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Zeitschrift für Palliativmedizin 2009; 10(1): 21-39
DOI: 10.1055/s-0028-1090178
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© Georg Thieme Verlag KG Stuttgart · New York

Palliative Strahlentherapie

Palliative Radiation TherapyB.  van Oorschot, D.  Rades, W.  Schulze, P.  Feyer, G.  Beckmann
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Publication History

Publication Date:
23 March 2009 (online)

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Zusammenfassung

Die meisten Tumorpatienten erhalten im Verlauf ihrer Erkrankung eine Strahlentherapie. Zwischen 30 und 50 % aller Strahlenbehandlungen werden unter palliativer Zielsetzung durchgeführt. Durch eine lokale Bestrahlung können vielfältige tumorbedingte Symptome gelindert oder präventiv zukünftig bedrohliche Situationen durch den Tumor oder durch Metastasen abgewendet werden. Die Strahlentherapie ist eine lokal wirksame Therapie und erzeugt typischerweise keine systemischen und i. d. R. nur milde Nebenwirkungen. Der folgende Beitrag gibt einen Überblick über Prinzipien und neue Entwicklungen in der palliativen Strahlentherapie.

Abstract

The majority of cancer patients will require radiation therapy at some times during the course of their disease. An estimated 30–50 % of all radiation treatments are of palliative nature, either to alleviate symptoms or prophylactic to prevent deterioration of quality of live due to local progressive disease. Radiotherapy is a locally effective tool and typically causes no systemic and mostly mild acute side effects. The following article will provide an overview of principles and new developments in palliative radiation therapy.

