Paraspinale Tumore: Epidemiologie, Diagnostik und Therapie

Zusammenfassung

Paraspinale Tumore breiten sich entlang der Wirbelsäule in den umgebenden Geweben wie Knochen, Muskulatur, Bindegewebe und Bandscheiben aus. Sie betreffen dadurch mitunter die Halsweichteile, den intrathorakalen sowie retroperitonealen Raum. Eine Unterscheidung erfolgt anatomisch, nach Ursprung oder nach Dignität. Grundlage der Diagnostik stellt die Schnittbildgebung in Form von MRT und CT dar. Bei der Planung des operativen Vorgehens muss insbesondere das Vorliegen einer Instabilität oder die Kompression neuraler Strukturen berücksichtigt werden. Therapeutische Optionen werden interdisziplinär erörtert. Ergänzend zur Operation stellen die Radio- und Chemotherapie alternative oder zusätzliche Therapieoptionen dar.

Abstract

Paraspinal tumors spread along the vertebral column in surrounding tissues, i. e. bones, muscles, soft tissue, or intervertebral discs. Thereby they invade the cervical, thoracic or retroperitoneal spaces. Various classifications consider anatomy, tissue origin, or dignity of the lesion. The diagnosis is based on MRI and CT scans. According to possible instability or compression of neural structures, decompression and stabilizating procedures are recommended. Therapeutical options are discussed by interdisciplinary tumorboards. Radiatiotherapy and chemotherapy are used as complemetary or alternative treatment options.

Schlüsselwörter

paraspinale Tumore - Klassifikation - Tumorboard

Keywords

paraspinal tumors - classification - tumorboard

• Literatur

• 1 Delank KS, Wendtner C, Eich HT. et al. The treatment of spinal metastases. Dtsch Arztebl Int 2011; 108: 71-80
• 2 Greenlee RT, Murray T, Bolden S. et al. Cancer statistics, 2000. CA Cancer J Clin 2000; 50: 7-33
• 3 Dardic M, Wibmer C, Berghold A. et al. Evaluation of prognostic scoring systems for spinal metastasis in 196 patients treated during 2005-2010. Eur Spine J 2015; 24: 2133-41
• 4 Ibrahim T, Flamini E, Fabbri L. et al. Multidisciplinary approach to the treatment of bone metastases: Osteo-oncology center, a new organizational model. Tumori 2009; 95: 291-97
• 5 Kimura T. Multidisciplinary approach for bone metastases: a review. Cancers 2018; 10: pii E156
• 6 Fisher CG, DiPaola CP, Ryken TC. et al. A novel classification system for spinal instability in neoplastic desease: an evidence based approach and expert consensus from the Spine Oncology Study Group. Spine 2010; 35: E1221-E1229
• 7 Gruenberg M, Mereles ME, Willhuber GOC. et al. Usefulness of Tokuhashi score in survival prediction of patients operated for vertebral metastatic desease. Global Spine J 2017; 7: 260-65
• 8 Tokuhashi Y, Kawano H, Oda H. et al. A revised scoring system for preoperativ evaluation of metastatic spine tumor prognosis. Spine (Phila Pa 1976) 2005; 30: 2186-2191
• 9 Marino RJ, Graves DE. Metric properties oft he ASIA motor score: subscales improve correlation with functional activities. Arch Phys Med Rehabil 2004; 85: 1804-10
• 10 Tomita K, Kawahara N, Kobayashi T. et al. Surgical strategy for spinal metastases. Spine (Phila Pa 1976) 2001; 26: 298-306
• 11 Stark AM, Hugo HH, Buhl R. et al. Tumoren peripherer Nerven. Dtsch Arztebl 2002; 99: A928-A933
• 12 Skovronsky DM, Oberholtzer JC. Pathologic classification of peripheral nerve tumors. Neurosurg Clin N Am 2004; 15: 157-166
• 13 Celli P, Trillo G, Ferrante L. Extrathecal intraradicular nerve sheath tumor. J Neurosurg Spine 2005; 3: 1-11
• 14 Van Goethem JW, van den Hauwe L, Ozsarlak O. et al. Spinal tumors. Eur J Radiol 2004; 50: 159-76
• 15 Li C, Ye Y, Gu Y. et al. Minimally invasive resection of extradural dumbbell tumors of thoracic spine: surgical techniques and literature review. Eur Spine J 2016; 25: 4108-4115
• 16 Ducatman BS, Scheithauer BW, Piepgras DG. et al. Malignant peripheral nerve sheath tumors. Cancer 1986; 57: 2006-2011
• 17 Schütte J, Bauer S. et al. Onkopedia DGHO Leitlinie Weichteilsarkome (maligne Weichgewebstumore) des Erwachsenen, April 2019. https://www.onkopedia.com/de/onkopedia/guidelines/weichgewebssarkome-maligne-weichgewebstumoren-des-erwachsenen/@@guideline/html/index.html
• 18 Dunn GP, Spiliopoulos K, Plotkin SR. et al. Role of resection of malignant peripheral nerve sheath tumors in patients with neurofibromatosis type 1. J Neurosurg 2013; 118: 142-148
• 19 Gilder HE, Puffer RC, Bydon M. et al. The implications of intradural extension in paraspinal malignant peripheral nerve sheath tumors: effects on central nervous system metastases and overall survival. J Neurosurg Spine 2018; 29: 725-728
• 20 Tora MS, Xenos D, Texakalidis P. et al. Treatment of neurofibromatosis 1-associated malignant peripheral nerve sheath tumors: a systematic review. Neurosurg Rev 2019;
• 21 Minovi A, Basten O, Hunter B. et al. Malignant peripheral nerve sheath tumors of the head and neck: management of 10 cases and literature review. Head Neck 2007; 29: 439-445
• 22 Beccaria K, Sainte-Rose C, Zerah M. et al. Paediatric Chordomas. Orphanet J Rare Dis 2015; 10: 116
• 23 Stacchiotti S, Sommer J. Chordome Global Consensus Group: building a global consensus approach to chordoma: a position paper from the medical and patient community. Lancet Oncol 2015; 16: e71-82
• 24 DeLaney TF, Liebsch NJ, Pedlow FX. et al. Long term results of phase II study of high dose photon/proton radiotherapy in the management of spine chordomas, chondrosarcomas, and other sarcomas. J Surg Oncol 2014; 110: 115-22
• 25 Held G, Zeynalova S, Murawski N. et al. Impact of rituximab and radiotherapy on outcome of patients with aggressive B-cell lymphoma and skeletal involvement. J Clin Oncol 2013; 31: 4115-22
• 26 Balducci M, Chiesa S, Manfrida S. et al. Impact of radiotherapy on pain relief and recalcification in plasma cell neoplasms: long-term experience. Strahlenther Onkol 2011; 187: 114-119
• 27 Mose S, Pfitzner D, Rahn A. et al. Role of radiotherapy in the treatment of multiple myeloma. Strahlenther Onkol 2000; 176: 506-512