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Therapie und Versorgung von orbitalen Tumoren

Treatment and management of orbital tumors

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Zusammenfassung

Hintergrund

Für die Behandlung häufiger orbitaler Tumoren stehen verschiedene konservative Therapien zur Verfügung. Diese können das häufig komplikationsbehaftete chirurgische Vorgehen hinauszögern, ergänzen oder diesem überlegen sein.

Fragestellung

Es erfolgt eine Zusammenfassung der möglichen Behandlungsoptionen der häufigen orbitalen Tumoren im Kindes- und Erwachsenenalter.

Methoden

Eine Literaturrecherche und Darstellung der Behandlungspfade werden vorgenommen.

Ergebnisse

1. Häufige orbitale Tumoren im Kindesalter: Beim kapillären Hämangiom der Orbita ist eine systemische Behandlung mit nichtkardioselektiven β‑Blockern die Therapie der Wahl. Bei Nichtansprechen können Steroide, Interferon‑α oder Cyclophosphamid zum Einsatz kommen. Kleinere Dermoidzysten können beobachtet werden, bei Progression sollte eine Exzision erfolgen. Auch asymptomatische Optikusgliome werden beobachtet, bei Progression stehen Chemotherapie, mTOR/MEK-Inhibitoren oder eine Strahlentherapie (Kinder > 5 Jahre) zur Verfügung. Rhabdomyosarkome werden biopsiert und anschließend mit Strahlen- und Chemotherapie behandelt. 2. Häufige orbitale Tumoren im Erwachsenenalter: Kavernöse Hämangiome der Orbita werden in asymptomatischen Fällen beobachtet. Symptomatische Kavernome können chirurgisch entfernt oder strahlentherapeutisch behandelt werden. Bei Optikusscheidenmeningeomen steht mit der Strahlentherapie ein effektives Therapeutikum zur Verfügung. Eine chirurgische Entfernung sollte Fällen ohne Visusprognose vorbehalten bleiben. Zudem besteht eine mögliche Therapie in der Gabe von Antiprogesteron. Orbitale Lymphome können bei reiner orbitaler Beteiligung mittels Strahlentherapie, Chemotherapie oder Rituximab-Gabe behandelt werden

Schlussfolgerung

Es stehen mittlerweile für viele orbitale Tumoren sehr effektive konservative Therapiemöglichkeiten zur Verfügung. Ein chirurgisches Vorgehen kann hierdurch in einigen Fällen verhindert werden und eine gute Sehfunktion erhalten bleiben.

Abstract

Background

There are various options for the conservative treatment of the most frequent orbital tumors. These can delay, complement or be superior to the surgical approach, which is often prone to complications.

Objective

This article gives a summary of the possible treatment options for the most common orbital tumors in childhood and adulthood.

Methods

A literature search was carried out and the possible treatment pathways are presented.

Results

1. Frequent orbital tumors in childhood: a systemic treatment with noncardioselective beta blockers is the primary treatment for capillary orbital hemangiomas. In cases of no response, steroids, interferon alpha or cyclophosphamide are treatment options. Observation is a possible option for smaller dermoid cysts, in cases of progression excision can become necessary. Symptomatic optic nerve gliomas can also be observed and in cases of progression treated with chemotherapy, mTOR/MEK inhibitors or radiotherapy (children > 5 years). Rhabdomyosarcomas are biopsied and subsequently treated by radiotherapy and chemotherapy. 2. Frequent orbital tumors in adulthood: asymptomatic cases of cavernous hemangiomas of the orbit can just be observed. Symptomatic hemangiomas can be surgically excised or treated with radiotherapy. For meningiomas of the optic nerve sheath radiotherapy is a very effective treatment. Surgical excision should be reserved for cases with no prognosis of visual acuity. There is also the option to treat with antiprogesterone. Orbital lymphomas with purely orbital involvement can be treated with radiotherapy, chemotherapy or the application of rituximab.

Conclusion

There are now very effective conservative treatment options for many orbital tumors. In some cases a surgical procedure can be avoided and a good visual function can be retained.

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Danksagung

Bilder mit freundlicher Genehmigung zur Verfügung gestellt aus der klinischen Sammlung von Frau Dr. Neppert (Oberärztin UKSH Lübeck, Leitung Orthoptik)

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Authors and Affiliations

  1. Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    Michael Zimbelmann, Birte Neppert, Roya Piria, Neele Babst, Salvatore Grisanti & Vinodh Kakkassery

  2. Universitäts-Augenklinik, Unversitätsmedizin Mainz, Mainz, Deutschland

    Katharina A. Ponto

  3. Klinik für Augenheilkunde, Universitätsklinikum Köln, Köln, Deutschland

    Ludwig M. Heindl

  4. Center for Integrated Oncology (CIO) Aachen-Bonn-Köln-Düsseldorf, Aachen-Bonn-Köln-Düsseldorf, Deutschland

    Ludwig M. Heindl

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  1. Michael Zimbelmann
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Correspondence to Michael Zimbelmann.

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M. Zimbelmann, B. Neppert, R. Piria, N. Babst, K.A. Ponto, S. Grisanti, L.M. Heindl und V. Kakkassery geben an, dass kein Interessenkonflikt besteht.

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Zimbelmann, M., Neppert, B., Piria, R. et al. Therapie und Versorgung von orbitalen Tumoren. Ophthalmologe 118, 1004–1011 (2021). https://doi.org/10.1007/s00347-021-01471-9

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