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Primäre und adjuvante Radio(chemo)therapie bei Kopf-Hals-Tumoren

Indikationen, Techniken, Ergebnisse

Primary and adjuvant radio(chemo)therapy of head and neck cancer

Indications, techniques, results

  • Leitthema
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Die perkutane definitive bzw. adjuvante Radiotherapie oder Radio(chemo)therapie bildet eine der kurativen Behandlungsoptionen beim Plattenepithelkarzinom der Kopf-Hals-Region.

Ziel

Der Beitrag soll eine Übersicht zu aktuell gültigen Behandlungsansätzen und Ergebnissen der Radio(chemo)therapie im Rahmen der definitiven und postoperativen Therapie sein.

Material und Methoden

Es erfolgte eine Sichtung der aktuellen Leitlinien und Literaturrecherche via PubMed-Datenbank.

Ergebnisse

Plattenepithelkarzinom der Kopf-Hals-Region werden stadienadaptiert behandelt. Frühstadien (cT1–2, cN0–1) mit alleiniger Radiotherapie (RT), lokal fortgeschrittenen Stadien mit Radiochemotherapie (RCT). Intensitätsmodulierte RT (IMRT) führt zu vergleichbaren Ergebnissen bei weniger Nebenwirkungen. Partikeltherapie kann Vorteile haben. Die definitive RCT ist der Goldstandard. Adjuvante RT ist bei ≥pT3, pN+, adjuvante RCT bei positivem Resektionsrand oder extranodulärer Ausbreitung (ENE) indiziert. HPV-positive Oropharynxkarzinome haben die beste Prognose. Klinische Studien zur Deintensivierung und Kombination mit Checkpointinhibitoren laufen.

Schlussfolgerung

Moderne perkutane Radiotherapie ist integraler Bestandteil der Therapie, kann Nebenwirkungen reduzieren und wird stadienabhängig alleine oder in Kombination mit Systemtherapie und/oder Operation angewandt. Die Therapie des HPV-assoziierten Oropharynxkarzinoms und HPV-negativen Kopf-Hals-Tumor unterscheidet sich derzeit nicht. Goldstandard im lokal-fortgeschrittenen Stadium ist die simultane Radiochemotherapie mit Cisplatin.

Abstract

Background

Percutaneous definitive or adjuvant radiotherapy or radio(chemo)therapy is one of the curative treatment options for squamous cell carcinoma of the head and neck region (HNSCC).

Objective

This article gives an overview of current treatment approaches and results of radio(chemo)therapy in the context of definitive and postoperative treatment.

Material and methods

A review of current guidelines and a literature search via the PubMed database were carried out.

Results

The HNSCC is treated in a stage-adapted manner. Early stages (cT1–2, cN0–1) are treated with radiotherapy alone (RT) and locally advanced stages with radiochemotherapy (RCT). Intensity-modulated RT (IMRT) results in comparable results with fewer side effects. Particle therapy can have advantages. The definitive RCT represents the gold standard. Adjuvant RT is indicated in cases of ≥pT3, pN + and adjuvant RCT for high-risk features such as positive resection margins or extranodal spread (ENE). The HPV positive oropharyngeal carcinomas have the most favorable prognosis. Clinical trials for de-intensification and combination with checkpoint inhibitors are currently recruiting.

Conclusion

Modern percutaneous radiotherapy is an integral part of treatment, can reduce side effects and is used in a stage-dependent manner alone or in combination with systemic treatment and/or surgery. The treatment for HPV-associated and HPV negative HNSCC is identical. The gold standard for locally advanced stages is simultaneous radiochemotherapy with cisplatin.

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Authors and Affiliations

  1. Klinik für Radioonkologie und Strahlentherapie, Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland

    Carmen Stromberger

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Correspondence to Carmen Stromberger.

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

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Stromberger, C. Primäre und adjuvante Radio(chemo)therapie bei Kopf-Hals-Tumoren. Onkologe 25, 240–245 (2019). https://doi.org/10.1007/s00761-018-0518-5

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  • DOI: https://doi.org/10.1007/s00761-018-0518-5

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