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Erschienen in:

01.01.2014 | Leitthema

Systemische Therapie von Hirnmetastasen

verfasst von: PD Dr. A. Korfel, U. Schlegel

Erschienen in: Die Onkologie | Ausgabe 1/2014

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Zusammenfassung

Hintergrund

Die lokalen Therapien von Hirnmetastasen sind effektiv, haben jedoch Limitationen bei multiplen zerebralen Filiae und bei systemischer Metastasierung und/oder Progress der Primärtumorerkrankung. Systemische Therapien besitzen dagegen den Vorteil einer gleichzeitigen Behandlung der oft die Prognose bestimmenden systemischen Erkrankung.

Ziel

Es soll die aktuelle Rolle systemischer Therapien in der Behandlung von Hirnmetastasen solider Tumoren dargestellt werden.

Material und Methoden

Die relevanten Publikationen insbesondere der letzten Jahre zum Wert der systemischen Therapien von Hirnmetastasen wurden kritisch evaluiert.

Ergebnisse

Eine entscheidende Verbesserung der Prognose von Patienten mit Hirnmetastasen wurde durch den Einsatz systemischer Therapien bisher nicht erreicht. Bei Hirnmetastasen des kleinzelligen Bronchialkarzinoms und von Keimzelltumoren sollte die systemische Chemotherapie, sofern es die klinische Situation erlaubt, als primäre Therapie eingesetzt werden und im Verlauf ggf. durch Radiotherapie und/oder operative Resektion ergänzt werden. Bei Keimzelltumoren kann damit Langzeitüberleben erreicht werden. Bei anderen Tumoren sollte bei gutem Allgemeinzustand und asymptomatischen multiplen Hirnmetastasen eine systemische Chemotherapie erwogen werden, insbesondere wenn eine aktive systemische Erkrankung vorliegt und eine Ganzhirnbestrahlung bereits erfolgt ist. Gezielte Therapie („targeted therapy“) und Immuntherapien stellen auch bei Hirnmetastasen einiger Tumoren eine Erweiterung des therapeutischen Arsenals da.

Schlussfolgerung

Systemische Therapien sind häufig eine sinnvolle Ergänzung der neurochirurgischen und strahlentherapeutischen Maßnahmen bei Hirnmetastasen im Rahmen eines multimodalen Therapiekonzepts.
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Metadaten
Titel
Systemische Therapie von Hirnmetastasen
verfasst von
PD Dr. A. Korfel
U. Schlegel
Publikationsdatum
01.01.2014
Verlag
Springer Berlin Heidelberg
Erschienen in
Die Onkologie / Ausgabe 1/2014
Print ISSN: 2731-7226
Elektronische ISSN: 2731-7234
DOI
https://doi.org/10.1007/s00761-013-2563-4

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