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Stellenwert der Strahlentherapie bei sezernierenden und nichtsezernierenden Hypophysenadenomen

Importance of radiotherapy for treatment of secreting and non-secreting pituitary adenomas

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Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Die Therapieoptionen der modernen Radioonkologie für die Behandlung von Hypophysenadenomen werden beschrieben. Die moderne Technik ermöglicht einen steilen Dosisabfall zum gesunden Gewebe und damit bei exzellenter lokaler Tumorkontrolle ein optimales Nebenwirkungsspektrum.

Ziel

Aus den vorliegenden Daten können interdisziplinäre Behandlungspfade abgeleitet werden.

Material und Methoden

Es wird die aktuelle Literatur zur Behandlung von Hypophysenadenomen diskutiert. Darüber hinaus werden die Techniken beschrieben, die als Radiochirurgie oder als fraktionierte Hochpräzisionsstrahlentherapie für die Behandlung von gutartigen Tumoren zur Verfügung stehen.

Ergebnisse

Die lokale Kontrolle von Hypophysenadenomen liegt bei etwa 80–100 %, abhängig von der zugrunde liegenden Histologie, der Größe sowie der Lage des Tumors. Bei kleineren Volumina kann eine Radiochirurgie, aber auch eine fraktionierte Strahlentherapie eingesetzt werden. Bei größeren Volumina sollte ein fraktioniertes Konzept angeboten werden. Auch bei persistierender Hormonproduktion kann ein guter Therapieerfolg erzielt werden, wobei die Normalisierung der Hormonfunktion erst mittelfristig erfolgt.

Schlussfolgerung

Die Strahlentherapie von Hypophysenadenomen bietet heute mit modernen Techniken ein günstiges Risiko-Effekt-Profil und sollte in der interdisziplinären Entscheidungsfindung berücksichtigt werden.

Abstract

Background

This manuscript summarizes the treatment options available in modern radiation oncology for the treatment of secreting and non-secreting pituitary adenomas. Modern high-precision treatment options enable a steep reduction in dosing to healthy tissue and therefore provide excellent local control with low rates of side effects.

Objective

Interdisciplinary treatment paradigms can be derived from the available data.

Material and methods

This article summarizes the most recent literature on high-precision radiotherapy for the treatment of pituitary adenomas. Furthermore, techniques are described that can be performed as radiosurgery (in one single fraction) or as fractionated regimens for benign tumors.

Results

Local control of pituitary adenomas lies between 80–100% depending on the underlying histology, size and location of the lesion. Small volumes can be safely treated with radiosurgery, while fractionated regimens have an improved therapeutic window also in larger lesions. Radiotherapy is an effective option for persisting hormone secretion; however, normalization of hormone secretion is a continuous process.

Conclusion

Modern radiation oncology provides excellent treatment alternatives for benign lesions, such as pituitary adenomas with a favorable risk-benefit profile and should be considered in the interdisciplinary decision making process.

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Authors and Affiliations

  1. Klinik und Poliklinik für RadioOnkologie und Strahlentherapie, Klinikum rechts der Isar, Technische Universität München (TUM), Ismaninger Straße 22, 81675, München, Deutschland

    Christoph Straube &  Stephanie E. Combs

  2. Institut für Innovative Radiotherapie (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Oberschleißheim, Deutschland

    Stephanie E. Combs

  3. Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site München, München, Deutschland

    Christoph Straube &  Stephanie E. Combs

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  1. Christoph Straube
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Correspondence to Stephanie E. Combs.

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Interessenkonflikt

C. Straube und S.E. Combs geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Straube, C., Combs, S.E. Stellenwert der Strahlentherapie bei sezernierenden und nichtsezernierenden Hypophysenadenomen. Onkologe 24, 143–150 (2018). https://doi.org/10.1007/s00761-017-0313-8

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