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Die Rolle der externen Strahlentherapie bei der Behandlung des Schilddrüsenkarzinoms

Role of external beam radiation therapy in the treatment of thyroid cancer

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Zusammenfassung

Ergebnisse retrospektiver Studien zum differenzierten Schilddrüsenkarzinom zeigen, dass Patienten mit echter Infiltration angrenzender Organe (Stadium T4 der TNM-Klassifikation 2002) bezüglich der lokoregionären Kontrolle von einer externen Strahlentherapie profitieren, bei R2-Situation sogar bezüglich des krankheitsspezifischen Überlebens. Die deutsche MSDS-Studie konnte aufgrund einer geringen Anzahl randomisierter Patienten den Stellenwert der externen Strahlentherapie beim differenzierten Karzinom mit Kapselüberschreitung nur teilweise klären. Internationale Leitlinien sehen übereinstimmend eine kleine Gruppe von Hochrisikopatienten, die nach optimaler Operation und Radioiodtherapie von einer externen Strahlentherapie profitieren. Beim undifferenzierten Schilddrüsenkarzinom ist die externe Strahlentherapie, auch bei Fernmetastasierung, in der Regel indiziert. Sie sollte mit mindestens 40 Gy durchgeführt werden und ermöglicht eine lokoregionäre Kontrolle in 60–80% der Fälle. Für Patienten ohne Fernmetastasen und mit mindestens einer makroskopischen Komplettresektion kann eine trimodale Therapie von Nutzen sein.

Abstract

Results of retrospective studies on differentiated thyroid cancer suggest that patients with true invasion of adjacent organs (stage T4 in TNM 2002) benefit from external beam radiotherapy regarding locoregional control and in an R2 situation even regarding disease-specific survival. The German MSDS trial could only partly clarify the role of external beam radiotherapy in differentiated thyroid cancer with extracapsular extension. International guidelines currently recognize a small high-risk group which benefits from external beam radiotherapy after optimal surgery and radioiodine treatment. In undifferentiated thyroid cancer external-beam radiotherapy is usually indicated even in the presence of distant metastases. It should be administered with at least 40 Gy and achieves locoregional control in 60-80% of cases. Patients without distant metastases and at least macroscopically complete resection might benefit from trimodal treatment.

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  1. Universitätsklinik für Strahlentherapie, Martin-Luther-Universität Halle-Wittenberg, Dryanderstr. 4, 06110, Halle (Saale), Deutschland

    D. Vordermark, T. Pelz & F. Sieker

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  1. D. Vordermark
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  2. T. Pelz
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  3. F. Sieker
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Vordermark, D., Pelz, T. & Sieker, F. Die Rolle der externen Strahlentherapie bei der Behandlung des Schilddrüsenkarzinoms. Onkologe 16, 695–700 (2010). https://doi.org/10.1007/s00761-010-1871-1

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