Stellenwert der externen Radiotherapie bei der adjuvanten Behandlung der pigmentierten villonodulären Synovitis

Zusammenfassung

Ziel: Zur Evaluation der Wertigkeit der externen Radiotherapie (RT) bei der Behandlung der pigmentierten villonodulären Synovitis (PVNS) wurde von der Arbeitsgruppe „Strahlentherapie nicht-maligner Erkrankungen“ der Deutschen Gesellschaft für Radioonkologie (DEGRO) eine nationale Patterns-of-Care-Studie (PCS) durchgeführt. Material und Methode: Ein strukturierter Fragebogen zur Erhebung von Informationen zur Vorbehandlung, der RT-Indikation und -Technik sowie der Effektivität hinsichtlich der Progressionsfreiheit und funktionellen Ergebnisse sowie möglicher Nebenwirkungen der RT wurde an alle 227 Strahlentherapieinstitutionen in Deutschland versandt. Ergebnisse: Mit einer Rücklaufrate von 83,2 % ist PCS national repräsentativ. Klinische Erfahrungen zur Behandlung der PVNS lagen in 10 % der Einrichtungen vor. Auswertbar waren 41 Fälle aus 14 Institutionen, über die ausreichende Angaben vorlagen. Alle 41 Fälle waren primär mit 1 bis > 4 Eingriffen chirurgisch vorbehandelt worden. Die RT wurde bei nicht komplett resektablen Fällen oder präventiv in der Rezidivsituation indiziert. Die applizierten Gesamtdosen variierten zwischen 30–50 Gy (median 36 Gy). In 39 Fällen (95,1 %) wurde eine Progression der PVNS verhindert, davon wurde in 34 Fällen (82,9 %) ein sehr gutes oder gutes funktionelles Ergebnis erzielt. Gravierende Früh- oder Spätnebenwirkungen der RT wurden nicht beobachtet. Schlussfolgerungen: Die postoperative RT ist eine nebenwirkungsarme Therapieoption, durch die bei nicht komplett resektablen Läsionen oder adjuvant nach Resektion von Rezidiven der PVNS eine Optimierung der lokalen Kontrolle erzielt werden kann. Die empfohlenen Gesamtdosen liegen bei mindestens 30 bis 36 Gy.

Abstract

Aim: Pigmented villonodular synovitis (PVNS) is a rare proliferative disorder arising from synovial cells of the tendon sheets and joint capsules. The potential value of external beam radiation therapy in the interdisciplinary management of PVNS is demonstrated by a comprehensive literature review on the clinical use of radiotherapy and the results of national patterns of care study (PCS) which was conducted by the German Cooperative Group on Radiotherapy in Benign Diseases (GCG-BD) in 2008–2009. Material and Method: A structured questionnaire was mailed to all 227 RT institutions in Germany to assess all previous treatments, the RT indication and techniques, the rate of local control, the functional outcome and the possible adverse effects related to the use of external beam radiation therapy (RT). For comparison of the clinical outcome data, a systematic literature research in several international electronic databases and a conventional library search were performed to identify publications addressing the use of RT for PVNS. Results: Based on an overall response rate of 83.2 %, the PCS was nationally representative. Ten percent of institutions presented clinical experience with the use of RT for PVNS; from this database a total of 41 treated sites from 14 institutions were evaluable for long-term analysis. The primary therapeutic approach was cytoreductive surgery in all cases. In cases of residual tissue or complete resection of extensive local recurrences, RT was applied in 39 cases (95.1 %). An excellent or good functional outcome was noted in 34 cases (82.9 %). The use of RT was not associated with early or late toxicity larger than RTOG grade II. The literature review identified 19 published studies (1940–2009) which represented a total of 140 cases or patients, respectively. After follow-up periods ranging from 1–250 months and administration of total doses in the range of 16–50 Gy the overall rate of local control was 84.5 %. Conclusion: Both the results of the national PCS and the literature review demonstrate that RT is a very safe and effective treatment option for the prevention of disease progression or recurrence in PVNS after primary surgical interventions. The planned treatment volume should include the whole synovial space and eventually all invasive components of the disease. Currently, total doses in the range of 30–36 Gy are recommended.

Schlüsselwörter

pigmentierte villonoduläre Synovitis - nicht maligne Erkrankungen/Tumoren - Patterns-of-Care-Studie (PCS) - Gelenkprobleme - Radiotherapie

Key words

pigmented villonodular synovitis - benign disease/tumours - patterns of care study - joint disorders - radiotherapy

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