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Strahlentherapie nichtresektabler Knochentumoren

Radiotherapy for unresectable bone sarcomas

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Die Onkologie Aims and scope

Zusammenfassung

Hintergrund

Osteosarkome werden multimodal behandelt. Bei nichtresektablen Osteosarkomen, insbesondere zentraler Tumorlokalisation, ist eine Radiotherapie des Primärtumors erforderlich. Die multimodale Therapie des Ewing-Sarkoms beinhaltet neben Polychemotherapie auch chirurgische und/oder strahlentherapeutische Lokaltherapie. Bei Irresektabilität stellt die definitive Strahlentherapie des Primärtumors die Therapie der Wahl dar.

Fragestellung

Ergebnisse einer definitiven Radiotherapie nichtresektabler Ewing-Sarkome und Osteosarkome werden erörtert.

Material und Methode

Es erfolgte eine Analyse der Literatur.

Ergebnisse

Bei nichtresektablen Osteosarkomen, insbesondere zentraler Tumorlokalisation am Körperstamm, ist eine primäre Strahlentherapie zusammen mit einer neoadjuvanten und Erhaltungschemotherapie Therapie der Wahl. Bei Einsatz moderner Bestrahlungstechniken und hoher Strahlendosen wurden lokale Kontrollraten von 60–70 % nach 5 Jahren beschrieben. Bei nichtresektablen Ewing-Sarkomen sollte nach einer Induktionschemotherapie die lokale Strahlentherapie des Primärtumors erfolgen. Dabei sollte das Bestrahlungsvolumen die initiale, prätherapeutische Tumorausdehnung berücksichtigen. Es werden Bestrahlungsdosen von 54–59,4 Gy empfohlen. Auf mögliche Interaktionen mit verwendeten Chemotherapeutika ist zu achten. Zusätzlich sollte bei einer pulmonalen Metastasierung eine Ganzlungenbestrahlung (15–18 Gy) durchgeführt werden.

Schlussfolgerungen

Eine definitive Radiotherapie von nichtresektablen Osteosarkomen soll mit modernen Bestrahlungstechniken, auch mit einer Partikeltherapie, unter Verwendung von hohen Strahlendosen über 70 Gy erfolgen. Die definitive Strahlentherapie stellt eine alternative Lokaltherapie nach Induktionschemotherapie bei Patienten mit inoperablen Ewing-Sarkomen dar.

Abstract

Background

Multimodal therapy is used to treat osteosarcoma. For unresectable osteosarcoma, definitive radiotherapy is necessary. Multimodal therapy for Ewing sarcoma includes multiagent chemotherapy and local treatment (surgery and/or radiotherapy). For unresectable tumors, radiotherapy of the primary tumor is used in the definitive management.

Objectives

Results of primary radiotherapy for unresectable Ewing sarcoma and osteosarcoma are discussed.

Materials and methods

An analysis of the literature was performed.

Results

For unresectable osteosarcoma, especially centrally located tumors, definitive radiotherapy in combination with neoadjuvant and maintenance chemotherapy is the treatment of choice. Using modern treatment techniques and high radiation doses, 5‑year local control rates of 60–70% have been reported. For unresectable Ewing sarcoma, definitive radiotherapy should be administered after neoadjuvant chemotherapy of the primary tumor. The irradiation volume must consider the initial, pretherapeutic extent of the tumor. Radiation doses of 54–59.4 Gy are recommended. Potential interactions with the administered chemotherapeutic agents must be taken into account. In addition, whole lung irradiation (15–18 Gy) is indicated in patients with pulmonary metastases.

Conclusions

For definitive radiotherapy of unresectable osteosarcoma, modern treatment techniques, including particle therapy, should be standard. High radiation doses over 70 Gy have to be delivered. For Ewing sarcomas, definitive radiotherapy is an alternative local treatment option after neoadjuvant chemotherapy.

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Correspondence to Stephanie E. Combs.

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S.E. Combs, K. Sommer und R. Schwarz geben an, dass kein Interessenkonflikt besteht.

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Combs, S.E., Sommer, K. & Schwarz, R. Strahlentherapie nichtresektabler Knochentumoren. Onkologie 28, 572–577 (2022). https://doi.org/10.1007/s00761-022-01136-5

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