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16.07.2021 | Strahlentherapie | CME Zertifizierte Fortbildung

Chirurgische Behandlung und Strahlentherapie von Hirnmetastasen

verfasst von: Univ.-Prof. Dr. Jan P. Boström, Kathleen Jetschke, Univ.-Prof. Dr. Kirsten Schmieder, Univ.-Prof. Dr. Irenäus A. Adamietz

Erschienen in: Die Radiologie | Ausgabe 8/2021

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Zusammenfassung

In dieser Arbeit sollen die Grundsätze der interdisziplinären Behandlung von Hirnmetastasen skizziert werden. Die interdisziplinäre Behandlung wird bestimmt durch die klinische Situation, anatomische Gegebenheiten und die Tumorentität. Sie hat eine Reduktion der Toxizität im Fokus. Zur Diagnostik von Hirnmetastasen werden Magnetresonanztomographie, Computertomographie (CT) und Positronenemissionstomographie-CT verwendet. Bei zugänglichen, symptomatischen Metastasen wird die Neurochirurgie eingesetzt. Bei umschriebenen, auch multiplen, jedoch chirurgisch schlecht erreichbaren Metastasen kommt die Radiochirurgie zum Einsatz. Die Teilhirnbestrahlung wird, wenn möglich, einer Ganzhirnbestrahlung vorgezogen. Eine Schonung des Hippocampus bei Ganzhirnbestrahlung reduziert die Therapietoxizität. In Notsituationen leisten Steroide einen effektiven Beitrag, eine neurochirurgische Intervention ist eventuell lebensrettend. Die Möglichkeiten einer medikamentösen Systemtherapie nehmen zu.

Schmieder K, Keilholz U, Combs S (2016) The interdisciplinary management of brain metastases. Dtsch Arztebl Int 113(24):415–421. https://doi.org/10.3238/arztebl.2016.0415 CrossRefPubMedPubMedCentral

Gállego Pérez-Larraya J, Hildebrand J (2014) Brain metastases. Handb Clin Neurol 121:1143–1157. https://doi.org/10.1016/B978-0-7020-4088-7.00077-8 CrossRefPubMed

Greenberg MS (2019) Handbook of neurosurgery, 9. Aufl. Thieme, Stuttgart

Cagney DN, Martin AM, Catalano PJ, Redig AJ, Lin NU, Lee EQ, Wen PY, Dunn IF, Bi WL, Weiss SE, Haas-Kogan DA, Alexander BM, Aizer AA (2017) Incidence and prognosis of patients with brain metastases at diagnosis of systemic malignancy: a population-based study. Neuro Oncol 19(11):1511–1521. https://doi.org/10.1093/neuonc/nox077 CrossRefPubMedPubMedCentral

Robert Koch Institut (2019). https://www.rki.de/DE/Content/Gesundheitsmonitoring/Krebsregisterdaten/krebs_node.html. Zugegriffen: 12. Juni 2020

Arbeitsgemeinschaft Deutscher Tumorzentren (2019). https://www.adt-netzwerk.de/Forschung_mit_Krebsregisterdaten/Positionspapier_Fachgesellschaften/. Zugegriffen: 12. Juni 2020

Achrol AS, Rennert RC, Anders C, Soffietti R, Ahluwalia MS, Nayak L, Peters S, Arvold ND, Harsh GR, Steeg PS, Chang SD (2019) Brain metastases. Nat Rev Dis Primers 5(1):5. https://doi.org/10.1038/s41572-018-0055-y CrossRefPubMed

Leitlinien für Diagnostik und Therapie in der Neurologie – Hirnmetastasen und Meningeosis neoplastica Entwicklungsstufe: S2k – AWMF-Registernummer: 030/060; https://www.awmf.org/leitlinien/detail/ll/030-060.html

Mulvenna P, Nankivell M, Barton R, Faivre-Finn C, Wilson P, McColl E, Moore B, Brisbane I, Ardron D, Holt T, Morgan S, Lee C, Waite K, Bayman N, Pugh C, Sydes B, Stephens R, Parmar MK, Langley RE (2016) Dexamethasone and supportive care with or without whole brain radiotherapy in treating patients with non-small cell lung cancer with brain metastases unsuitable for resection or stereotactic radiotherapy (QUARTZ): results from a phase 3, non-inferiority, randomised trial. Lancet 388 (10055):2004–2014. https://doi.org/10.1016/S0140-6736(16)30825-X CrossRefPubMedPubMedCentral

10.

Palma DA, Louie AV, Rodrigues GB (2015) New strategies in stereotactic radiotherapy for oligometastases. Clin Cancer Res 21(23):5198–5204. https://doi.org/10.1158/1078-0432.CCR-15-0822 CrossRefPubMed

11.

