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Prognoseadaptierte operative Behandlung von Knochenmetastasen

Prognosis-adapted surgical management of bone metastases

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Zusammenfassung

Die operative Therapie von Skelettmetastasen ist die häufigste onkologische Operation in der Chirurgie des Bewegungsapparates. Die Lebensqualität dieser Patienten mit oft kurzer Überlebenszeit kann durch Eingriffe am Bewegungsapparat erheblich verbessert werden. Andererseits können falsch-palliativ verstandene Ansätze Prognose und Lebensqualität auch deutlich verschlechtern. Um valide Kriterien zur prognoseadaptierten Therapie zu evaluieren, wurden 513 Eingriffe bei 453 eigenen Patienten, die zwischen 1980 und 2005 operativ versorgt worden waren, retrospektiv ausgewertet. Zudem erfolgte eine kritische Durchsicht der Literatur.

Der entscheidende Prognosefaktor ist die Histologie des Primärtumors. Eine Biopsie zur Diagnosesicherung ist deshalb bei unbekanntem Primärtumor insbesondere beim Solitärherd unverzichtbar. Prognostisch ungünstig ist das Bronchialkarzinom, günstig das Nierenzell- und Mammakarzinom. Ein radikal resezierendes Vorgehen bei isolierten Metastasen des Nierenzellkarzinoms reduziert nicht nur das Risiko eines Lokalrezidivs – in diesem Fall kann auch ein kurativer Therapieansatz möglich sein. Beim Mammakarzinom ist der ossäre und viszerale Disseminationsgrad entscheidend für die Prognose. Zur Qualitätssicherung der verbleibenden Lebenszeit ist ein interdisziplinärer Therapieansatz unerlässlich.

Abstract

Surgery in metastatic disease to the bone is the most common procedure in orthopaedic oncology. To assess an adequate therapeutic approach we analysed 513 surgeries performed on 453 patients between 1980 and 2005 and reviewed the literature.

The most significant factor is the histology of the primary tumour. A biopsy is mandatory to confirm the diagnosis in an unknown primary tumour, especially in cases of solitary lesions. Pulmonary carcinoma has an unfavourable prognosis compared to breast and renal cell carcinoma patients. Radical resection in isolated metastatic disease in renal cell carcinoma reduces the risk of local recurrence and even may result in a long progression-free survival. In breast cancer osseous and visceral dissemination is the most decisive factor for prognosis. An interdisciplinary approach is mandatory in every patient.

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  1. Schwerpunkt Tumororthopädie, Orthopädische Klinik und Poliklinik, Ludwig-Maximilians-Universität, Klinikum Großhadern, Marchioninistraße 15, 81377, München, Deutschland

    S. Utzschneider, P. Weber, A. Fottner, B. Wegener, V. Jansson &  H.R. Dürr

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  1. S. Utzschneider
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  2. P. Weber
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  3. A. Fottner
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  4. B. Wegener
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  5. V. Jansson
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  6. H.R. Dürr
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Correspondence to H.R. Dürr.

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Utzschneider, S., Weber, P., Fottner, A. et al. Prognoseadaptierte operative Behandlung von Knochenmetastasen. Orthopäde 38, 308–315 (2009). https://doi.org/10.1007/s00132-008-1374-6

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