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Strahlentherapie beim Myelom

Radiotherapy for myeloma

  • Leitthema: Myelom
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Durch eine alleinige Strahlenbehandlung kann die Mehrzahl der Patienten mit einem solitären Plasmozytom geheilt werden wobei deutliche Unterschiede zugunsten der extramedullären Manifestationsform auffallen. Beim Patienten mit multiplem Myelom ist die Strahlenbehandlung ein wesentlicher Bestandteil der Palliativtherapie. Die Indikation zur palliativen Radiotherapie stellt sich bei schmerzhaften oder frakturgefährdeten Osteolysen, radikulären Symptomen sowie bei Kompression des Myelons durch Wirbelkörperfrakturen oder Tumorinfiltration. Die Ganzkörperbestrahlung als Teil der Konditionierungsbehandlung vor Transplantation von Knochenmark oder Blutstammzellen ist in ihrer Wertigkeit heute umstritten. Spezifisch für die Situation des multiplen Myeloms wurden Behandlungsrichtlinien im Sinne einer totalen Knochenmarkbestrahlung, d. h. Ganzkörperbestrahlung (GKB) mit Abschirmung von Lungen und Leber anstelle der sonst üblichen GKB in die klinische Behandlungsroutine eingeführt.

Abstract

Tumoricidal radiation is the treatment of choice for a solitary plasmacytoma and the local response rate exceeds 80–90%. Progression to multiple myeloma (MM) is much less common in extramedullary plasmacytoma than in solitary plasmacytoma of the bone. MM is characterized by the neoplastic proliferation of immunoglobulin-producing plasma cells, often resulting in extensive skeletal destruction with focal lytic lesions. Radiotherapy is especially useful to palliate bone pain, fractures, radiculopathy, and spinal cord compression. High-dose chemotherapy has become a common treatment of MM. The role of total body irradiation (TBI) in the conditioning regimens before transplantation remains controversial. To overcome TBI-related toxicity, total marrow irradiation (TMI) with lung and liver shielding was developed representing a specific therapeutic approach for multiple myeloma instead of the standard TBI procedures.

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Authors and Affiliations

  1. Radioonkologie, Universitätsspital Basel

    L. Plasswilm

  2. Radioonkologie, Universitätsklinik Tübingen

    C. Belka

  3. Radioonkologie, Universitätsspital, Petersgraben 4, 4031 , Basel

    L. Plasswilm

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  1. L. Plasswilm
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  2. C. Belka
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Correspondence to L. Plasswilm.

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Plasswilm, L., Belka, C. Strahlentherapie beim Myelom. Onkologe 10, 858–863 (2004). https://doi.org/10.1007/s00761-004-0749-5

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  • DOI: https://doi.org/10.1007/s00761-004-0749-5

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