Zusammenfassung
Ziel Diskutiert wird die nach derzeitigem Stand optimale Therapie der metastatisch bedingten Rückenmarkskompression (MBRK) unter Berücksichtigung der aktuellen Literatur. Methodik Es wird der Stellenwert der alleinigen Strahlentherapie (RT) sowie der Operation mit nachfolgender Bestrahlung unter Berücksichtigung der Überlebensprognose, des Primärtumors und der Ausdehnung der Metastasierung erörtert. Ferner werden die relevanten Prognosefaktoren hinsichtlich motorischer Funktion nach RT, lokaler Kontrolle und Gesamtüberleben beschrieben. Ergebnisse und Schlussfolgerungen Die alleinige RT ist die häufigste Therapie der MBRK. Eine zusätzliche Operation ist nur bei ausgewählten Patienten in gutem Allgemeinzustand und guter Überlebensprognose indiziert. Patienten mit strahlensensiblen Tumoren (Plasmozytome/Lymphome), insbesondere Patienten mit Oligometastasierung, sollten nach Möglichkeit nicht operiert werden. Die Langzeit-RT führt bei Patienten mit Plasmozytom, Mammakarzinom oder Prostatakarzinom zu besserer lokaler Kontrolle als die Kurzzeit-RT. Plasmozytompatienten sollten immer eine Langzeit-RT erhalten, da diese zu einer besseren motorischen Funktion führt als eine Kurzzeit-RT. Eine Kurzzeit-RT sollte bei Patienten mit anderen Primärtumoren als einem Plasmozytom/Lymphom und einer Lebenserwartung < 6 Monaten eingesetzt werden. Das Überleben kann mithilfe eines neu entwickelten Scores abgeschätzt werden.
Abstract
Background The optimal treatment of metastatic spinal cord compression (MSCC) is discussed considering the current literature. Material and methods The role of radiotherapy (RT) and of surgery followed by radiotherapy considering survival prognosis, primary tumor, and extension of metastatic disease is described. Relevant prognostic factors regarding motor function, local control, and overall survival are presented. Results and conclusions RT alone is the most common treatment of MSCC. Additional surgery is indicated only for selected patients with good performance status and favorable survival prognosis. Patients with radiosensitive tumors (myeloma/lymphoma), in particular those with oligometastatic disease, should generally not receive surgery. Long-course-RT results in better local control than short-course-RT in patients with myeloma, breast cancer, or prostate cancer. Myeloma patients should always receive long-course-RT, as it is associated with better functional outcome than short-course RT. Short-course-RT should be used in patients with primary tumors other than myeloma/lymphoma and expected survival < 6 months. Survival can be estimated with a recently developed score.
Schlüsselwörter
metastatisch bedingte Rückenmarkskompression - motorische Funktion - lokale Kontrolle - Gesamtüberleben
Key words
metastatic spinal cord compression - motor function - local control - survival
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PD Dr. med. Dirk Rades
Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
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