Zusammenfassung
Fragestellung
Ziel dieser Arbeit ist es, dem Radioonkologen die Empfehlungen und Diskussionswege der neuen S3-Leitlinie zum Nierenzellkarzinom für die tägliche Praxis pointiert darzustellen.
Methodik
Es werden Indikationsstellung, Dosisverschreibung, technische Durchführung sowie aktuelle Literatur für den Strahlentherapeuten, vor allem mit Fokus auf die Behandlung der Oligometastasierung, zusammengefasst.
Ergebnis
Entsprechend der unterschiedlichen Erkrankungsstadien und der Gliederung der Leitlinie werden fünf radiotherapeutische Therapiesituationen und die Empfehlungen dazu vorgestellt: (1) Primärsituation – neoadjuvante/adjuvante Therapie: Keine radiotherapeutische Indikation. (2) Primärsituation – „small renal mass“/fokale Therapie: Stereotaktisch-ablative Radiotherapie derzeit fallzahlbedingt noch als experimentell eingestuft, bei jedoch hoher Effektivität mit lokaler 2‑Jahres-Tumorkontrolle von >90 %. (3) Oligometastasierung: Höherdosierte Radiotherapie/Stereotaxie interdisziplinär anbieten. Hinsichtlich der palliativen Situation (4) und der symptomatischen Behandlung (5) gelten die gleichen Grundsätze wie für andere Entitäten.
Schlussfolgerung
Für die Strahlentherapie gibt es derzeit keine Indikation in der Primärtherapie des Nierentumors (adjuvant, neoadjuvant, definitiv). In der Zukunft sollte aufgrund der günstigen therapeutischen Breite die stereotaktische Bestrahlung eine wichtigere Rolle in der Therapie inoperabler Patienten mit einem primären Nierenzellkarzinom sowie in der Situation der Oligometastasierung einnehmen.
Abstract
Purpose
We aim to introduce and discuss the statements and recommendations of the German S3 guideline on renal cell cancer for daily practice of radiation oncologists.
Methods
This report comprises indication, treatment decision, dose prescription and current literature including treatment of oligometastatic disease.
Results
According to different stages of the disease and the structure of the guideline we focus on five treatment situations and recommendations for decision making: (1) Neo-/adjuvant treatment before or after nephrectomy: No indication for radiotherapy. (2) Small renal mass: Stereotactic ablative radiotherapy is currently seen as experimental option due to small patient numbers reported in the literature. However, local tumor control achieved by SBRT appears favourable with >90% at 2 years. (3) Oligometastasis: Radiation treatment with higher local doses or stereotactic treatment is possible after interdisciplinary discussion. Indications for palliative (4) and symptomatic treatment (5) are not different compared to other tumor entities.
Conclusion
Currently, there is no evidence-based indication for radiation treatment in the primary setting (adjuvant/neoadjuvant or definitive) of renal cell cancer. In the future stereotactic radiotherapy should have a stronger role in the treatment of medically inoperable patients with primary renal cell cancer and especially in the setting of oligometastasis.
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Acknowledgement
An der Erstellung der Leitlinie waren die Autoren als Mandatsträger beteiligt. Für die DEGRO (ACM, MG), für den BVDST (OM) und für APM (BvO).
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A.-C. Müller, B. van Oorschot, O. Micke und M. Guckenberger geben an, dass kein Interessenkonflikt besteht.
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Müller, AC., van Oorschot, B., Micke, O. et al. Die deutsche S3-Leitlinie zum Nierenzellkarzinom. Strahlenther Onkol 194, 1–8 (2018). https://doi.org/10.1007/s00066-017-1185-y
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DOI: https://doi.org/10.1007/s00066-017-1185-y