Zusammenfassung
Die intrauterine Brachytherapie ist eine wesentliche Komponente der definitiven Behandlung des Zervixkarzinoms, vor allem bei lokal fortgeschrittener Erkrankung.
Während der letzten Jahrzehnte wurden richtungweisende Fortschritte in der Entwicklung der Brachytherapietechniken erzielt, um die Applikation der Strahler und so die Dosisverteilung im Tumor und in den angrenzenden Risikoorganen zu optimieren: Afterloading-Technik, computergestützte Rechnerplanung und Bestrahlung mit hoher Dosisleistung („high dose rate“, HDR).
In den letzten Jahren lag der Fokus der Entwicklung auf der bildgestützten Brachytherapie. Sie erlaubt eine Anpassung der Strahlendosen bezogen auf die individuelle, dreidimensionale Tumorausbreitung und das individuelle 3D-Tumoransprechen nach Radio-Chemo-Therapie unter Berücksichtigung der Strahlendosen in den angrenzenden Risikoorganen.
Erste klinische Erfahrungen mit der 3D-MRT-gestützten Brachytherapie an mehr als 200 Patientinnen zeigen exzellente lokale Kontrollraten (90–100%, stadienabhängig) im Vergleich mit historischen Daten (60–90%). Ausmaß und Häufigkeit nennenswerter Nebenwirkungen scheinen außerordentlich begrenzt zu sein. Die MRT-gestützte Brachytherapie sollte als Therapie der Wahl bei fortgeschrittenen Zervixkarzinomen zur Anwendung kommen, damit das große Potenzial der modernen Radiotherapie auch für Zervixkarzinompatientinnen optimal genutzt werden kann.
Abstract
Brachytherapy (BT) is an essential component of the definitive treatment of patients with cervical cancer, particularly in locally advanced stages. Throughout the years, progress has been made in BT techniques in an attempt to improve dose delivery while minimizing side effects and maximizing local control (LC). This includes the use of high dose rate and afterloading machines, yielding patient benefits such as the ability to give higher doses in a shorter time and no need for total isolation. Lately, the focus of research and development has shifted to image-guided radiotherapy/BT. The use of computed tomography, ultrasound, and, particularly, magnetic resonance imaging (MRI) in the guidance of BT implants allows for higher doses to the tumor based on spread and response. Data on three-dimensional MRI-guided BT have shown higher LC rates (90–100%, stage-dependent) compared with historical data (60–90%). The rate and profile of side effects seem to be similar to those for standard BT. Despite remaining uncertainties related to MRI-guided BT, we recommend this therapeutic modality in locally advanced cervical cancer (IIB–IVA) to exploit the full potential of modern radiotherapy (combined with chemotherapy) and improve the therapeutic ratio.
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Sturdza, A., Dimopoulos, J., Lettmayer, A. et al. Brachytherapie des Zervixkarzinoms. Gynäkologe 42, 941–948 (2009). https://doi.org/10.1007/s00129-009-2403-1
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DOI: https://doi.org/10.1007/s00129-009-2403-1