Radio(chemo)therapie lokal fortgeschrittener plattenepithelkarzinome im kopf-hals-bereich

Squamous epithelial carcinomas in the ENT region are mostly distinguished by a large tumor volume at the primary focus as well as in the cervical lymph nodes. Characteristic findings are rapid tumor proliferation with very brief potential tumor duplication times of a few days and accelerated repopulation of tumor cells commencing approximately 3 weeks after the start of radiotherapy. In many cases, at first diagnosis the situation already exceeds functionally justifiable limits even for resection surgery that appears sensible from the point of view of operative technique and tumor biology. This is compounded by the increasing rate of distant metastases in UICC stages III and IV of over 30%, which at present have almost no chance of cure. Even today treatment of these tumors constitutes a considerable challenge. For many years, treatment exclusively by conventional fractionated radiotherapy for 7-8 weeks was considered standard. Local tumor control rates achieved with this method of about 20-40% after 5 years are poor. This initially led to development of alternative fractionation regimens. Numerous studies confirmed the superiority of these irradiation procedures over standard fractionation with clearly better local control and slightly improved overall survival. The meta-analysis performed by Pignon et al. [23] demonstrated that the simultaneous administration of chemotherapy during radiotherapy produces clearly improved relapse-free survival and decrease of distant metastases, thus obtaining an absolute increase in survival rates of 8%. Newer studies have shown that by intensifying radio(chemo)therapy a survival benefit of even 20-30% can be achieved in comparison to radiation treatment alone. Two studies of the ARO on this topic were recently evaluated. Employing modern radiation techniques, new cytostatic agents, and effect modulators holds out hope for further improvement of treatment results.