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Strahlen-, Chemo- und Targettherapie von Kopf-Hals-Karzinomen

Neue Entwicklungen

Radiotherapy, chemotherapy and target therapy for treatment of head and neck cancer

New developments

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Zusammenfassung

Bei etwa 60% der erstmals wegen eines Plattenepithelkarzinoms im oberen Aerodigestivtrakt behandelten Patienten ist die Tumorerkrankung fortgeschritten (UICC-Stadium III oder IV). Heute können etwa 50% der Patienten primär geheilt werden. Neuere Studien enthalten Hinweise, dass das Fernmetastasenrisiko nach Induktions-Chemotherapie (CT) geringer ist als nach primärer Radio-CT (RCT). Hyperfraktionierung oder akzelerierte Bestrahlung mit gleichzeitigem Boost sind der klassischen RT überlegen. Bei der intensitätsmodulierten RT (IMRT) ist die Dosisverteilung besser angepasst. Die Targettherapie (TT) mit Antikörpern, z. B. gegen den epidermalen Wachstumsfaktorrezeptor (EGFR) zeigte eine Überlegenheit gegenüber der alleinigen RT, gegenüber der klassischen RCT steht dies noch aus. Die TT gegen VEGF („vascular endothelial growth factor“) erzielt einen antiangiogenetischen Effekt im Tumor. Bei Irresektabilität oder Fernmetastasen wird eine palliative CT bzw. TT empfohlen. Die Wiederbestrahlung oder IMRT bietet bei hoher Toxizität eine erhöhte lokoregionäre Kontrolle. Insgesamt liegen durch die Erforschung der Tumorbiologie zunehmend prognostische Faktoren und Marker für eine individuelle TT und CT vor.

Abstract

Approximately 60% of patients initially treated for squamous cell cancer of the upper gastrointestinal tract suffer from advanced tumor disease (UICC stages III and IV). Multimodal strategies lead to overall survival rates of up to 50%. Recent studies show indications that the risk of distant metastases after induction chemotherapy (CT) is less than after primary radiotherapy (RT) or radiochemotherapy (RCT). Hyperfractionation or accelerated radiation with concomitant boost shows superior results compared to classic RT. Intensity-modulated radiotherapy (IMRT) is a new method for better adjusted dose distribution. Targeted therapy with specific antibodies against biological targets, such as epidermal growth factor receptor (EGFR), showed superiority over RT but the comparison to classic RCT is still pending. Targeted therapy against vascular endothelial growth factor (VEGR) showed antiangiogenetic effects on tumors. In cases of non-resectability or distant metastases, palliative CT and target therapy are recommended. Reirradiation or IMRT offer increased locoregional tumor control at the expense of higher toxicity. Overall, advances in research on tumor biology offer increasingly more prognostic factors and markers for customized individual targeted therapy and CT.

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  1. Klinik für Hals- Nasen- Ohrenheilkunde, Kopf- und Halschirurgie, Universtitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland

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Knecht, R. Strahlen-, Chemo- und Targettherapie von Kopf-Hals-Karzinomen. HNO 57, 436–445 (2009). https://doi.org/10.1007/s00106-009-1909-0

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