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Intensitätsmodulierte Bestrahlung (IMRT) von Kopf-Hals-Tumoren

Höhere biologische Wirksamkeit in Risikosituationen durch „integrierten Boost“

Intensity modulated radiotherapy (IMRT) of head and neck tumors

Increased biological effectiveness in high-risk situations by “integrated boost” therapy

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Zusammenfassung

Primäre Tumoren der Nasennebenhöhlen sind selten, aber wegen ihrer Lokalisation und Ausbreitung über den Gesichtsschädel ein therapeutisches Problem. Wegen des hohen Rezidivrisikos ist meist eine postoperative Strahlentherapie indiziert. Die intensitätsmodulierte Strahlentherapie (IMRT) ist eine neue Technik, mit der sich präziser als bisher die Dosisverteilung an das Zielvolumen anpassen lässt. Höhere Dosen im Zielvolumen bei gleichzeitig reduzierten Dosen für die Risikoorgane (Sehstrukturen, Hirnstamm, Speicheldrüsen) sind möglich. Auch kann die Dosis innerhalb des Zielvolumens noch einmal so moduliert werden, dass in Bereichen mit der vermutlich höchsten Tumorzelldichte die höchste Dosis appliziert, also eine sog. „integrierte Boostbestrahlung“ durchgeführt wird. Wir stellen am Beispiel einer Patientin mit einem fortgeschrittenen NNH-Tumor die klinische Implementierung dieser Technik vor.

Abstract

Primary tumors of the paranasal sinuses are rare entities which, because of precarious localization and frequently diffuse propagation into neighbouring cavities and the skull base, pose a significant therapeutic problem. Even after complete surgical resection, local relapses are frequent. Postoperative radiotherapy is therefore usually indicated. Intensity modulated radiotherapy (IMRT) is a new technique that helps creating dose distributions that conform closely to the target volume while maximally sparing the organs at risk. This results in the possibility of applying escalated doses to the target while still keeping the incidence of side effects low. What is especially appealing is the possibility of shaping the dose distribution within the target in such a way that areas with a presumably high tumor cell load receive increased doses, a concept which is best described by the term “integrated boost”. We present the case of a patient with a sinunasal carcinoma and describe the implications of the clinical implementation of this technique.

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Authors and Affiliations

  1. Sektion Strahlentherapie des Instituts für Klinische Radiologie

    D. Milanovic,  F. Lohr, B. Dobler, B. Hermann & F. Wenz

  2. Universitäts Hals-Nasen-Ohren-Klinik des Universitätsklinikum Mannheim

    K. Götte & K. Hörmann

  3. Sektion Strahlentherapie des Instituts für Klinische Radiologie am Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1–3, 68167 , Mannheim

    F. Lohr

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  1. D. Milanovic
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Correspondence to F. Lohr.

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Milanovic, D., Lohr, F., Götte, K. et al. Intensitätsmodulierte Bestrahlung (IMRT) von Kopf-Hals-Tumoren. HNO 52, 729–736 (2004). https://doi.org/10.1007/s00106-003-0951-6

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  • DOI: https://doi.org/10.1007/s00106-003-0951-6

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