Bestrahlung von Knochenmetastasen
| Complete response | A pain score of 0 at treated site with no concomitant increase in analgesic intake (stable or reducing analgesics in daily oral morphine equivalent [OMED]) |
| Partial response | Pain reduction of 2 or more at the treated site on a scale of 0 to 10 scale without analgesic increase, or Analgesic reduction of 25% or more from baseline without an increase in pain. |
| Pain progression | Increase in pain score of 2 or more above baseline at the treated site with stable OMED, or An increase of 25% or more in OMED compared with baseline with the pain score stable or 1 point above baseline |
| Indeterminate response | Any response that is not captured by the complete response, partial response, or pain progression definitions |
| Recursive Partitionierungs - Analyse (RPA)(8) | medianes OS | |||
| Intervall zur Primärtherapie | >30 Monate | KPS > 70 | Gruppe 1 | 21,1 Monate |
| KPS bis 70 | Gruppe 2 | 8,7 Monate | ||
| bis 30 Monate | bis 70a | |||
| über 70a | Gruppe 3 | 2,4 Monate | ||
Knöcherner Wirbel + 7 oder 8 mm = PTV
Nierenschonung: Querfortsätze nicht mit konturieren. PTV = CTV + 8 mm - Nieren
| Indikationen | Toleranzdosis von Risikoorganen mit konventionellen Techniken überschritten. | Myelon Hirnstamm Ösophagus Dünndarm Nieren | |
| Re-Bestrahlung | Überschreitung der tolerierten Dosissumme zum Beispiel am Myelon | Eine Planungsstudie wurde publiziert (9). | |
| simultane Radio-Chemotherapie | Die erhöhte Toxizität erfordert maximale Schonung der Risikoorgane. | Bestrahlungen der BWS mit konventionellen Methoden belasten das Myokard. | In Kombination mit Anthrazyklinen besteht das Risiko einer Kardiomyopathie. |
Teil von
Palliative radiotherapy trials for bone metastases: A systematic review.
J Clin Oncol 25(2007):1423–1436
2.) Cole DJ.:
A randomized trial of a single treatment versus conventional fractionation in the palliative radiotherapy of painful bone metastases.
Clin Oncol (R Coll Radiol) 1(1989):59–62
3.) Gaze MN, Kelly CG, Kerr GR, et al.:
Pain relief and quality of life following radiotherapy for bone metastases: A randomised trial of two fractionation schedules.
Radiother Oncol 45(1997):109–116
4.) Nielsen OS, Bentzen SM, Sandberg E, et al.:
Randomized trial of single dose versus fractionated palliative radiotherapy of bone metastases.
Radiother Oncol 47(1998):233–240
5.) Roos DE, Turner SL, O’Brien PC, et al.:
Randomized trial of 8 Gy in 1 versus 20 Gy in 5 fractions of radiotherapy for neuropathic pain due to bone metastases (Trans-Tasman Radiation Oncology Group, TROG 96.05).
Radiother Oncol 75(2005):54–63
6.) Sze WM, Shelley MD, Held I, et al.:
Palliation of metastatic bone pain: Single fraction versus multifraction radiotherapy—a systematic review of randomised trials.
Clin Oncol(R Coll Radiol) 15(2003):345–352
7.) Wu JS, Wong R, Johnston M, et al.:
Meta-analysis of dosefractionation radiotherapy trials for the palliation of painful bone metastases.
Int J Radiat Oncol Biol Phys 55(2003):594–605
8.) Chao T et al.:
Recursive partitioning analysis index is predictive for overall survival in patients undergoing spine stereotactic body radiation therapy for spinal metastases.
Int. J. Radiation Oncology Biol Phys 82(2012):1738–1743
9.) Dobler B, Khemissi A, Obermeier T, Hautmann MG, Katsilieri Z, Kölbl O:
Re-irradiating spinal column metastases using IMRT and VMAT with and without flattening filter - a treatment planning study.
Radiat Oncol. 2016;11(1):1280
10.) Inoue T, Oh R-J, Shiomi H:
New approach for treatment of vertebral metastases using intensity-modulated radiotherapy.
Strahlenther Onkol 2011;187(2):108–13.
11.) Rich SE, Chow R, Raman S, et al.:
Update of the systematic review of palliative radiation therapy fractionation for bone metastases.
Radiother Oncol 2018; 126: 547-557
12.) Pin Y, Paix A, Le Fèvre C, et al.:
A systematic review of palliative bone radiotherapy based on pain relief and retreatment rates.
Crit Rev Oncol Hematol. 2018; 123: 132-137
13.) Bedard G, Hoskin P, Chow E:
Overall response rates to radiation therapy for patients with painful uncomplicated bone metastases undergoing initial treatment and retreatment.
Radiother Oncol. 2014; 112: 125-127
14.) Howell DD, James JL, Hartsell WF et al.:
Single-fraction radiotherapy versus multifraction radiotherapy for palliation of painful vertebral bone metastases—Equivalent efficacy, less toxicity, more convenient: A subset analysis of Radiation Therapy Oncology Group trial 97-14.
Cancer 2013; 119: 888-896
15.) Chow E, van der Linden YM, Roos D, et al.:
Single versus multiple fractions of repeat radiation for painful bone metastases: A randomised, controlled, non-inferiority trial.
Lancet Oncol. 2014; 15: 164-171
16.) Pielkenrood BJ, Gal R, Kasperts N et al.:
Quality of Life After Stereotactic Body Radiation Therapy Versus Conventional Radiation Therapy in Patients With Bone Metastases.
Int J Radiat Oncol Biol Phys 2022;112 (5):1203–1215
