Urologische Onkologie: Radiologische Diagnostik Und Strahlentherapie
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Die interdisziplinare Zusammenarbeit ist eine Grundforderung flir die fortschrittliche Behandlung maligner Tumoren. Die urologische und radiologische Kooperation hat in den letzten Jahren flir die Therapie des malignen Urogenitaltumors neue Impulse gesetzt. Aus dieser Erkenntnis und der Entwicklung neuer diagnostischer und therapeutischer Verfahren unter Berlicksichtigung zytosta- tischer Behandlungsformen sind diagnostische und therapeutische Konzepte zu liberprlifen. Die Klassifikation fast ailer Tumoren des Urogenital systems durch das TNM-System (UICC) hat verbindliche Vorschlage flir die Indikation der unterschiedlichen Techniken zur Bestimmung der T-, N- und M-Kategorie zur Foige. Diagnostik und Therapie (mit Ausnahme des weiblichen Genitaies) orientieren sich in gieicher Weise an dem neuen Gerlist. Die ersten Ergebnisse der im Anhang aufgeflihrten Register undVerbundstudien sind dabei berlicksichtigt. Die Computertomographie, immer mehr in den Blickpunkt diagno- stischer und therapeutischer Uberlegungen gestellt, wird hin- sichtlich des Einsatzes eine kritische Wertung erfahren mlissen. Sie ist zumindest eine entscheidende Hilfe der physikalisch-tech- nischen Bestrahlungsplanung. Die Grundzlige der systematischen Diagnostik und Therapie sind tabellarisch erfaBt. Die systemische Strahlentherapie (Tumor und LymphabfluBgebiete) ist in den Vordergrund gestellt, syste- matisierte, am TNM-System orientierte Behandlungsvorschlage sind deshalb besonders wertvoll, weil neben der Behandlungsplanung mit kurativer oder pailiativer Zielsetzung neue therapeutische Vorsteliungen, wie z.B. die integrierte Strahlentherapie von Blasenkarzinomen, in ein optimales Therapiekonzept einflieBen mlissen. Derartige Konzepte beziehen von Anfang an radiologische und operative Ma nahmen gleichrangig in die Behandlungsplanung ein. Die zytostatische Behandlung oder die Kombination von Strah- lentherapie und Chemotherapie mlissen berlicksichtigt werden. Praktisch bedeutungsvoll sind die strahlentherapeutischen Nebenwirkungen und ihre Behandlung. Die Nachsorge wird besonders berlicksichtigt.
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