Radiotherapie des kutanen malignen Melanoms

Leitthema
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Zusammenfassung

Hintergrund

Das Melanom galt früher als strahlenresistenter Tumor. Publikationen der letzten 20 Jahre konnten zeigen, dass die Radiotherapie in der primären und in der Rezidivsituation sowie auch bei Metastasen einen wichtigen therapeutischen Beitrag leisten kann.

Material und Methode

Diese Arbeit basiert auf einer selektiven Literaturrecherche in der Datenbank PubMed zum Thema „Radiotherapie und Melanom“.

Ergebnisse und Schlussfolgerung

Die Radiotherapie nimmt bei der definitiven Behandlung kutaner Melanome eher eine untergeordnete Rolle ein. Eine Ausnahme stellt das Lentigo-maligna-Melanom dar, wo sich bei Patienten, die nicht operabel sind, durch eine Bestrahlung sehr gute lokale Kontrollraten erzielen lassen. In der postoperativen Situation kann bei R1- oder R2-resezierten Tumoren bzw. bei knapp resezierten desmoplastischen Tumoren eine Bestrahlung mit dem Ziel der lokalen Kontrolle durchgeführt werden. Bei Vorliegen von Risikofaktoren (Zahl und Größe der befallenen Lymphknoten, Kapseldurchbruch, Rezidiv) sollte eine adjuvante Bestrahlung der Lymphknotenregion erfolgen, um die lokale Tumorkontrollrate zu erhöhen. Bei Vorliegen von symptomatischen Knochenmetastasen lassen sich die Beschwerden durch eine palliative Radiotherapie gut kontrollieren. Bei der Behandlung einer Hirnmetastasierung sollte eine lokale Radiotherapie (z. B. Radiochirurgie) der Ganzhirnbestrahlung vorgezogen werden. Dabei kann eine Radiotherapie mit Ipilimumab auch simultan kombiniert werde; eine Kombination mit BRAF-Inhibitoren sollte dagegen sequenziell erfolgen.

Schlüsselwörter

Strahlentherapie Radiochirurgie Lentigo-maligna-Melanom Hirnmetastasen Radioimmuntherapie 

Radiation therapy of cutaneous malignant melanoma

Abstract

Background

In the past melanoma was considered intrinsically resistant to radiotherapy. In the last two decades radiotherapy was shown to be effective in the treatment of primary and recurrent tumors as well as in metastatic situations.

Material and methods

This review is based on a PubMed search of the medical subject heading terms “radiotherapy and melanoma”.

Results and conclusion

Radiotherapy does not play an important role in the definitive treatment of cutaneous melanoma. An exception is medically inoperable patients with lentigo maligna, where definitive radiotherapy offers a treatment option with good local control rates. Postoperative radiotherapy reduces the risk of recurrence in patients with positive margins and in patients with desmoplastic melanoma and closed margins. Radiotherapy of the nodal basis should be considered in high-risk patients (size and number of involved nodes, extranodal spread, lymph node relapse). Palliative radiotherapy can effectively reduce the symptoms in patients with bone metastases. Local radiosurgery should be preferred to whole brain radiotherapy. Radiotherapy may be simultaneously combined with ipilimumab but should be combined with BRAF inhibitors only sequentially.

Keywords

Radiotherapy Radiosurgery Lentigo maligna Brain metastases Radioimmunotherapy 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

O. Kölbl gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Klinik und Poliklinik für StrahlentherapieUniversitätsklinikum RegensburgRegensburgDeutschland

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