Literatur

  • 1 Lutz T, Chow L, Hartsell W. et al . A review of hypofractionated palliative radiotherapy.  Cancer. 2007;  109 1463-1469
    PubMedGoogle Scholar
  • 2 Christakis N A, Lamont E B. Extent and determinants of error in doctors' prognoses in terminally ill patients: prospective cohort study.  BMJ. 2000;  320 469-472
    CrossrefPubMedGoogle Scholar
  • 3 Glare P, Virik K, Jones M. et al . A systematic review of physicians' survival predictions in terminally ill cancer patients. Review.  BMJ. 2003;  327 195-198
    CrossrefPubMedGoogle Scholar
  • 4 Gripp S, Moeller S, Bölke E. et al . Survival prediction in terminally ill cancer patients by clinical estimates, laboratory tests, and self-rated anxiety and depression.  J Clin Oncol. 2007;  25 3313-3320
    CrossrefPubMedGoogle Scholar
  • 5 Maltoni M, Caraceni A, Brunelli C. et al . Prognostic factors in advanced cancer patients: evidence-based clinical recommendations – a study by the Steering Committee of the European Association for Palliative Care.  J Clin Oncol. 2005;  23 6240-6248
    CrossrefPubMedGoogle Scholar
  • 6 Glare P A, Sinclair C T. Palliative medicine review: prognostication. Review.  J Palliat Med. 2008;  11 84-103
    CrossrefPubMedGoogle Scholar
  • 7 Van der Linden Y M, Dijkstra S P, Vonk E J. et al . Prediction of survival in patients with metastases in the spinal column: results based on a randomized trial of radiotherapy.  Cancer. 2005;  103 320-328
    CrossrefPubMedGoogle Scholar
  • 8 Nieder C, Nestle U, Motaref B. et al . Prognostic factors in brain metastases: should patients be selected for aggressive treatment according to recursive partitioning analysis (RPA) classes?.  Int J Radiat Oncol Biol Phys. 2000;  46 297-302
    CrossrefPubMedGoogle Scholar
  • 9 Rades D, Dunst J, Schild S E. A new scoring system to predict the survival of patients treated with whole-brain radiotherapy for brain metastases.  Strahlenther Onkol. 2008;  184 251-255
    CrossrefPubMedGoogle Scholar
  • 10 Sperduto P W, Berkey B, Gaspar L E. et al . A new prognostic index and comparison to three other indices for patients with brain metastases: an analysis of 1,960 patients in the RTOG database.  Int J Radiat Oncol Biol Phys. 2008;  70 510-514
    PubMedGoogle Scholar
  • 11 Rades D, Rudat V, Veninga T. et al . A score predicting posttreatment ambulatory status in patients irradiated for metastatic spinal cord compression.  Int J Radiat Oncol Biol Phys. 2008;  72 905-908 , Epub 2008 Apr 23
    CrossrefPubMedGoogle Scholar
  • 12 Chow E, Abdolell M, Panzarella T. et al . Validation of a predictive model for survival in metastatic cancer patients attending an outpatient palliative radiotherapy clinic.  Int J Radiat Oncol Biol Phys. 2009;  73 280-287
    PubMedGoogle Scholar
  • 13 Shakespeare T P, Lu J J, Back M F. et al . Patient preference for radiotherapy fractionation schedule in the palliation of painful bone metastases.  J Clin Oncol. 2003;  21 2156-2162
    CrossrefPubMedGoogle Scholar
  • 14 Tang J I, Shakespeare T P, Lu J J. et al . Patients' preference for radiotherapy fractionation schedule in the palliation of symptomatic unresectable lung cancerdagger.  J Med Imaging Radiat Oncol. 2008;  52 497-502
    PubMedGoogle Scholar
  • 15 Gaspar L, Scott C, Rotman M. et al . Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials.  Int J Radiat Oncol Biol Phys. 1997;  37 745-751
    Google Scholar
  • 16 Hoskin P J. Bisphosphonates and radiation therapy for palliation of metastatic bone disease.  Cancer Treat Rev. 2003;  29 321-327
    CrossrefPubMedGoogle Scholar
  • 17 Vassiliou V, Kardamakis D, Kalogeropoulou C. Clinical and radiologic response in patients with bone metastases managed with combined radiotherapy and bisphosphonates.  J Surg Oncol. 2008;  98 567-568
    CrossrefPubMedGoogle Scholar
  • 18 Wu J S, Wong R, Johnston M. et al . Meta-analysis of dose-fractionation radiotherapy trials for the palliation of painful bone metastases.  Int J Radiat Oncol Biol Phys. 2003;  55 594-605
    CrossrefPubMedGoogle Scholar
  • 19 Wai M S, Mike S, Ines H. et al . Palliation of metastatic bone pain: single fraction versus multifraction radiotherapy – a systematic review of the randomized trials.  The Cochrane database of systematic reviews. 2004;  ((2)) , CD004721
    PubMedGoogle Scholar
  • 20 van der Linden Y M, Lok J J, Steenland E. et al . Single fraction radiotherapy is efficacious: a further analysis of the Dutch Bone Metastasis Study controlling for the influence of retreatment.  Int J Radiat Oncol Biol Phys. 2004;  59 528-537
    CrossrefPubMedGoogle Scholar
  • 21 Koswig S, Budach V. Remineralisation und Schmerzlinderung von Knochenmetastasen nach unterschiedlich fraktionierter Strahlentherapie (10-mal 3 Gy vs. 1-mal 8 Gy).  Strahlenther Onkol. 1999;  175 500-508
    CrossrefPubMedGoogle Scholar
  • 22 Tang V, Harvey D, Park Dorsay J. et al . Prognostic indicators in metastatic spinal cord compression: using functional independence measure and Tokuhashi scale to optimize rehabilitation planning.  Spinal Cord. 2007;  45 671-677
    CrossrefPubMedGoogle Scholar
