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Präoperative Bestrahlung von Hirnmetastasen

Neues Therapiekonzept in der Radioonkologie

Preoperative irradiation of brain metastases

New treatment concepts in radiation oncology

  • Leitthema
  • Published:
Die Onkologie Aims and scope

Zusammenfassung

Hintergrund

Symptomatische Hirnmetastasen sollten zur dauerhaften Symptomlinderung operiert werden. Die postoperative Radiotherapie kann das Risiko für ein Lokalrezidiv deutlich senken, die fokale Bestrahlung der Resektionshöhle ist hierfür ein etabliertes Verfahren.

Fragestellung

Bietet sich eine neoadjuvante Bestrahlung der Hirnmetastase vor Resektion als alternatives Verfahren an?

Material und Methode

Es erfolgte die Auswertung der verfügbaren Literatur zur präoperativen Radiotherapie vor Resektion von Hirnmetastasen in Bezug auf Technik, Sicherheit und klinischen Nutzen.

Ergebnisse

Seit 2014 wurden mehrere, mehrheitlich retrospektive Studien zur neoadjuvanten Bestrahlung veröffentlicht. Neben einer vereinfachten Bestrahlungsplanung sowie verkürzten Gesamtbehandlungszeit zeigen sich nach 1 bzw. 2 Jahren niedrige Lokalrezidivraten von 15 % bzw. 17,9 %.

Schlussfolgerungen

Basierend auf aktuellen Studiendaten könnte sich die neoadjuvante Radiotherapie von Hirnmetastasen für eine Subgruppe von Patienten als Alternative zur postoperativen Bestrahlung nach Resektion etablieren. Randomisierte Daten stehen jedoch noch aus.

Abstract

Background

Symptomatic brain metastases should be resected for permanent symptom relief. Postoperative radiotherapy can significantly reduce the risk of local recurrence; therefore, focal irradiation of the resection cavity is an established procedure for this purpose.

Objectives

Does neoadjuvant irradiation of the brain metastasis prior to resection represent an alternative procedure?

Methods

To evaluate the available literature on preoperative radiotherapy before metastatic resection in terms of technique, safety, and clinical benefit.

Results

Since 2014, several, mostly retrospective studies on neoadjuvant radiotherapy have been published. In addition to simplified radiation planning and shortened overall treatment time, local recurrence rates were only 15.0 and 17.9% after 1 and 2 years, respectively.

Conclusions

Based on current trial data, neoadjuvant radiotherapy of brain metastases may become established as an alternative to postoperative radiation after resection for a subgroup of patients. However, randomized data are still pending.

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Authors and Affiliations

  1. Klinik für Radioonkologie und Strahlentherapie, Klinikum rechts der Isar, TU München, Ismaninger Straße 22, 81675, München, Deutschland

    Christian Diehl & Stephanie E. Combs

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  1. Christian Diehl
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  2. Stephanie E. Combs
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Correspondence to Christian Diehl.

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Interessenkonflikt

C. Diehl: Beratertätigkeit für Carl Zeiss Meditec AG, Oberkochen, Deutschland. S.E. Combs gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Diehl, C., Combs, S.E. Präoperative Bestrahlung von Hirnmetastasen. Onkologie 29, 883–888 (2023). https://doi.org/10.1007/s00761-023-01361-6

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  • DOI: https://doi.org/10.1007/s00761-023-01361-6

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