Knochenmetastasierung - Die Zielsetzung bestimmt die Therapie

Zusammenfassung

Die Behandlung einer Skelettmetastasierung erfordert ein interdisziplinär abgestimmtes Konzept. Abhängig von den jeweils vorliegenden Symptomen und Funktionsstörungen sind die Therapieziele individuell zu definieren und die einzusetzenden Therapiemodalitäten angemessen auszuwählen. Lokale operative Therapien orientieren sich primär an der Wiederherstellung oder der Sicherung der Funktion und Mobilität. Perkutane Radiotherapien zielen dagegen auf die lokale Schmerzlinderung, einen Stabilitätserhalt und eine örtliche Tumorzellvernichtung. Weitere Behandlungsoptionen sind systemische kausale antineoplastische und antiosteoklastische Therapien sowie eine Behandlung mit osteotropen Radionukliden, die dazu beitragen, eine möglichst hohe Lebensqualität und Symptomfreiheit zu erhalten oder zu erreichen. Bei der Auswahl der Therapiemodalitäten und -belastungen ist die maßgeblich durch den Primärtumor und den Allgemeinzustand bestimmte Prognose des Patienten im Hinblick auf seine mutmaßliche Überlebenszeit zu berücksichtigen.

Summary

The treatment of skeletal metastases requires an interdisciplinary concept. Depending on the respective symptoms and functional disorders presenting, the aims of treatment must be individually defined, and appropriate therapeutic modalities selected accordingly. Local operative options are oriented primarily to the restoration or securement of function and mobility. In contrast, percutaneous radiotherapy aims at achieving local amelioration of pain, preserving stability and destroying local tumour cells. Further therapeutic options are systemic, causal, antineoplastic and anti-osteoclastic measures, as well as treatment with osteotropic radionuclides, all of which help to preserve or achieve a maximum quality of life and freedom from symptoms. When considering therapeutic modalities and their associated stresses, the prognosis of the patient as determined largely by the primary tumour and the patient's general state of health must be borne in mind with regard to the presumed time left to him.

Key Words

bone metastases - solitary - multiple - surgery - radiotherapy - parameters for decision-taking - systemic anti-osteoclastic treatment

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