  • 23 Helweg-Larsen S, Sørensen P S, Kreiner S. Prognostic factors in metastatic spinal cord compression: a prospective study using multivariate analysis of variables influencing survival and gait function in 153 patients.  Int J Radiat Oncol Biol Phys. 2000;  46 1163-1169
    CrossrefPubMedGoogle Scholar
  • 24 Rades D, Heidenreich F, Karstens J H. Final results of a prospective study of the prognostic value of the time to develop motor deficits before irradiation in metastatic spinal cord compression.  Int J Radiat Oncol Biol Phys. 2002;  53 975-979
    CrossrefPubMedGoogle Scholar
  • 25 Patchell R A, Tibbs P A, Regine W F. et al . Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial.  Lancet. 2005;  366 643-648
    CrossrefPubMedGoogle Scholar
  • 26 Rades D, Stalpers L J, Hulshof M C. et al . Comparison of 1 × 8 Gy and 10 × 3 Gy for functional outcome in patients with metastatic spinal cord compression.  Int J Radiat Oncol Biol Phys. 2005;  62 514-518
    CrossrefPubMedGoogle Scholar
  • 27 Katagiri H, Takahashi M, Wakai K. et al . Prognostic factors and a scoring system for patients with skeletal metastasis.  J Bone Joint Surg Br. 2005;  87 698-703
    CrossrefPubMedGoogle Scholar
  • 28 Rades D, Lange M, Veninga T. et al . Preliminary results of spinal cord compression recurrence evaluation (score-1) study comparing short-course versus long-course radiotherapy for local control of malignant epidural spinal cord compression.  Int J Radiat Oncol Biol Phys. 2009;  73 228-234 , Epub 2008 Jun 6
    PubMedGoogle Scholar
  • 29 Guckenberger M, Goebel J, Wilbert J. et al . Clinical outcome of dose-escalated image-guided radiotherapy for spinal metastasis.  Int J Radiat Oncol Biol Phys. 2009 in press; 
    PubMedGoogle Scholar
  • 30 Spanos W J, Clery M, Perez C A. et al . Late effect of multiple daily fraction palliation schedule for advanced pelvic malignancies (RTOG 8502).  Int J Radiat Oncol Biol Phys. 1994;  29 961-967
    PubMedGoogle Scholar
  • 31 Janjan N A. Palliative therapy. Introduction.  Semin Radiat Oncol. 2000;  10 169-174
    CrossrefPubMedGoogle Scholar
  • 32 Porceddu S V, Rosser B, Burmeister B H. et al . Hypofractionated radiotherapy for the palliation of advanced head and neck cancer in patients unsuitable for curative treatment – „Hypo Trial”.  Radiother Oncol. 2007;  85 456-462
    CrossrefPubMedGoogle Scholar
  • 33 Agarwal J P, Nemade B, Murthy V. et al . Hypofractionated, palliative radiotherapy for advanced head and neck cancer.  Radiother Oncol. 2008;  89 51-56
    CrossrefPubMedGoogle Scholar
  • 34 Falk S J, Girling D J, White R J. et al . Immediate versus delayed palliative thoracic radiotherapy in patients with unresectable locally advanced non-small cell lung cancer and minimal thoracic symptoms: randomised controlled trial. Medical Research Council Lung Cancer Working Party.  BMJ. 2002;  325 465
    CrossrefPubMedGoogle Scholar
  • 35 Fairchild A, Harris K, Barnes E. et al . Palliative thoracic radiotherapy for lung cancer: a systematic review.  J Clin Oncol. 2008;  26 4001-4011
    CrossrefPubMedGoogle Scholar
  • 36 Budach W, Belka C. Palliative percutaneous radiotherapy in non-small-cell lung cancer.  Lung Cancer. 2004;  45 (Suppl. 2) 239-245
    CrossrefPubMedGoogle Scholar
  • 37 Toy E, Macbeth F, Coles B. et al . Palliative thoracic radiotherapy for non-small-cell lung cancer: a systematic review.  Am J Clin Oncol. 2003;  26 112-120
    CrossrefPubMedGoogle Scholar
  • 38 Kramer G W, Wanders S L, Noordijk E M. et al . Results of the Dutch National study of the palliative effect of irradiation using two different treatment schemes for non-small-cell lung cancer.  J Clin Oncol. 2005;  23 2962-2970
    CrossrefPubMedGoogle Scholar
  • 39 Kramer G W, Gans S, Ullmann E. et al . Hypofractionated external beam radiotherapy as retreatment for symptomatic non-small-cell lung carcinoma: an effective treatment?.  Int J Radiat Oncol Biol Phys. 2004;  58 1388-1393
    CrossrefPubMedGoogle Scholar
  • 40 Wong W W, Schild S E, Sawyer T E. et al . Analysis of outcome in patients reirradiated for brain metastases.  Int J Radiat Oncol Biol Phys. 1996;  34 585-590
    CrossrefPubMedGoogle Scholar
  • 41 Kao J, Garofalo M C, Milano M T. et al . Reirradiation of recurrent and second primary head and neck malignancies: a comprehensive review.  Cancer Treat Rev. 2003;  29 21-30
    PubMedGoogle Scholar
  • 42 Flentje M, Frey M, Kuttig H. et al . Radiotherapy of locally recurring colorectal tumors. Prognostic factors, follow-up diagnosis and results.  Strahlenther Onkol. 1988;  164 402-407
    PubMedGoogle Scholar
  • 43 Overgaard M, Overgaard J, Sell A. Dose-response relationship for radiation therapy of recurrent, residual, and primarily inoperable colorectal cancer.  Radiother Oncol. 1984;  1 217-225
    CrossrefPubMedGoogle Scholar
  • 44 Rödel C, Grabenbauer G G, Schick C. et al . Preoperative radiation with concurrent 5-fluorouracil for locally advanced T4-primary rectal cancer.  Strahlenther Onkol. 2000;  176 161-167
    CrossrefPubMedGoogle Scholar

Dr. med. Birgitt van Oorschot

Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Würzburg

Josef-Schneider-Straße 11

97080 Würzburg

Email: oorschot_b@klinik.uni-wuerzburg.de

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