Soffietti R, Abacioglu U, Baumert B, Combs SE, Kinhult S, Kros JM, Marosi C, Metellus P, Radbruch A, Villa Freixa SS, Brada M, Carapella CM, Preusser M, Le Rhun E, Ruda R, Tonn JC, Weber DC, Weller M (2017) Diagnosis and treatment of brain metastases from solid tumors: guidelines from the European Association of Neuro-Oncology (EANO). Neuro Oncol 19(2):162–174. https://doi.org/10.1093/neuonc/now241 CrossRefPubMedPubMedCentral

12.

Obermueller T, Schaeffner M, Gerhardt J, Meyer B, Ringel F, Krieg SM (2014) Risks of postoperative paresis in motor eloquently and non-eloquently located brain metastases. BMC Cancer 14:21. https://doi.org/10.1186/1471-2407-14-21 CrossRefPubMedPubMedCentral

13.

Schebesch KM, Rosengarth K, Brawanski A, Proescholdt M, Wendl C, Hohne J, Ott C, Lamecker H, Doenitz C (2019) Clinical benefits of combining different visualization modalities in neurosurgery. Front Surg 6:56. https://doi.org/10.3389/fsurg.2019.00056 CrossRefPubMedPubMedCentral

14.

Schackert G, Schmiedel K, Lindner C, Leimert M, Kirsch M (2013) Surgery of recurrent brain metastases: retrospective analysis of 67 patients. Acta Neurochir (Wien) 155(10):1823–1832. https://doi.org/10.1007/s00701-013-1821-y CrossRef

15.

Niikura N, Hayashi N, Masuda N, Takashima S, Nakamura R, Watanabe K, Kanbayashi C, Ishida M, Hozumi Y, Tsuneizumi M, Kondo N, Naito Y, Honda Y, Matsui A, Fujisawa T, Oshitanai R, Yasojima H, Tokuda Y, Saji S, Iwata H (2014) Treatment outcomes and prognostic factors for patients with brain metastases from breast cancer of each subtype: a multicenter retrospective analysis. Breast Cancer Res Treat 147(1):103–112. https://doi.org/10.1007/s10549-014-3090-8 CrossRefPubMed

16.

Kellogg RG, Munoz LF (2013) Selective excision of cerebral metastases from the precentral gyrus. Surg Neurol Int 4:66. https://doi.org/10.4103/2152-7806.112189 CrossRefPubMedPubMedCentral

17.

Pintea B, Baumert B, Kinfe TM, Gousias K, Parpaley Y, Boström JP (2017) Early motor function after local treatment of brain metastases in the motor cortex region with stereotactic radiotherapy/radiosurgery or microsurgical resection: a retrospective study of two consecutive cohorts. Radiat Oncol 12(1):177. https://doi.org/10.1186/s13014-017-0917-6 CrossRefPubMedPubMedCentral

18.

Ahn JH, Lee SH, Kim S, Joo J, Yoo H, Lee SH, Shin SH, Gwak HS (2012) Risk for leptomeningeal seeding after resection for brain metastases: implication of tumor location with mode of resection. J Neurosurg 116(5):984–993. https://doi.org/10.3171/2012.1.JNS111560 CrossRefPubMed

19.

Prabhu RS, Miller KR, Asher AL, Heinzerling JH, Moeller BJ, Lankford SP, McCammon RJ, Fasola CE, Patel KR, Press RH, Sumrall AL, Ward MC, Burri SH (2018) Preoperative stereotactic radiosurgery before planned resection of brain metastases: updated analysis of efficacy and toxicity of a novel treatment paradigm. J Neurosurg. https://doi.org/10.3171/2018.7.JNS181293 CrossRefPubMed

20.

Andrews DW (2008) Should surgery followed by whole-brain radiation therapy be the standard treatment for single brain metastasis? Nat Clin Pract Oncol 5(10):572–573. https://doi.org/10.1038/ncponc1217 CrossRefPubMed

21.

Linskey ME, Andrews DW, Asher AL, Burri SH, Kondziolka D, Robinson PD, Ammirati M, Cobbs CS, Gaspar LE, Loeffler JS, McDermott M, Mehta MP, Mikkelsen T, Olson JJ, Paleologos NA, Patchell RA, Ryken TC, Kalkanis SN (2010) The role of stereotactic radiosurgery in the management of patients with newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol 96(1):45–68. https://doi.org/10.1007/s11060-009-0073-4 CrossRefPubMed

22.

Halasz LM, Rockhill JK (2013) Stereotactic radiosurgery and stereotactic radiotherapy for brain metastases. Surg Neurol Int 4(Suppl 4):S185–S191. https://doi.org/10.4103/2152-7806.111295 CrossRefPubMedPubMedCentral

23.

