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Behandlung früher Stadien des Hodgkin-Lymphoms unter dem Aspekt der Qualitätssicherung

Treatment of early stages of Hodgkin’s lymphoma with regard to quality assurance

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Zusammenfassung

Das Hodgkin-Lymphom (HL) gilt als sehr strahlensensibel. Mit einer alleinigen Extended-Field-Radiotherapie (EF-RT) in den Stadien I und II können in 90–100% komplette Remissionen erzielt werden. Allerdings wurde in den frühen Stadien die alleinige EF-RT zugunsten der kombinierten Therapie, bestehend aus einer Polychemotherapie und einer Involved-Field-Radiotherapie (IF-RT), verlassen. Die kombinierte Therapie gilt heute in diesen Stadien als Standardtherapie. Die IF-RT bedeutet gegenüber der EF-RT eine drastische Reduktion der RT-Volumina und eine Verminderung der Dosis an den Normalgeweben (Abb. 1, 2). Die aktuelle Zwischenauswertung der HD10 Studie zeigt, dass die Akuttoxizitäten bei niedrigen Gesamtreferenzdosen von 20 oder 30 Gy sehr gering sind. Radioonkologen in der DHSG praktizieren heute effiziente Qualitätssicherungsprogramme. In den frühen und intermediären Stadien des HL erfolgt eine zentrale prospektive Bildbeurteilung des gesamten Stagings zur Festlegung der Befallslokalisationen und zur Vorgabe eines IF-RT-Volumens.

Abstract

Hodgkin’s lymphoma (HL) is a very radiosensitive entity. In stages I and II, a complete remission can be achieved in 90–100% of cases with extended field radiotherapy (EF-RT) only. However, in early stages EF-RT has been abandoned in favor of combined modality therapy consisting of polychemotherapy and involved field radiotherapy (IF-RT). Nowadays, the combined modality treatment is the standard therapy for these stages. IF-RT has led to a dramatic reduction in irradiated volumes and the doses effecting normal tissue compared to EF-RT (Fig. 1, 2). Current interim results of the HD10 trial show that the acute toxicity rate at doses of 20 or 30 Gy IF-RT is very low. Today, radiation oncologists in the GHSG carry out efficient quality assurance programs. For early favorable and unfavorable HL, a central prospective review of all diagnostic imaging is performed by expert radiation oncologists to control the disease extension and to define the IF treatment volume.

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Authors and Affiliations

  1. Klinik und Poliklinik für Strahlentherapie, Klinikum der Universität zu Köln

    H. T. Eich, K. Hansemann & R.-P. Müller

  2. Klinik und Poliklinik für Strahlentherapie, Klinikum der Universität zu Köln, Joseph-Stelzmann-Straße 9, 50924, Köln

    H. T. Eich

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  1. H. T. Eich
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Correspondence to H. T. Eich.

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Die Arbeit wurde unterstützt durch das Kompetenznetz Maligne Lymphome, gefördert vom deutschen Bundesministerium für Bildung und Forschung (Förderkennzeichen 01GI0491) und der „Deutschen Krebshilfe e.V.“.

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Eich, H.T., Hansemann, K. & Müller, RP. Behandlung früher Stadien des Hodgkin-Lymphoms unter dem Aspekt der Qualitätssicherung. Onkologe 11, 924–932 (2005). https://doi.org/10.1007/s00761-005-0923-4

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