Zusammenfassung
Bei der Behandlung von Hirntumoren pädiatrischer und erwachsener Patienten stellt die Strahlentherapie eine regelhaft angewendete Behandlungsmodalität dar. Die Protonentherapie ist eine innovative Art der Bestrahlung, mit der die therapeutische Breite weiter verbessert werden soll. Aufgrund der technisch-physikalischen Besonderheiten kann mittels Protonentherapie eine bessere Normalgewebsschonung erreicht werden, während die Zielvolumenerfassung i. d. R. sehr ähnlich zur Standard-Photonentherapie ist. Dabei wird die biologische Strahlenwirkung unter Berücksichtigung eines Korrekturfaktors von 1,1 („relative biological effectiveness“, RBE) als vergleichbar angenommen. Bei kindlichen Hirntumoren ist die Indikation zur Protonentherapie i. d. R. aufgrund der erhöhten Strahlenempfindlichkeit des sich noch entwickelnden Nervengewebes sowie aufgrund bereits vorliegender vergleichender Daten gegeben, die eine geringere Toxizität der Protonentherapie im Vergleich zu Photonen zeigen. Pädiatrische Tumoren werden möglichst in klinischen Studien oder zumindest analog nach der Empfehlung von Referenzzentren behandelt. Trotz der zunehmend breiteren Anwendung der Protonentherapie bei Erwachsenen weltweit fehlen noch belastbare Studiendaten zur geringeren Toxizität im Normalgewebe für die meisten Tumorarten. Es muss untersucht werden, ob und in welchen Patientengruppen sich die veränderte Dosisverteilung in klinisch relevante Vorteile übersetzt und damit den erhöhten Aufwand bzw. die vermehrten Kosten einer Protonentherapie rechtfertigt. Translationaler Forschungsbedarf besteht auch bei der Identifikation von besonders profitierenden Subgruppen und der Integration biologischer Erkenntnisse, insbesondere zur Variabilität der Protonen-RBE, in die optimierte Bestrahlungsplanung.
Abstract
Radiotherapy is a commonly used modality for treatment of brain tumors in children and adults. Proton therapy is one promising innovation in radiooncology aiming to further broaden the therapeutic window. Due to its unique physical properties, proton therapy has the potential to reduce the dose in surrounding normal tissue while target volume coverage is often similar to standard photon radiotherapy. The biological effect is assumed to be comparable with a correction factor of 1.1 (relative biological effectiveness, RBE). Pediatric brain tumors represent a common indication for proton therapy due to the high radiosensitivity of the developing brain and because comparative datasets have shown lower toxicity of proton versus photon radiotherapy. For further treatment optimization, children should be treated within clinical trials or at least according to recommendations given by reference centers. Despite the increasing use of proton therapy worldwide in adults, evidence for lower normal tissue toxicity is still lacking for most indications. Further clinical trials are needed to show whether and in which patient groups the theoretical advantages translate into clinically relevant improvements that justify the high effort and costs of this emerging treatment. Moreover, translational research is necessary to identify subgroups of patients with specific benefits from proton radiotherapy and to integrate biological knowledge, particularly concerning a variable proton RBE, into optimized treatment planning.
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A. Seidlitz, K. Gurtner, J. Eulitz, S. Appold und M. Krause geben an, dass kein Interessenkonflikt besteht.
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Seidlitz, A., Gurtner, K., Eulitz, J. et al. Strahlentherapie mit Protonen bei Hirntumoren. best practice onkologie 16, 394–401 (2021). https://doi.org/10.1007/s11654-021-00304-0
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DOI: https://doi.org/10.1007/s11654-021-00304-0
Schlüsselwörter
- Relative biologische Wirksamkeit
- Protonentherapie
- Tumoren des zentralen Nervensystems
- Neurokognition
- Translationale Forschung