Perkutane strahlentherapie zur schmerzlinderung. Update - Knochenmetastasen

Background. Bone metastases are the most common cause of cancer pain. Objective. The use of radiation therapy for pain control in bone metastases is described. Methods. Review of literature and PubMed and analysis of own patients. Results. Pain in patients with bone metastases can be effectively and safely treated with radiotherapy. The partial response rates range between 50 and 90%, while 19-50% of patients show total response (alleviation of pain without further medication). Meta-analyses have shown that a single fraction of 8 Gy results in similar pain relief as fractionated regimes (5 fractions of 4 Gy, 10 fractions of 3 Gy, or 20 fractions of 2 Gy). Pain relapse occurs more often after single-fraction than after multifraction radiation (20% vs. 7%). However, re-irradiation following one fraction of 8 Gy is also effective and safe. In contrast to former studies, in the most recent meta-analysis the proportion of patients with pathological fractures after single fraction irradiation was similar to those patients treated with fractionated regimes. Thus, one fraction of 8 Gy can be considered the standard schedule for uncomplicated bone metastases without (impending) fractures, without a larger soft tissue mass, and - in case of vertebral metastases - without (impending) spinal cord compression. Patients with relatively good performance status and a survival prognosis of at least 3 months should receive fractionated radiotherapy. Because of possible temporary increase in pain 3-5 days after the first radiation session (pain flare), patients need adequate pain management before starting radiotherapy. In addition, a pain flare can be prevented by prophylactic administration of corticosteroids. Conclusion. Because of the different options for alleviating pain in patients with bone metastases, the optimal regime for radiotherapy should be determined individually in an interdisciplinary context and together with the patient (shared decision making).