Wir überwinden Grenzen

Stereotactic radiotherapy is a relatively new technique of external radiotherapy in which, compared to conventional radiotherapy, a high dose of radiation is applied to the tumor tissue with high precision in just one or a few sessions. Due to the rigid anatomy of the head, the roots of stereotactic radiotherapy lie in the treatment of tumors in the brain. However, the immense advances in image-guided radiotherapy now also allow it to be used outside the brain in more mobile tissue, where the technique is also known as "stereotactic body radiotherapy" (SBRT). Germany is one of the international pioneers of SBRT.

The Department of Radiation Oncology at the Medical Center - University of Freiburg leads the research program "Imaging in Radiotherapy" within the Excellence Initiative at eight selected universities of the "German Consortium for Translational Cancer Research" (DKTK). The Freiburg clinic occupies a special position in this program, as it has conducted the highest number of studies on stereotaxy in the brain, lungs and abdomen in Germany:

• The HIPPORAD study (whole brain irradiation with hippocampus sparing and dose escalation to the metastases) focuses on the brain: Neurocognitive Investigation of Brain Imaging / prospective, randomized, multicenter phase II trial), the GLIAA trial (Amino Acid PET versus MRI planned RE radiation for recurrent glioma / prospective, randomized, multicenter phase II trial) and the Stereotactic Fractionated Radiotherapy to the Resection Cavity as Adjuvant Therapy for Resected Brain Metastases trial.
• In the lung, it is the STRIPE trial (Stereotactic fractionated radiotherapy in patients with internally inoperable small lung tumors. Prospective phase II study) and the LungTech study (Stereotactic body stem radiotherapy of inoperable central non-small cell lung carcinomas. Prospective, randomized, multicenter phase II study in preparation for a randomized phase III study).
• In the abdomen, it is the HERACLES study (Response of stereotactic radiotherapy in hepatocellular carcinoma. Prospective, randomized phase II study) and the POLAR-BEAR study (pancreatic cancer, oligometastatic, ablative radiotherapy)
• For lung and abdomen, it is the SIP study

In line with the outstanding expertise of the Department of Radiation Oncology at the Medical Center - University of Freiburg in the field of body radiotherapy, the Stereotaxy Working Group of the German Society of Radiation Oncology (DEGRO) met for the first time in Freiburg at the beginning of December 2015 for its annual meeting. Following meetings in Würzburg (2013) and Heidelberg (2014), more than 80 participants - primarily from Germany, Switzerland, Austria and Romania - traveled to Freiburg in 2015. Founded in 2000, the Stereotaxy Working Group sees itself as an organization that continues to promote this technique and is committed to ensuring that stereotaxy can be used across the board for recognized indications with the required quality. The fact that the working group's achievements are highly valued is demonstrated by the fact that it has produced the world's largest study series with up to 100 patients undergoing SBRT in the lungs and patients undergoing SBRT of liver metastases.

At the conference, Prof. Dr. Gabriele Niedermann, Head of the Radiobiology Section in the Department of Radiation Oncology at the Medical Center - University of Freiburg, gave a presentation on the combination of stereotaxy with immunotherapy. It has been proven that stereotaxy in combination with immunotherapy with so-called checkpoint inhibitors, which virtually release the immune brake, reactivates the immune system. Astonishing results show that in some patients who have metastases at several sites, irradiation of a selected lesion can ensure that the immune system can again recognize cell signals from the tumour as a threat at all sites and thus kill the tumour cells. This observation is also known as the abscopal effect. The tumor-killing effect also occurs at non-irradiated sites in the body. This effect is particularly - but not exclusively - known in black skin cancer. A clinical study on this is already being conducted at the Department of Radiation Oncology at the Medical Center - University of Freiburg. The fact that Prof. Niedermann is a proven specialist in this field is demonstrated by the two awards she received this year for her laboratory work: "Best of ESTRO" (European Society for Radiotherapy and Oncology) and "Best of ASTRO" (American Society for Radiotherapy and Oncology).

In keeping with Freiburg's role in stereotactic body radiotherapy, Prof. Dr. Ursula Nestle, Head Senior Physician at the Department of Radiation Oncology at the Medical Center - University of Freiburg, was unanimously elected Vice-Chair of the working group.