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Sekundärmalignome nach perkutaner Radiotherapie

Second neoplasms after percutaneous radiotherapy

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Zusammenfassung

Die Strahlentherapie (perkutane Radiotherapie, Low-dose-rate- [LDR-] oder High-dose-rate- [HDR-]Brachytherapie) stellt eine der therapeutischen Alternativen zur radikalen Prostatektomie des organbegrenzten bzw. des lokal fortgeschrittenen Prostatakarzinoms (PCa) dar. Strahlentherapieassoziierte Sekundärmalignome werden definitionsgemäß nach einer Latenzperiode von mindestens 5 Jahren, der Lokalisation innerhalb des Strahlenfeldes sowie einer vom Primärtumor abweichenden Histologie diagnostiziert. Basierend auf den Daten der Literatur zeigt sich gegenüber der Allgemeinbevölkerung bzw. der nicht strahlentherapierten PCa-Patienten reproduzierbar ein erhöhtes sekundäres Karzinomrisiko für die Entwicklung eines Blasenkarzinoms (Hazard Ratio [HR] 1,67; 95 %-Konfidenzintervall [‑KI] 1,55–1,80) sowie eines Rektum- (HR 1,79; 95 %-KI 1,34–2,38) und kolorektalen Karzinoms (HR 1,79; 95 %-KI 1,34–23,8) nach perkutaner Radiotherapie. Nach Brachytherapie ergibt sich nur ein erhöhtes Risiko für die Entwicklung eines Harnblasenkarzinoms (HR 2,14; 95 %-KI 1,03–3,94). Die Inzidenz der Sekundärneoplasien steigt mit zunehmender Dauer der Nachbeobachtung an. Bis dato konnten keine negativen Auswirkungen der Strahlentherapie auf das Gesamtüberleben und das tumorspezifische Überleben nach radikaler Zystektomie nachgewiesen werden, wenngleich die Rate an lokal fortgeschrittenen T3/4-Tumoren nach Radiatio deutlich gegenüber den Kontrollgruppen erhöht ist. Ab dem 5. posttherapeutischen Jahr sollten Symptome oder Zufallsbefunde, die auf ein Blasenkarzinom hindeuten könnten (Mikrohämaturie), einer intensiven Diagnostik zugeführt werden.

Abstract

Radiation therapy represents an alternative treatment to radical prostatectomy in the management of clinically localized prostate cancer. Radiation-induced second neoplasms are defined by a latency period of at least 5 years, location within the field of radiation therapy, and a histology which differs from the primary tumor. Based on the data in the literature, there is a consistently increased risk of bladder cancer (HR: 1.67, 95% CI 1.55–1.80), rectal cancer (HR: 1.79, 95% CI 1.34–2.38), and colorectal cancer (HR: 1.79, 95% CI 1.34–23.8) following percutaneous radiation therapy. Following brachytherapy only an increased for the development of bladder cancer (HR: 2.14, 95% CI 1.03–3.94) has been observed. The incidence of second neoplasms increases significantly and continuously with the posttreatment time interval. Although bladder cancers following RT of the prostate are usually more locally advanced and of high grade, no negative impact in terms of overall survival and cancer-specific survival has been observed. Symptoms or findings of microhematuria need to be examined thoroughly after radiation therapy to identify bladder cancer quite early.

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Authors and Affiliations

  1. Klinik für Urologie, Kerpener Str. 62, 50937, Köln, Deutschland

    F. Haidl, D. Pfister &  A. Heidenreich

  2. Klinik und Poliklinik für Strahlentherapie, Kerpener Str. 62, 50937, Köln, Deutschland

    R. Semrau

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  1. F. Haidl
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  2. D. Pfister
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  3. R. Semrau
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  4. A. Heidenreich
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Correspondence to A. Heidenreich.

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F. Haidl, D. Pfister, R. Semrau und A. Heidenreich geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Haidl, F., Pfister, D., Semrau, R. et al. Sekundärmalignome nach perkutaner Radiotherapie. Urologe 56, 342–350 (2017). https://doi.org/10.1007/s00120-016-0277-0

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  • DOI: https://doi.org/10.1007/s00120-016-0277-0

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