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Rolle der Radiotherapie beim Hodgkin-Lymphom

Role of radiotherapy in Hodgkin lymphoma

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Die Onkologie Aims and scope

Zusammenfassung

Hintergrund

Die Rolle der Radiotherapie (RT) in der Behandlung des Hodgkin-Lymphoms (HL) hat sich in der Vergangenheit stark verändert. Dennoch ist sie fester Bestandteil im Rahmen der kombinierten Modalität geblieben, aber mit dem zunehmenden Einsatz von Immuntherapeutika wird erneut der Stellenwert der RT geprüft werden. Dieser Beitrag gibt eine aktuelle Übersicht zur RT beim HL über die Themen Indikation, Zielvolumenkonzepte, Nebenwirkungen und liefert einen Blick in die Zukunft.

Material und Methoden

Mittels Literaturrecherche und aktuellen Leitlinien wurde eine Übersichtsarbeit zur RT beim HL erstellt.

Ergebnisse

Die moderne RT beim HL wird nach aktueller Studienlage in den frühen Stadien weiterhin als Standard mit einer 20-Gy-Involved-Site-RT (IS-RT) eingesetzt. In den intermediären Stadien hat sich basierend auf der HD17-Studie eine mittels Positronenemissionstomographie (PET-)gesteuerte 30-Gy-IS-RT durchgesetzt, sodass alle PET-negativen Patienten nach Chemotherapie nicht mehr bestrahlt werden. In den fortgeschrittenen Stadien erfolgt weiterhin eine lokale RT nach positiver Abschluss-PET mit 30 Gy. Darüber hinaus haben neue Zielvolumenkonzepte, wie die IS-RT, zu einer weiteren Reduktion der RT-Felder geführt, wodurch eine Verringerung von Spätnebenwirkungen und Sekundärmalignomen angestrebt wird. Mit Blick auf die Zukunft hat die neu aufgekommene Checkpointimmuntherapie die Behandlung des HL deutlich verändert. Die Rolle und der Nutzen der RT müssen nun auch in diesem Umfeld erarbeitet werden, und erste Ergebnisse weisen auf vielversprechende Optionen hin.

Schlussfolgerung

Die RT hat ihren Charakter in der Behandlung des HL über die Jahrzehnte deutlich verändert. Dennoch scheint sie auch in Zukunft ein wichtiger Part in der kombinierten Therapie des HL zu bleiben.

Abstract

Background

The role of radiotherapy (RT) in the treatment of Hodgkin lymphoma (HL) has changed considerably over time. Nevertheless, it remains an integral part of combined-modality therapy; however, the increasing use of immunotherapeutics means that the role of RT will be re-evaluated. This article provides an up-to-date review of RT in HL covering indications, target volume concepts, side effects, and a look to the future.

Materials and methods

A review of RT in HL was performed using a literature search and current guidelines.

Results

According to current studies, modern RT in HL continues to be the standard of care in the early stages with 20 Gy involved site RT (IS-RT). In the intermediate stages, based on the HD17 study, positron emission tomography (PET)-guided 30 Gy IS-RT has become the standard of care, so that all PET-negative patients are no longer irradiated after chemotherapy. In advanced stages, local RT continues to be given in patients with positive PET after chemotherapy with 30 Gy. In addition, new target volume concepts, such as IS-RT, have led to a further reduction in RT fields, aiming for a reduction in late side effects and secondary malignancies. Looking ahead, the emergence of checkpoint immunotherapy has significantly changed the treatment of HL. The role and benefits of RT must now be explored in this environment as well, and initial results appear promising.

Conclusion

Although the role of RT in the treatment of HL has changed significantly over the decades, it appears that it will also remain an important part of combined-modality therapy for HL in the future.

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Authors and Affiliations

  1. Klinik für Radioonkologie, Strahlentherapie und CyberKnife Center, Medizinische Fakultät, Uniklinik Köln, Kerpenerstr. 62, 50931, Köln, Deutschland

    Christian Baues & Simone Marnitz

  2. Universitätsklinik für Strahlentherapie-Radioonkologie, Medizinische Universität Innsbruck, Innsbruck, Österreich

    Peter Lukas

  3. Klinik für Radioonkologie und Strahlentherapie, Medizinische Fakultät, Uniklinik Heidelberg, Heidelberg, Deutschland

    Klaus Herfarth

  4. Klinik für Radioonkologie und Strahlentherapie, Medizinische Fakultät, Uniklinik Marburg, Marburg, Deutschland

    Rita Engenhart-Cabillic

  5. Klinik und Poliklinik für Radioonkologie und Strahlentherapie der Universitätsmedizin Mainz, Medizinische Fakultät, Uniklinik Mainz, Mainz, Deutschland

    Heinz Schmidberger

  6. Klinik für Strahlentherapie und Radioonkologie, Medizinische Fakultät, Uniklinik Münster, Münster, Deutschland

    Hans Eich

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  1. Christian Baues
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Correspondence to Christian Baues.

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Interessenkonflikt

C. Baues, S. Marnitz, P. Lukas, K. Herfarth, R. Engenhart-Cabillic, H. Schmidberger und H. Eich geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Baues, C., Marnitz, S., Lukas, P. et al. Rolle der Radiotherapie beim Hodgkin-Lymphom. Onkologie 28, 872–878 (2022). https://doi.org/10.1007/s00761-022-01185-w

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