Hauswald H, Dittmar JO, Habermehl D, Rieken S, Sterzing F, Debus J, Combs SE (2012) Efficacy and toxicity of whole brain radiotherapy in patients with multiple cerebral metastases from malignant melanoma. Radiat Oncol 7:130. https://doi.org/10.1186/1748-717X-7-130 CrossRefPubMedPubMedCentral

24.

Andrews DW, Scott CB, Sperduto PW, Flanders AE, Gaspar LE, Schell MC, Werner-Wasik M, Demas W, Ryu J, Bahary JP, Souhami L, Rotman M, Mehta MP, Curran WJ Jr (2004) Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial. Lancet 363(9422):1665–1672. https://doi.org/10.1016/S0140-6736(04)16250-8 CrossRefPubMed

25.

Brown PD, Jaeckle K, Ballman KV, Farace E, Cerhan JH, Anderson SK, Carrero XW, Barker FG 2nd, Deming R, Burri SH, Menard C, Chung C, Stieber VW, Pollock BE, Galanis E, Buckner JC, Asher AL (2016) Effect of radiosurgery alone vs radiosurgery with whole brain radiation therapy on cognitive function in patients with 1 to 3 brain metastases: a randomized clinical trial. JAMA 316(4):401–409. https://doi.org/10.1001/jama.2016.9839 CrossRefPubMedPubMedCentral

26.

Brown PD, Ballman KV, Cerhan JH, Anderson SK, Carrero XW, Whitton AC, Greenspoon J, Parney IF, Laack NNI, Ashman JB, Bahary JP, Hadjipanayis CG, Urbanic JJ, Barker FG 2nd, Farace E, Khuntia D, Giannini C, Buckner JC, Galanis E, Roberge D (2017) Postoperative stereotactic radiosurgery compared with whole brain radiotherapy for resected metastatic brain disease (NCCTG N107C/CEC.3): a multicentre, randomised, controlled, phase 3 trial. Lancet Oncol 18(8):1049–1060. https://doi.org/10.1016/S1470-2045(17)30441-2 CrossRefPubMedPubMedCentral

27.

Mahajan A, Ahmed S, McAleer MF, Weinberg JS, Li J, Brown P, Settle S, Prabhu SS, Lang FF, Levine N, McGovern S, Sulman E, McCutcheon IE, Azeem S, Cahill D, Tatsui C, Heimberger AB, Ferguson S, Ghia A, Demonte F, Raza S, Guha-Thakurta N, Yang J, Sawaya R, Hess KR, Rao G (2017) Post-operative stereotactic radiosurgery versus observation for completely resected brain metastases: a single-centre, randomised, controlled, phase 3 trial. Lancet Oncol 18(8):1040–1048. https://doi.org/10.1016/S1470-2045(17)30414-X CrossRefPubMedPubMedCentral

28.

Sahgal A, Ruschin M, Ma L, Verbakel W, Larson D, Brown PD (2017) Stereotactic radiosurgery alone for multiple brain metastases? A review of clinical and technical issues. Neuro Oncol 19(suppl_2):ii2–ii15. https://doi.org/10.1093/neuonc/nox001 CrossRefPubMedPubMedCentral

29.

Kocher M, Wittig A, Piroth MD, Treuer H, Seegenschmiedt H, Ruge M, Grosu AL, Guckenberger M (2014) Stereotactic radiosurgery for treatment of brain metastases. A report of the DEGRO working group on stereotactic radiotherapy. Strahlenther Onkol 190(6):521–532. https://doi.org/10.1007/s00066-014-0648-7 CrossRefPubMed

30.

Weide HL, de Kunder S, Houben RMA, Bosmans G, Lambin P, Baumert B (2011) Influence of metastatic volume on local control and survival assessed by 3D volumetric measurements after radiosurgery in patients with brain metastases and planned observation. Strahlenther Onkol 187:523–524

31.

Weltman E, Salvajoli JV, Brandt RA, de Morais Hanriot R, Prisco FE, Cruz JC, de Oliveira Borges SR, Wajsbrot DB (2000) Radiosurgery for brain metastases: a score index for predicting prognosis. Int J Radiat Oncol Biol Phys 46(5):1155–1161. https://doi.org/10.1016/s0360-3016(99)00549-0 CrossRefPubMed

32.

Patchell RA, Tibbs PA, Walsh JW, Dempsey RJ, Maruyama Y, Kryscio RJ, Markesbery WR, Macdonald JS, Young B (1990) A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 322(8):494–500. https://doi.org/10.1056/NEJM199002223220802 CrossRefPubMed

33.

Specht HM, Combs SE (2016) Stereotactic radiosurgery of brain metastases. J Neurosurg Sci 60(3):357–366 PubMed

34.

Combs SE, Bilger A, Diehl C, Bretzinger E, Lorenz H, Oehlke O, Specht HM, Kirstein A, Grosu AL (2018) Multicenter analysis of stereotactic radiotherapy of the resection cavity in patients with brain metastases. Cancer Med 7(6):2319–2327. https://doi.org/10.1002/cam4.1477 CrossRefPubMedPubMedCentral

35.

