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Möglichkeiten der lokal-ablativen Bestrahlung (SBRT) bei metastasiertem kolorektalem Karzinom

Local ablative radiotherapy of oligometastatic colorectal cancer

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Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Kolorektale Karzinome (KRK) sind häufig oligometastasiert. Aktuell verfügbare intensive systemische Therapieregime mit Chemotherapie und molekular zielgerichteten Substanzen bewirken ein Tumoransprechen oder die Krankheitskontrolle bei einem Großteil der Patienten, weshalb sich die Frage nach dem weiteren Vorgehen stellt. Eine chirurgische Resektion oder Radiofrequenzablation kann ein Langzeitüberleben und sogar eine Heilung ermöglichen, mindestens jedoch zu einem verlängerten chemotherapiefreien Intervall führen. Diese Therapieansätze sind bezüglich der anatomischen Lokalisation, der Invasivität und der Morbidität nur eingeschränkt anwendbar. Die stereotaktische Bestrahlung ist eine strahlentherapeutische Technik, mit der in wenigen Sitzungen und sehr geringer Toxizität eine lang anhaltende Metastasenkontrolle erreicht werden kann.

Fragestellung

Was ist die Evidenz zur stereotaktischen Bestrahlung von Patienten mit metastasiertem kolorektalem Karzinom? Wie ist der Einfluss der SBRT auf die lokale Kontrolle von Leber- und Lungenmetastasen. Welche Nebenwirkungen können auftreten.

Material und Methode

Literatursuche nach prospektiven und retrospektiven Studien.

Ergebnisse und Schlussfolgerung

Die stereotaktische Radiotherapie bei Patienten mit metastasiertem kolorektalem Karzinom ist eine valide Therapieoption und sollte in der klinischen Praxis als Alternative zur Metastasenchirurgie und anderen lokal ablativen Verfahren erwogen werden.

Abstract

Background

Colorectal cancer (CRC) often presents as oligometastatic disease. Currently available intensive systemic treatment regimens, including combination chemotherapy and molecular targeted agents, result in tumor response and transient to long-term disease control in a high percentage of patients, thus raising the question of further management. Secondary resection and ablation, e.g. by surgery or radiofrequency may contribute to long-term survival and even be curative or at least allow a relevant chemotherapy-free interval. These approaches are often limited by the anatomical site, invasiveness and morbidity of the respective procedure. With stereotactic body radiotherapy (SBRT) metastases can be treated with very high efficiency in only a few sessions and achieving long-term control.

Objectives

Identification of clinical studies investigating the use of SBRT for treatment of oligometastases in CRC patients. Control rates in liver and lung metastases and survival after SBRT. Toxicity and side effects of the treatment.

Material and methods

A literature search was carried out for prospective and retrospective studies on local SBRT.

Results and conclusion

The SBRT procedure has become a valid treatment option for patients with oligometastatic CRC and should also be considered in clinical practice as an alternative to surgical treatment of metastases or other local ablative techniques.

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Interessenkonflikt. C. Petersen und T. Gauer geben an, dass kein Interessenkonflikt besteht.

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Authors and Affiliations

  1. Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

    C. Petersen & T. Gauer

  2. Ambulanzzentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

    C. Petersen

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  1. C. Petersen
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  2. T. Gauer
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Correspondence to C. Petersen.

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Petersen, C., Gauer, T. Möglichkeiten der lokal-ablativen Bestrahlung (SBRT) bei metastasiertem kolorektalem Karzinom. Onkologe 22, 115–120 (2016). https://doi.org/10.1007/s00761-015-3009-y

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