Aktuelle Standards und Fortschritte in der onkologischen Bildgebung von Kopf-Hals-Tumoren

 

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Zusammenfassung

Plattenepithelkarzinome der Kopf-Hals Region (HNSCC) sind zunehmend und machen derzeit ca. 5% aller malignen Erkrankungen weltweit aus. Trotz zunehmender Entwicklungen in der bildgebenden Diagnostik und neuer Therapieoptionen, stellt das HNSCC eine multidisziplinäre Herausforderung dar. Einer der bedeutendsten Prognosefaktoren dieser Erkrankung ist die Präsenz von Lymphknotenmetastasen. Patienten mit gesichertem nodalen Befall haben eine deutlich eingeschränkte 5-Jahres Überlebensrate. Im Zeitalter der optimierten individualisierten chirurgischen und medikamentösen Tumortherapie, aber auch der intensitätsmodulierten Radiotherapie, bleibt die Hauptanforderung an die prä- und posttherapeutische Bildgebung eine frühzeitige Diagnosestellung und rechtzeitige Nachsorge. Fundiertes Tumorstaging und engmaschige Verlaufsbeobachtung nach Chirurgie und/oder Radio-Chemotherapie beeinflussen den Therapieverlauf und die Outcome-Prädiktion maßgeblich.

Der folgende Übersichtsbeitrag setzt sich mit aktuellen Standards und Fortschritten in der onkologischen Bildgebung des Plattenepithelkarzinoms der Kopf-Hals Region auseinander. Neben dem diagnostischen Indikationsspektrum der einzelnen bildgebenden Modalitäten werden auch ihre Grenzen aufgezeigt. Ein wesentlicher Bestandteil der Arbeit ist der PET-CT gewidmet, die funktionelle und morphologische Bildgebung vereint, sowie neue Entwicklungen in der MRT, insbesondere zum Lymphknotenstaging und zur Responseprädiktion. Nicht zuletzt findet sich ein klinischer Beitrag zu den Anforderungen des Kopf-Hals Chirurgen an die multimodale Bildgebung und den Einfluss der radiologisch-nuklearmedinischen Diagnostik auf das operative Behandlungskonzept.

Abstract

Currrent Oncologic Concepts and Emerging Techniques for Imaging of Head and Neck Squamous Cell Cancer

The incidence of head and neck squamous cell carcinoma (HNSCC) is increasing and currently they account for 5% of all malignancies worldwide. Inspite of ongoing developments in diagnostic imaging and new therapeutic facilities, HNSCC still represents a multidisciplinary challenge.

One of the most important prognostic factors in HNSCC is the presence of lymph node metastases. Patients with confirmed nodal involvement have a considerable reduction of their 5-year overall survival rate. In the era of individually optimised surgery, chemotherapy and intensity modulated radiotherapy, the main role of pre- and posttherapeutic imaging remains cancer detection at an early stage and accurate follow-up. The combined effort of early diagnosis and close patient monitoring after surgery and/or radio-chemotherapy influences disease progression and outcome prediction in patients with HNSCC.

This review article focuses on currrent oncologic concepts and emerging tools in imaging of head and neck squamous cell cancer. Besides the diagnostic spectrum of the individual imaging modalities, their limitations are also discussed. One main part of this article is dedicated to PET-CT which combines functional and morphological imaging. Furthermore latest developments in MRT are presented with regard to lymph node staging and response prediction. Last but not least, a clinical contribution in this review explains, which information the head and neck surgeon requires from the multimodality imaging and its impact on operation planning.

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