Value of Brachytherapy as Part of Interdisciplinary Therapeutic Concepts for Solid Tumor Lesions – Brachytherapeutic Options and Spectrum of Treatment Results at the Center of Radiology (Department of Radiotherapy - University Hospital of Magdeburg)

Abstract

As in many other medical disciplines, a substantial change of paradigms in oncology and oncotherapy can be observed. In particular, for the treatment of solid tumor lesions the former rather rigid approach to differentiate between curative (no detection of distant metastases) and palliative intention (including systemic advancement of tumor disease) has been increasingly overcome. The concept of oligometastases has been getting more and more attention. Oligometastatic status can be classified if in first diagnosis or in follow-up investigation for tumor staging only a few distant metastases are found. According to the former guidelines, this might only lead to initiation of a palliative treatment, in the majority of cases to a systemic type of therapy! Interestingly, there has been substantial evidence that local ablation of the small number of filiae can favorably influence quality of life (the main intent of "palliative care" according to the definition by WHO) and prognosis. However, there are no predictive markers yet such as laboratory parameters, which allow to assess prognosis of a certain tumor stage / disease including oligometastases.Surgical resection was and is the gold standard of local ablation but only a certain percentage of patients with oligometastases can be approached with surgical intervention since several of them areunresectable from a technical or inoperable from an anesthesiological point of view. In addition to surgical ablation, there have been a number of non-or minimally invasive techniques available such as thermo-, chemo-and radioablading procedures.This review aims at Brachytherapy (BT) as radioablating method, its indications as part of curative concepts, the possible treatment spectrum shown in detail at the University Hospital of Magdeburg (Germany), and, in particular, indicating what is feasible and achievable from a qualitative and quantitative point of view. Finally, exemplary and representative cases document the potential benefit in radioablation of metastases.