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Osteologie 2014; 23(04): 275-280
DOI: 10.1055/s-0037-1622025
Osteoonkologie
Schattauer GmbH

Strahlentherapie von Skelettmetastasen

Standardverfahren und zukünftige TherapieansätzeRadiotherapy for skeletal metastasesStandard of therapy and prospective therapeutical approach
B. Gauter-Fleckenstein
1   Klinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Mannheim, Universität Heidelberg, Mannheim
,
T. Reis
1   Klinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Mannheim, Universität Heidelberg, Mannheim
,
F. Wenz
1   Klinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Mannheim, Universität Heidelberg, Mannheim
› Author Affiliations
Further Information

Publication History

eingereicht: 01 July 2014

angenommen: 06 October 2014

Publication Date:
02 January 2018 (online)

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Zusammenfassung

Die Strahlentherapie der Knochenmetastasen ermöglicht eine suffiziente Analgesie bei den meisten behandelten Patienten, wobei diese in bis zu 50 % aller Fälle noch nach einem Jahr anhält. Im Verlauf von Wochen kommt es nach erfolgter Strahlentherapie auch zur Rekalzifizierung, so dass auch eine Stabilisierung osteolytischer Metastasen möglich ist. Die Therapie kann sowohl von einem bis wenige Tage als auch über mehrere Wochen dauern, wobei hierbei gleichwertig Analgesie, bei den protrahierten Regimen aber vermehrt Stabilität erreicht wird. Durch moderne Techniken, wie zum Beispiel externe stereotaktische intensitätsmodulierte Strahlentherapie oder aber auch durch kombinierte operative Verfahren wie Kyphoplastie mit intraoperativer Radiatio mit 50 kV-Photonen lassen sich auch Bestrahlungen komplizierter Volumina in der Nähe von Risikoorganen realisieren. Daher werden damit auch kurzfristige ReBestrahlungen möglich. Wenn indiziert, sollten immer eine antiresorptive Therapie und eine Hormontherapie (bei Mammaund Prostatakarzinom) durchgeführt werden. Falls eine operative Stabilisierung oder Tumordebulking (bei Rückenmarkkompression) notwendig wird, sollte im Anschluss die Radiotherapie zur Tumorzellsterilisation erfolgen.

Summary

Radiotherapy of bone metastases causes analgesia within two weeks in almost every treated patient, while after one year 50 % of all treated patients are still free of pain at the treated site. Stability in osteolytic lesions results from recalcification that can be detected several weeks after cessation of radiotherapy. Different fractionation regimens exist from days to several weeks. These regimens do not differ in their analgesic potency but more protracted radiotherapy results in a higher rate of stability and less re-irradiation. Modern radiotherapy modalities, i. e. stereotactic IMRT or the combination of kyphoplasty and intraoperative radiotherapy with 50 kV photons (Kypho-IORT) allow radiotherapy of complicated fields in vicinity of organs at risk. Therefore, repeated radiotherapy becomes an option even after short intervals. Antiresorptive agents or anti-hormone therapy (in breast- or prostate cancer) should be incorporated whenever indicated. Post-operative radiotherapy with the goal of tumour-cell sterilisation should always be implemented after surgical stabilisation or tumour debulking/ laminectomy in case of myelocompression.

Schlüsselwörter

Knochenmetastasen - Strahlentherapie - Kypho-IORT - SBRT - erneute Bestrahlung

Keywords

Bone metastases - external beam radiotherapy - Kypho-IORT - SBRT - repeated radiotherapy
 

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