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.

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

Literatur

• 1 Anderson PM, Wiseman GA, Dispenzieri A. et al. . High-dose samarium-153 ethylene diamine tetramethylene phosphonate: low toxicity of skeletal irradiation in patients with osteosarcoma and bone metastases.  J Clin Oncol. 2002;  20 189-196
• 2 Bates T. A review of local radiotherapy in the treatment of bone metastases and cord compression.  Int J Radiat Oncol Biol Phys. 1992;  23 217-221
• 3 Bates T, Yarnold JR, Blitzer P. et al. . Bone metastasis consensus statement.  Int J Radiat Oncol Biol Phys. 1992;  23 215-216
• 4 Bonadonna G, Rossi A. et al. . Cancer.  1977;  39 2904-2915
• 5 Chow E, Wu JS, Hoskin P. et al. . International consensus on palliative radiotherapy endpoints for future clinical trials in bone metastases.  Radiother Oncol. 2002;  64 275-280
• 6 Fuster D, Herranz D, Vidal-Sicart S. et al. . Usefulness of strontium-89 for bone pain palliation in metastatic breast cancer patients.  Nucl Med Commun. 2000;  21 623-626
• 7 Haddad P, Wong R. et al. . Int J Radiat Oncol Biol Phys. 2003;  57 S278
• 8 Han SH, Zonneberg BA, de JM Klerk. et al. . 186Re-etidronate in breast cancer patients with metastatic bone pain.  J Nucl Med. 1999;  40 639-42
• 9 Hartsell WF, Scott C. et al. . Int J Radiat Oncol Biol Phys. 2003;  57 S124
• 10 Hipp JA, Springfield DS, Hayes WC. et al. . Predicting pathologic fracture risk in the management of metastatic bone defects.  Clin Orthop. 1995;  312 120-135
• 11 Hoskin PJ, Yarnold JR, Roos DR. et al. . Radiotherapy for bone metastases.  Clin Oncol (R Coll Radiol). 2001;  13 88-90
• 12 Kasalicky J, Krajska V. The effect of repeated strontium-89 chloride therapy on bone pain palliation in patients with skeletal cancer metastases.  Eur J Nucl Med. 1998;  25 1362-1367
• 13 Kolesnikov-Gauthier H, Carpentier P, Depreux P. et al. . Evaluation of toxicity and efficacy of 186Re-hydroxyethylidene diphosphonate in patients with painful bone metastases of prostate or breast cancer.  J Nucl Med. 2000;  41 1689-1694
• 14 McQuay HJ, Collins SL, Carroll D, Moore RA. Radiotherapy for the palliation of painful bone metastases.  Cochrane Database Syst Rev. 2000;  2
• 15 Mertens WC, Filipczak LA, Ben-Josef E. et al. . Systemic bone-seeking radionuclides for palliation of painful osseous metastases: current concepts.  CA Cancer J Clin. 1998;  48 361-374
• 16 Mirels H. Metastatic disease in long bones.  A proposed scoring system for diagnosing impending pathologic fractures.  Clin Orthop. 1989;  249 256-264
• 17 Mirels H. Metastatic disease in long bones: A proposed scoring system for diagnosing impending pathologic fractures. 1989.  2003;  415 4-13
• 18 Patel B, DeGroot H 3rd.. Evaluation of the risk of pathologic fractures secondary to metastatic bone disease.  Orthopedics. 2001;  24 612-617
• 19 Roodman GD. Mechanisms of bone metastasis.  N Engl J Med. 2004;  350 1655-1664
• 20 Roos DE, O'Brien PC, Smith JG. et al. . A role for radiotherapy in neuropathic bone pain: preliminary response rates from a prospective trial (Transtasman Radiation Oncology Group, TROG 96.05).  Int J Radiat Oncol Biol Phys. 2000;  46 975-981
• 21 Salazar OM, Sandhu T, da Motta NW. et al. . Fractionated half-body irradiation (HBI) for the rapid palliation of widespread, symptomatic, metastatic bone disease: a randomized Phase III trial of the International Atomic Energy Agency (IAEA).  Int J Radiat Oncol Biol Phys. 2001;  50 765-775
• 22 Sciuto R, Festa A, Pasqualoni R. et al. . Metastatic bone pain palliation with 89-Sr and 186-Re-HEDP in breast cancer patients.  Breast Cancer Res Treat. 2001;  66 101-119
• 23 Serafini AN. Systemic metabolic radiotherapy with samarium-153 EDTMP for the treatment of painful bone metastasis.  Q J Nucl Med. 2001;  45 91-99
• 24 Steenland E, Leer J, van Houwelingen H. et al. . The effect of a single fraction compared to multiple fractions on painful bone metastases: a global analysis of the Dutch Bone Metastasis Study.  Radiother Oncol. 1999;  52 101-109
• 25 Thompson Jr. RC. Impending fracture associated with bone destruction.  Orthopedics. 1992;  15 547-550
• 26 Yarbro JW, Page DL, Fielding LP. et al. . American Joint Committee on Cancer prognostic factors consensus conference.  Cancer. 1999;  86 2436-2446
• 27 Van der Linden Y, Lok J. et al. . Int J Radiat Oncol Biol Phys.  2003;  57 S222

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