemildert werden, nahezu unabhängig von der Fraktionierung, d. h. für den palliativen Fall konzentriert sich die Therapie unter Umständen auf nur eine Sitzung. Die zweite wichtige Indikation ergibt sich bei der Behandlung von Hirnmetastasen, sei es als Ganzhirnbestrahlung nach Operation und bei multiplen Hirnmetastasen oder als stereotaktische Einzeitbestrahlung (Radiochirurgie) bei bis zu 3 synchronen Hirnmetastasen mit lokalen Kontrollraten von über 90%, die bei neurochirurgischen Eingriffen kaum erreicht werden.
Abstract
In this review we present the options of palliative radiotherapy for patients with metastatic renal cell carcinoma. While evidence has accumulated over several years that adjuvant, neoadjuvant and even definitive treatment for primary tumor provide no benefit, radiotherapy is an important mainstay in palliation of disseminated diseases. Local pain due to bone metastases can be alleviated by over 70% almost irrespective of the fractionation, i.e. in palliative cases treatment is concentrated in only one session under certain conditions. The second important indication is for treatment of brain metastases, whether this involves whole brain irradiation following surgery and in cases of multiple metastases or stereotactic single-dose radiation therapy (radiosurgery) in cases of up to three synchronous brain metastases. The local control rates of over 90% can rarely be achieved with neurosurgical interventions.
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Bottke, D., Wiegel, T. Palliative strahlentherapeutische Konzepte bei Patienten mit Nierenzellkarzinom. Onkologe 16, 168–174 (2010). https://doi.org/10.1007/s00761-009-1759-0
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DOI: https://doi.org/10.1007/s00761-009-1759-0