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Prinzipien der Strahlentherapie und der kombinierten Radio-/Chemotherapie

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Praxis der Viszeralchirurgie Onkologische Chirurgie
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Zusammenfassung

Eine kurative oder palliative Strahlenbehandlung erhalten 60–70% aller Krebskranken. In der Abtötung von Tumorzellen ist die Strahlentherapie hoch effizient (Abb. 26.1 und Abb. 26.2). Sie kann als alleinige Therapieform oder in Kombination mit der Chemotherapie, solide Tumoren definitiv vernichten und damit heilen. Bei den gastrointestinalen Tumoren sind hier insbesondere das ösophaguskarzinom und das Analkarzinom zu nennen. Der wesentliche Beitrag der Strahlentherapie im Rahmen kurativer und multimodaler Behandlungskonzepte besteht in der Verbesserung der lokalen Tumorkontrolle.

Der Unterschied in der quantitativen Zellabtötung zwischen Strahlentherapie und Chemotherapie. Verglichen mit der Operation oder einer fraktionierten Strahlenbehandlung bewirken 6 Zyklen einer Chemotherapie (Pfeile) eine deutlich geringere Zellvernichtung. Während ein mikroskopischer Tumor durch Chemotherapie (ChT) erfolgreich behandelt werden kann (untere Chemotherapiekurve), zeigt die klinische Beobachtung, dass die makroskopischen soliden Tumoren (Ausnahme: Hodentumoren) bei Medikamententherapie nur vorübergehend auf mikroskopische Grüße verkleinert werden. Die gestrichelte Linie unterscheidet zwischen makroskopischen Tumoren (mehr als ca. 5–10 mm Durchmesser: ≥1–10 Millionen Zellen) und mikroskopischen Tumoren. Wie im Insert schematisch dargestellt, liegt der Vorteil der Chemotherapie in simultaner Kombination mit der Radiotherapie (RT) in der Verstärkung der Zellvernichtung im Vergleich zur Strahlentherapie allein

Die Abbildung erklärt den Unterschied in der Wirksamkeit der Zellvernichtung zwischen Strahlen- und Chemotherapie (Abb. 26.1). Dargestellt ist ein histologischer Schnitt durch ein Plattenepithelkarzinom (mit freundlicher Genehmigung von Prof. Dr. W. Müller-Klieser, Mainz). Die unterschiedlichen Färbungen repräsentieren die biologische Heterogenität des soliden Tumors

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Geinitz, H., Röper, B., Molls, M. (2010). Prinzipien der Strahlentherapie und der kombinierten Radio-/Chemotherapie. In: Siewert, J.R., Rothmund, M., Schumpelick, V. (eds) Praxis der Viszeralchirurgie Onkologische Chirurgie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-03808-2_26

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