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DOI: 10.1055/s-2002-36432
© Johann Ambrosius Barth
Einfluss der postoperativen Nachbestrahlung zerebraler Metastasen auf Überlebenszeit und krankheitsbedingte Lebensbedingungen der Patienten
Influence of Postoperative Radiation Therapy of Cerebral Metastases on Survival Time and Disease Related Living ConditionsPublication History
Publication Date:
08 January 2003 (online)
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Zusammenfassung:
Hirnmetastasen werden häufig bei Patienten mit stationären systemischen Karzinomen als Zeichen eines neuen Wachstumsschubs beobachtet. Treten Hirnmetastasen auf, wird besonders die Lebensqualität der betroffenen Patienten durch neurologische Ausfälle oder ein Krampfanfallsleiden eingeschränkt. Nach Diagnosestellung wird eine frühzeitige Therapie zur Verbesserung der Lebensqualität, aber auch der Überlebenszeit angestrebt.
Als Therapie akzeptiert ist heute die operative Metastasenentfernung sowie eine postoperative fraktionierte Ganzhirnbestrahlung, häufig verbunden mit einer am Primärtumor orientierten systemischen Chemotherapie. In einer retrospektiven Studie wurden 139 Patienten (mittleres Alter: 59 ± 2,3 Jahre, m : w = 84 : 55) mit zerebralen Metastasen untersucht, die während des Zeitraums vom 1. 1. 1994 bis zum 31. 12. 2000 wegen zerebraler Metastasen operiert wurden. Besonderes Augenmerk galt dem Vergleich von Patienten mit Nachbestrahlung mit solchen, die keine postoperative Radiotherapie erhielten.
In unserem nach singulären und multiplen Metastasen (max. 3 Metastasen) analysierten Kollektiv wurde bei Patienten nach Entfernung von Singulärmetastasen - die meistens aufgrund ihres Primärtumors verstarben - weder eine Überlebenszeitverlängerung noch eine Verbesserung krankheitsbedingter Lebensbedingungen beobachtet. Bei Patienten mit multiplen Metastasen kam es durch die Nachbestrahlung zu einer geringen Lebenszeitverlängerung, wenn diese nach der operativen Entfernung aller Metastasen vorgenommen wurde. Vor dem Hintergrund dieser Ergebnisse muss die Indikation einer grundsätzlichen Nachbestrahlung des Neurokranium nach Metastasenoperation überdacht werden.
Abstract
Cerebral metastases are frequently observed in patients with systemic carcinoma as indication for new progress of the disease. Neurological deficits or seizures indicating zerebral metastases reduce the disease-related living conditions of the patients.
Improving quality of life and survival time is the overriding goal of an early treatment after the diagnosis of cerebral metastases. Contemporary treatment include surgical removal of the cerebral metastases followed by whole brain irradiation and in some cases additional systemic chemotherapy for the primary tumor. This study was conducted to test the hypothesis that whole brain radiation following surgical removal improves the quality of life and the survival time in patients with cerebral metastasis.
From January 1, 1994 to December 31, 2000, a total of 139 patients (mean age 59 ± 2.3 years, m : f = 84 : 55) with cerebral metastases were investigated. Disease-related living conditions were assessed by Karnofsky score, the median time of follow-up was 11 months. For the analysis, patients were divided into groups with and without radiation therapy. Additionally, groups of patients with singular and two brain metastases were defined.
In patients with singular brain metastases neither the survival time nor disease-related living conditions during the remaining life time was increased by postoperative whole brain irradiation. Almost all patients died due to the progression of the primary tumor. Patients with more than one metastases seemed to have a slight but not significant benefit from irradiation therapy after surgical removal of all metastases.
In conclusion, these results indicate that an uncritical irradiation therapy of neurocranium after surgical removal of cerebral metastases is not beneficial in terms of survival time or disease-related living conditions.
Schlüsselwörter:
Hirnmetastasen - Überlebenszeit - Nachbestrahlung
Key words:
Cerebral metastases - survival time - radiation therapy
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PD Dr. Michael Winking
Neurochirurgische Klinik
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