Maligne Tumoren des Bewegungsapparates im Kindesund Jugendalter

Zusammenfassung

Primär maligne Tumoren des Skelettsystems stellen im Kindes- und Jugendalter eine Seltenheit dar. Gerade deswegen ist es wichtig, die Diagnose frühzeitig zu stellen, um eine adäquate Therapie einzuleiten. Die häufigsten Vertreter sind das Osteosarkom, seltener das Ewing-Sarkom und das Adamantinom. Das Chondrosarkom ist im Jugendalter auch unter den Tumoren eine Rarität.

Die Einführung der neoadjuvanten Chemotherapie hat in der Behandlung des Osteosarkoms und des Ewing-Sarkoms zu einer deutli-chen Verbesserung der Überlebenswahrscheinlichkeit geführt. Zudem kann durch neue Therapieprotokolle oftmals eine Extremitäten-erhaltende Operation durchgeführt werden.

Im Rahmen der Tumoroperation ist oftmals eine Resektion angrenzender Gelenke und großer Muskelgruppen erforderlich, sodass post-operativ mit einem funktionellen Defizit gerechnet werden muss. Zur Versorgung der Defekte dienen spezielle Tumorprothesen mit Gelenkersatz. Eine Defektüberbrückung kann allerdings auch über vaskularisierte autologe Transplantate wie etwa ein Fibulatransplantat erfolgen. Eine weitere Möglichkeit mit einer anschließenden, funktionell guten exoprothetischen Versorgungsmöglichkeit bietet die Rotationsplastik.

Dieser Artikel soll eine Übersicht über die genannten Tumoren sowie deren Diagnostik und Therapie geben.

Summary

Malignant tumours of the musculoskeletal system in childhood and adolescence are rare. It is important to diagnose the disease in early stadium in order to induce a sufficient therapy. The most common tumour is osteosarcoma followed by Ewing’s sarcoma and adamantinoma. Chondrosarcoma in adolescence or childhood can be seen as a rarity.

The implementation of neoadjuvant chemo-therapy had an immense impact on prognosis of osteosarcoma and Ewing’s sarcoma. These new regimes allow limb-sparing procedures instead of an amputation.

Nevertheless, limb-sparing procedures are often followed by functional deficits since joints, long distances of bone and large groups of muscles need to be resected. To replace those defects several tumour prothesis are used. Further surgical procedures to bypass defects include autologous transplants such as an autologous vascularised fibular transplant, allografts, or a rotationplasty. The following article shall overview the above mentioned tumours.

Schlüsselwörter:

Knochentumor - Osteosarkom - Ewing Sarkom

Keywords

Bone tumour - osteosarcoma - Ewing’s sarcoma

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