Radionuklidtherapie im Behandlungskonzept von Knochenmetastasen

Zusammenfassung

Die durch Knochenmetastasen hervorgerufenen Komplikationen und Schmerzen führen zu einer erheblichen Beeinträchtigung der Lebensqualität. Im Rahmen eines multimodalen Therapiekonzeptes für die Behandlung von Knochenmetastasen ist eine effektive Analgesie unverzichtbar. β-Strahler wie Strontium-89-Chlorid und Samarium- 153-EDTMP können vor allem bei Patienten mit osteoblastisch metastasierten Tumoren eine signifikante Schmerzreduktion erzielen. Die mit der Substanzgruppe verbundene Hämatotoxizität hat jedoch bisher zu einem zurückhaltenden Einsatz der Substanzen geführt. Des Weiteren ist diese Zurückhaltung auch auf die geringe Anzahl an prospektiv randomisierten Studien zurückzuführen. Für den β-Strahler Radium-223-Chlorid konnte in einer großen randomisierten Studie neben einer Schmerzreduktion eine Verlängerung des medianen Gesamtüberlebens von Patienten mit kastrationsrefraktärem Prostatakarzinom um 2,8 Monate (14 vs. 11,2 Monate im Placeboarm) beobachtet werden. Diese Effekte waren mit einer im Vergleich zu β-Strahlern deutlich niedrigeren Hämatotoxizität assoziiert. Die vielversprechenden Ergebnisse von Radium-223-Chlorid lassen einen vermehrten Einsatz von Radionukliden bei Patienten mit Prostatakarzinom erwarten.

Summary

The presence of metastastic bone disease has a significant impact on mortality and morbidity of patients with advanced tumour disease. Skeletal related events and tumor-associated bone pain lead to a decrease of quality of life. A multimodal approach is of utmost importance in the management of symptomatic metastatic bone disease. Besides analgetic drugs and external radiotherapy, radiopharmaceuticals are effective tools in the treatment of bone pain. Beta-emitters such as Strontium-189-chloride and Samarium- 153-EDTMP have shown promising effects on tumour- associated pain mainly in patients with osteoblastic metastases from prostate cancer. However, the hematotoxicity of betaemitters has led to a relatively restrained use. In metastatic breast cancer, the low number of prospective randomized trials also causes the reluctance of using radiopharmaceuticals. The alpha-emitter Radium-223-chloride has been investigated in a large randomized phase III trial in patients with metastatic castration- resistant prostate cancer. Compared to placebo, the administration of Radium-223-chloride every four weeks led to a significant delay of symptomatic skeletal related events and a significant improvement of pain. Most importantly, median overall survival of patients receiving Radium- 223-chloride was significantly improved compared to placebo (14 vs. 11.2 months). The rate of hematologic side effects was relatively moderate compared to betaemitters. The substance is currently investigated in combination with several other antitumour drugs in prostate cancer. Moreover, a phase II trial in breast cancer shows promising effects on bone-turnover markers and metabolic activity of bone metastases.

Schlüsselwörter

Knochenmetastasen - Radium-223 - Radionuklide - Prostatakarzinom - Mammakarzinom

Keywords

Bone metastases - Radium-223 - radionuclide - prostate cancer - breast cancer

^* Beide Autoren haben den gleichen Anteil an der Publikation.

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