Yamamoto M, Serizawa T, Shuto T, Akabane A, Higuchi Y, Kawagishi J, Yamanaka K, Sato Y, Jokura H, Yomo S, Nagano O, Kenai H, Moriki A, Suzuki S, Kida Y, Iwai Y, Hayashi M, Onishi H, Gondo M, Sato M, Akimitsu T, Kubo K, Kikuchi Y, Shibasaki T, Goto T, Takanashi M, Mori Y, Takakura K, Saeki N, Kunieda E, Aoyama H, Momoshima S, Tsuchiya K (2014) Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational study. Lancet Oncol 15(4):387–395. https://doi.org/10.1016/S1470-2045(14)70061-0 CrossRefPubMed

36.

US National Library of Medicine (2017) Whole brain radiation versus stereotactic radiation (SRS) in patients with 5‑20 brain metastases: a phase III, randomized clinical trial

37.

Hauswald H, Habl G, Krug D, Kehle D, Combs SE, Bermejo JL, Debus J, Sterzing F (2013) Whole brain helical tomotherapy with integrated boost for brain metastases in patients with malignant melanoma—a randomized trial. Radiat Oncol 8:234. https://doi.org/10.1186/1748-717X-8-234 CrossRefPubMedPubMedCentral

38.

Levegrun S, Pottgen C, Wittig A, Lubcke W, Jawad AJ, Stuschke M (2013) Helical tomotherapy for whole-brain irradiation with integrated boost to multiple brain metastases: evaluation of dose distribution characteristics and comparison with alternative techniques. Int J Radiat Oncol Biol Phys 86(4):734–742. https://doi.org/10.1016/j.ijrobp.2013.03.031 CrossRefPubMed

39.

Brown PD, Gondi V, Pugh S, Tome WA, Wefel JS, Armstrong TS, Bovi JA, Robinson C, Konski A, Khuntia D, Grosshans D, Benzinger TLS, Bruner D, Gilbert MR, Roberge D, Kundapur V, Devisetty K, Shah S, Usuki K, Anderson BM, Stea B, Yoon H, Li J, Laack NN, Kruser TJ, Chmura SJ, Shi W, Deshmukh S, Mehta MP, Kachnic LA (2020) Hippocampal avoidance during whole-brain radiotherapy plus memantine for patients with brain metastases: phase III trial NRG oncology CC001. J Clin Oncol 38(10):1019–1029. https://doi.org/10.1200/JCO.19.02767 CrossRefPubMedPubMedCentral

40.

Grosu AL, Frings L, Bentsalo I, Oehlke O, Brenner F, Bilger A, Fennell JT, Rothe T, Schneider-Fuchs S, Graf E, Schmoor C, Beck J, Becker G, Bock M, Egger K, Urbach H, Lahmann C, Popp I (2020) Whole-brain irradiation with hippocampal sparing and dose escalation on metastases: neurocognitive testing and biological imaging (HIPPORAD)—a phase II prospective randomized multicenter trial (NOA-14, ARO 2015‑3, DKTK-ROG). BMC Cancer 20(1):532. https://doi.org/10.1186/s12885-020-07011-z CrossRefPubMedPubMedCentral

41.

Scharp M, Hauswald H, Bischof M, Debus J, Combs SE (2014) Re-irradiation in the treatment of patients with cerebral metastases of solid tumors: retrospective analysis. Radiat Oncol 9:4. https://doi.org/10.1186/1748-717X-9-4 CrossRefPubMedPubMedCentral

42.

Petrelli F, De Stefani A, Trevisan F, Parati C, Inno A, Merelli B, Ghidini M, Bruschieri L, Vitali E, Cabiddu M, Borgonovo K, Ghilardi M, Barni S, Ghidini A (2019) Combination of radiotherapy and immunotherapy for brain metastases: a systematic review and meta-analysis. Crit Rev Oncol Hematol 144:102830. https://doi.org/10.1016/j.critrevonc.2019.102830 CrossRefPubMed

Titel: Chirurgische Behandlung und Strahlentherapie von Hirnmetastasen
verfasst von: Univ.-Prof. Dr. Jan P. Boström
Kathleen Jetschke
Univ.-Prof. Dr. Kirsten Schmieder
Univ.-Prof. Dr. Irenäus A. Adamietz
Publikationsdatum: 16.07.2021
Verlag: Springer Medizin
Schlagwörter: Strahlentherapie
Metastasen
Zerebrale Metastasen
Erschienen in: Die Radiologie / Ausgabe 8/2021
Print ISSN: 2731-7048
Elektronische ISSN: 2731-7056
DOI: https://doi.org/10.1007/s00117-021-00894-4

Springer Medizin

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