Therapie mit offenen Radionukliden bei multilokulärer Skelettmetastasierung

Zusammenfassung

Die nuklearmedizinische palliative Schmerztherapie stellt eine nebenwirkungsarme, ergänzende Behandlungsoption im Gesamtspektrum der Schmerztherapie bei Patienten mit einer multilokulär osteoblastischen Metastasierung vieler Primärtumoren dar. Sie zeichnet sich durch einen raschen Einsatz der Schmerzlinderung und durch lang anhaltende Wirkung aus. Vorläufige Berechnungen weisen auf eine günstige Kosten-Nutzen-Relation hin. Durch die nuklearmedizinische palliative Schmerztherapie bessert sich bei Patienten mit metastasiertem Mamma- oder Prostatakarzinom die Schmerzsymptomatik in 70–80%, bei anderen Primärtumoren weniger häufig [7] [10]. Völlig schmerzfrei werden nur wenige Patienten. Eine medikamentöse Basistherapie ist bei den meisten Tumorpatienten weiterhin erforderlich. Insgesamt zeichnet sich die Therapie durch eine hohe Akzeptanz bei den Patienten aus, da es sich bei der Verwendung von ⁸⁹Strontium oder ¹⁵³Samarium um eine einmalige intravenöse Applikation handelt. Aktuelle Studien zum kombinierten Einsatz von Radionukliden und Chemotherapie bzw. die klinischen Daten der Anwendung von ²²³Radium belegen weitere Entwicklungsmöglichkeiten der systemischen Radionuklidtherapie von einer rein palliativen Behandlung hin zu tumoriziden Effekten mit signifikanter Lebensverlängerung der betroffenen Patienten.

Abstract

Pain palliation therapy using radionulides is a safe, additive therapeutic procedure in the spectrum of effective treatment in patients with multilocular mainly osteoblastic skeletal metastases from different primaries. The radionulide therapy is characterized by fast pain palliation and long-term symptom benefit in 70–80% of patients suffering from breast or prostate cancer. Lower response rates are observed in other primaries. Only few patients are becoming totally pain free, most patients have to continue basal therapy with pain medication.

The single intraveneous administration is well tolerated and accepted by most patients. Recent studies administering combination therapy of radionuclides and chemotherapy show promising effects on tumoricity. Also preliminary results of trials using ²²³Radium, an alpha emitter show good pain symptom control and significantly prolonged survival.

Schlüsselwörter

Knochenmetastasen - Schmerztherapie - ¹⁵³Samarium EDTMP - ⁸⁹Strontium - ²²³Radium

Key words

bone metastases - pain treatment - ¹⁵³Samarium EDTMP - ⁸⁹Strontium - ²²³Radium

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