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Bedeutung der Radioonkologie beim Plasmozytom oder multiplen Myelom

Benefit of radiotherapy in patients with plasmacytoma and multiple myeloma

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Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Die Therapie des Plasmozytoms und multiplen Myeloms setzt eine enge Zusammenarbeit unterschiedlicher medizinischer Disziplinen voraus. Dieser Artikel befasst sich mit dem Stellenwert der Radiotherapie beim multiplen Myelom und Plasmozytom.

Ziel

Es soll ein Überblick über lokale radioonkologische Therapien beim Plasmozytom und multiplen Myelom gegeben werden.

Material und Methoden

Es erfolgte eine systematische Literaturrecherche und Zusammenfassung der aktuellen Datenlage zum Thema.

Ergebnisse

Eine kurativ dosierte Radiotherapie ± Operation stellt die Primärtherapie des Plasmozytoms dar. Dosiskonzepte variieren je nach Risikofaktoren (v. a. Größe) und Art des Befalls (extramedullär vs. medullär). Trotz hoher lokaler Kontrollraten persistiert ein relevantes Risiko für den Übergang in ein multiples Myelom. Bei Vorliegen eines multiplen Myeloms findet die Radiotherapie v. a. im Rahmen der Palliation ihr Anwendungsgebiet. Insbesondere bei stabilitätsgefährdeten oder schmerzhaften Osteolysen sowie bei Myelonkompression kann mittels lokaler Radiotherapie ein gutes Ergebnis bei geringer Toxizität erreicht werden. Auch hier sollte die Dosierung und Fraktionierung solch einer Radiotherapie insbesondere vom primären Therapieziel und Allgemeinzustand des Patienten abhängig gemacht werden.

Schlussfolgerung

Trotz primär systemtherapeutischer Therapieansätze benötigen ca. 40 % aller Patienten mit multiplem Myelom eine Radiotherapie im Krankheitsverlauf, welche dann meist mit palliativen Therapiezielen gute Ergebnisse erreichen kann. Beim Plasmozytom hingegen stellt die Radiotherapie die primäre und kurativ-intendierte Therapieoption dar.

Abstract

Background

Treatment options for patients with plasmacytoma or multiple myeloma should be discussed in an interdisciplinary context. This systematic review focusses on the importance of radiotherapy in multiple myeloma and plasmacytoma.

Objective

Summary of local radio-oncological treatment options for patients with plasmacytoma and multiple myeloma.

Material and methods

A systematic literature search and analysis was performed to summarize the current evidence on the topic.

Results

Patients with plasmacytoma should be primarily treated with curatively dosed radiotherapy with or without surgery. Irradiation concepts may vary depending on risk factors and manifestation (solitary bone plasmacytoma vs. solitary extramedullary plasmacytoma). Although local control rates are high after radiotherapy, progression to multiple myeloma frequently occurs. In patients with multiple myeloma radiation is mainly used in palliative settings for pain relief, prevention of fractures or in patients who suffer from neurological symptoms due to spinal cord compression. Irradiation dose and fractionation should be selected based on treatment indications and the general condition of the patient.

Conclusion

Although most patients receive systemic treatment at initial diagnosis, approximately 40% of patients with multiple myeloma will require radiation during the course of disease. While radiation is mainly used for palliative reasons in patients with multiple myeloma, it represents the primary and curative treatment option in patients with plasmacytoma.

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Authors and Affiliations

  1. Abteilung RadioOnkologie und Strahlentherapie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland

    Laila König & Klaus Herfarth

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  1. Laila König
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  2. Klaus Herfarth
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Correspondence to Laila König.

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Interessenkonflikt

L. König und K. Herfarth geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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König, L., Herfarth, K. Bedeutung der Radioonkologie beim Plasmozytom oder multiplen Myelom. Onkologe 24, 596–603 (2018). https://doi.org/10.1007/s00761-018-0361-8

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  • DOI: https://doi.org/10.1007/s00761-018-0361-8

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