Zusammenfassung
Hintergrund
Aufgrund längeren Krankheitsverlaufs durch neue Systemtherapien und basierend auf dem Konzept der Oligometastasierung wird in der klinischen Praxis immer häufiger die Indikation für eine lokal definitive Behandlung von Metastasen gestellt. Mit der stereotaktischen Radiotherapie können Metastasen in wenigen Sitzungen effizient abgetötet werden.
Fragestellung
Was ist die Evidenz zur stereotaktischen Radiotherapie von Patienten mit Oligometastasen? Wie ist der Einfluss der Metastasenkontrollrate auf das Überleben nach stereotaktischer Radiotherapie? Wie toxisch ist die Behandlung? Wie ist die Abgrenzung von anderen lokalen Therapiemethoden wie z. B. der Chirurgie? Gibt es prognostische Faktoren bei Patienten mit Oligometastasen?
Material und Methode
Literatursuche nach prospektiven und retrospektiven Studien.
Ergebnisse
Den einzigen Beweis für einen lebensverlängernden Effekt durch lokale Behandlung von Oligometastasen liefert eine randomisierte Studie, die den radiochirurgischen Boost nach Ganzhirnbestrahlung bei Patienten mit Hirnfiliae untersuchte. Prospektive Phase-II-Studien zur stereotaktischen Radiotherapie von Hirn-, Lungen-, Leber-, Wirbelkörper- und Oligometastasen an multiplen Lokalisationen belegen die hohe Tumorkontrollrate und gute Verträglichkeit dieser Behandlung. Prognostische Faktoren sind in erster Linie Histologie, Anzahl und Größe der Metastasen sowie das krankheitsfreie Überleben.
Schlussfolgerung
Die stereotaktische Radiotherapie ist eine valide Therapieoption in der Behandlung von Patienten mit Oligometastasen und sollte in der klinischen Praxis auch als Alternative zur Metastasenchirurgie und lokal ablativer Verfahren erwogen werden.
Abstract
Background
In clinical practice metastases are being treated increasingly more with local definitive intent based on a prolonged course of the disease due to novel systemic therapies and the concept of oligometastasis. With stereotactic radiotherapy metastases can be treated with very high efficiency in only a few fractions.
Objectives
Identification of clinical studies investigating the use of stereotactic radiotherapy for treatment of oligometastases. Metastasis control rates and survival after stereotactic radiotherapy. Toxicity of the treatment. Differentiation from other local treatment approaches including surgery. Prognostic factors in patients with oligometastases.
Methods
A literature search was carried out for prospective and retrospective studies on local stereotactic radiotherapy.
Results
The only proof that local treatment can prolong survival in patients with oligometastases comes from a randomized study that investigated the use of a radiosurgical boost after whole brain radiotherapy in patients with brain metastases. Various prospective phase II studies demonstrated excellent metastasis control rates and tolerability of extracranial stereotactic radiotherapy for treatment of lung, liver, spinal and oligometastases at multiple sites. Relevant prognostic factors for oligometastatic disease are histology, number and size of metastases and disease-free survival.
Conclusion
Stereotactic radiotherapy has become a valid treatment option for patients with oligometastases and in clinical practice should also be considered as an alternative to surgical treatment of metastases.
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Interessenkonflikt. O. Riesterer und M. Guckenberger geben an, dass kein Interessenkonflikt besteht. Der Beitrag enthält keine Studien an Menschen und Tieren.
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Riesterer, O., Guckenberger, M. Stereotaktische Strahlentherapie von Metastasen. Onkologe 20, 757–765 (2014). https://doi.org/10.1007/s00761-014-2670-x
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DOI: https://doi.org/10.1007/s00761-014-2670-x