Perkutane Radiotherapie zur Schmerzlinderung bei ossären Metastasen

Background: Bone metastases are the most common cause of pain in oncologic patients. Objective: This article aims to describe the use of external-beam radiotherapy for pain control in patients with bone metastases. Materials and methods: The relevant literature in PubMed was reviewed. Results: Pain in patients with bone metastases can be effectively and safely treated by modern radiotherapy. Partial response rates range between 50 and 90%, while 10 to 50% of patients achieve total response. For analgesic effects single, hypo-, and normofractionated concepts are described. Current meta-analyses show that a single fraction of 8 Gy results in similar pain relief as fractionated regimes. Better remineralization is achieved 3–6 months after conventional fractionated radiotherapy with 2–3 Gy than after single-fraction radiation; furthermore, less pain relapses occur, thus re-irradiation is required less frequently after multifraction radiation. A single fraction of 8 Gy is recommended as the standard of care for uncomplicated symptomatic bone metastases without fractures or spinal cord compression worldwide. Patients with a good performance status and a survival prognosis of at least 3 months should receive normofractionated radiotherapy. Since a temporary increase in pain can occur several days after the first fraction (“pain flare”), patients require adequate pain management before starting radiotherapy and, potentially, antiedematous prophylaxis. Conclusion: Since different radiotherapeutic options for alleviating pain in patients with bone metastases exist, the optimal regimen for radiotherapy should be determined in an interdisciplinary approach together with the patient (“shared decision making”).