Externe Strahlentherapie zur Schmerzkontrolle: Am Beispiel von Knochenmetastasen

Bone metastases represent the most common cause of cancer pain. They can be effectively and safely treated with radiotherapy. Although results to date have shown that a single fraction of 1×8 Gy resulted in similar pain relief to fractionated regimens. More re-treatments were required after 1×8 Gy than after fractionated radiotherapy. However, re-irradiation following 1×8 Gy is effective and safe. Thus, 1×8 Gy is considered worldwide the standard schedule for uncomplicated painful bone metastases. If re-mineralization of the osteolytic bone is indicated, both a fractionated short-course (6×4 Gy) and long-course radiotherapy (10×3 Gy or 20×2 Gy) resulted in significantly better re-mineralization than single-fraction radiotherapy with 1×8 Gy. The available data regarding radiotherapy of metastatic spinal cord compression showed that single-fraction radiotherapy results in similar functional outcome when compared to fractionated short-course and long-course regimens. However, single-fraction radiotherapy is associated with a higher rate of in-field recurrences. Since re-mineralization and recurrences of metastatic spinal cord compression occur only several months following radiotherapy, patients with a relatively favorable survival prognosis should receive long-course radiotherapy.