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Moderne Radiotherapie beim Hodgkin-Lymphom

Überlegungen zu einer personalisierten Planung

Modern radiotherapy for Hodgkin lymphoma

Considerations for a personalized treatment planning

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Forum Aims and scope

Zusammenfassung

Hintergrund

Die Radiotherapie ist ein integraler Bestandteil der Behandlung des Hodgkin-Lymphoms in den frühen Stadien. Angesichts der sehr guten Langzeitprognose ist die zusätzliche (Radio‑)Therapie gegenüber potenziellen (Langzeit‑)Toxizitäten kritisch abzuwägen, sodass eine individualisierte Risikoanalyse sinnvoll erscheint.

Material und Methoden

Im November 2022 erfolgte eine selektive Literaturrecherche zur Radiotherapie mediastinaler Lymphome mit Fokus auf Bestrahlungstechniken und -konzepten. Hierbei wurden die Erfahrungen der German Hodgkin Study Group sowie anderer Studiengruppen zusammengefasst.

Ergebnisse

Das aktuelle Bestrahlungskonzept ist die Involved-Node- bzw. Involved-Site-Radiotherapie, die eine Individualisierung der Bestrahlungsfelder ermöglicht. Bei der Behandlung des Mediastinums ist die Durchführung in tiefer Inspiration sinnvoll. Eine generelle Empfehlung für eine definierte Bestrahlungstechnik existiert nicht; diese sollte durch Vergleichsplanung ermittelt werden. Dosimetrische Analysen zeigen die insgesamt niedrige Exposition thorakaler Risikoorgane auf, die jedoch je nach Befallsmuster des Lymphoms stark variieren kann.

Diskussion

Schon jetzt existieren mögliche Strategien der Individualisierung der Bestrahlungsplanung, die situations- und patientenadaptiert eingesetzt werden sollten. Weitere Entwicklungen mittels künstlicher Intelligenz und gepoolter Datenbankanalysen können helfen, die Risikoabschätzung weiterzuentwickeln.

Abstract

Background

Radiotherapy is an integral part of treatment for early-stage Hodgkin lymphoma. Considering the excellent long-term prognosis, the use of additional (radio-)therapy has to be balanced against putative (long-term) toxicities, which encourages an individualized risk analysis.

Materials and methods

A selective literature search on radiotherapy for mediastinal lymphoma was carried out in November 2022 focusing on radiation techniques and -concepts. Experiences of the German Hodgkin Study Group and other groups were summarized.

Results

Involved-node or involved-site radiotherapy constitutes the state-of-the-art radiation concept, which may enable individualization of radiation fields. For treatment of mediastinal lymphoma, irradiation in deep-inspiration breath hold is reasonable. A general recommendation for a defined radiation technique cannot be given; the technique should be elaborated via comparative planning. Dosimetric analyses reveal the overall low exposure of thoracic organs at risk which may vary considerably according to the involved regions.

Conclusion

Possible strategies for individualizing radiation therapy planning already exist, which can be applied according to the treatment situation and individual patient. Further developments via artificial intelligence and pooled data analyses may help to further evolve the risk assessment.

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Authors and Affiliations

  1. Klinik für Strahlentherapie – Radioonkologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland

    Michael Oertel, Niklas Benedikt Pepper, David Rene Steike &  Hans Theodor Eich

  2. Klinik und Poliklinik für Radioonkologie, Cyberknife- und Strahlentherapie, Uniklinik Köln, Köln, Deutschland

    Christian Baues

  3. Innere Medizin I – Onkologie, Hämatologie, Klinische Infektiologie, Klinische Immunologie, Hämostaseologie, Internistische Intensivmedizin, Uniklinik Köln, Köln, Deutschland

    Michael Fuchs & Peter Borchmann

Authors
  1. Michael Oertel
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  2. Christian Baues
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  3. Michael Fuchs
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  4. Niklas Benedikt Pepper
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  5. David Rene Steike
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  6. Peter Borchmann
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  7. Hans Theodor Eich
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Correspondence to Hans Theodor Eich.

Ethics declarations

Interessenkonflikt

H.T. Eich und M. Oertel geben folgenden Interessenkonflikt an: Förderung zur Radiotherapie des Hodgkin Lymphoms durch die Deutsche Krebshilfe (Projekt 70112331). C. Baues, M. Fuchs, N.B. Pepper, D.R. Steike und P. Borchmann geben an, dass kein Interessenkonflikt besteht.

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

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Oertel, M., Baues, C., Fuchs, M. et al. Moderne Radiotherapie beim Hodgkin-Lymphom. Forum 38, 226–230 (2023). https://doi.org/10.1007/s12312-023-01185-w

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  • DOI: https://doi.org/10.1007/s12312-023-01185-w

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