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DOI: 10.1055/s-0032-1324997
Knochenmetastasen
Bone MetastasesPublication History
Publication Date:
11 April 2013 (online)
![](https://www.thieme-connect.de/media/uro/201302/lookinside/thumbnails/10.1055-s-0032-1324997-1.jpg)
Zusammenfassung
Die urologischen Tumorentitäten zählen zu den häufigsten Tumoren, die Knochenmetastasen entwickeln. In der Diagnostik stehen die bildgebenden Verfahren mit Nativröntgen, CT und MRT an vorderster Stelle. Die Differenzierung von benignen und malignen Veränderungen am Knochen kann dabei eine diagnostische Herausforderung sein und in seltenen Fällen auch eine invasive Diagnostik mittels perkutaner oder offener Knochenbiopsie notwendig machen. Mit dem Nachweis ossärer Metastasen sollte umgehend eine medikamentöse Prävention skeletaler Komplikationen mittels Bisphosphonaten oder Denosumab erfolgen. Die Therapieziele symptomatischer Knochenmetastasen liegen v. a. in der Reduktion tumorbedingter Schmerzen und Stabilisierung der Knochenstruktur. Pathologische Frakturen sind i. d. R. entweder durch minimalinvasive oder offen operative Verfahrung zur Stabilisierung des Knochenabschnitts zu versorgen. Bei Auftreten neurologischer Begleitsymptome ist eine notfallmäßige Dekompression der entsprechenden nervalen Strukturen notwendig, um bleibende neurologische Defizite zu vermeiden.
Abstract
Malignant urological tumours account for a relevant number of patients who develop bone metastasis throughout the course of their disease. Diagnosis of bone metastasis is mostly achieved by imaging studies including plain X-ray, computed tomography or magnetic resonance tomography. Differential diagnosis between benign and malignant processes in the bone can be sometimes challenging so that minimally or open operative biopsy of the bone becomes necessary in rare cases. After diagnosis of bone metastasis medical treatment using bisphosphonates or denosumab should be initiated in order to prevent skeletal complications. Therapeutic goals for symptomatic bone metastasis are the reduction of tumour associated pain and stabilization of the bone. Pathologic fractures are mostly being treated using either minimally invasive or open operative techniques for stabilizing the segment of the bone or spine. In case of accompanying neurologic symptoms immediate intervention and decompression of the neural structures is warranted in order to prevent irreversible neurologic deficits.
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Literatur
- 1 Greenlee RT, Murray T, Bolden S et al. Cancer statistics, 2000. CA Cancer J Clin 2000; 50: 7-33
- 2 Siegal T. Current considerations in the management of neoplastic spinal cord compression. Spine (Phila Pa 1976) 1989; 14: 223-228
- 3 Coleman RE. Bone cancer in 2011: Prevention and treatment of bone metastases. Nat Rev Clin Oncol 2011; 9: 76-78
- 4 Ulmar B, Huch K, Kocak T et al. The prognostic influence of primary tumour and region of the affected spinal segment in 217 surgical patients with spinal metastases of different entities. Z Orthop Ihre Grenzgeb 2007; 145: 31-38
- 5 Clohisy DR, Mantyh PW. Bone cancer pain.. Clin Orthop Relat Res 2003; S279-288
- 6 Kirsch CM. Positron emission tomography and scintigraphy. Nuclear imaging in clinical orthopaedics. Orthopade 2006; 35: 995-1009 quiz 1010
- 7 Romer W, Nomayr A, Uder M et al. SPECT-guided CT for evaluating foci of increased bone metabolism classified as indeterminate on SPECT in cancer patients. J Nucl Med 2006; 47: 1102-1106
- 8 Strobel K, Burger C, Seifert B et al. Characterization of focal bone lesions in the axial skeleton: performance of planar bone scintigraphy compared with SPECT and SPECT fused with CT. AJR Am J Roentgenol 2007; 188: W467-474
- 9 Lecouvet FE, Geukens D, Stainier A et al. Magnetic resonance imaging of the axial skeleton for detecting bone metastases in patients with high-risk prostate cancer: diagnostic and cost-effectiveness and comparison with current detection strategies. J Clin Oncol 2007; 25: 3281-3287
- 10 Spuentrup E, Buecker A, Adam G et al. Diffusion-weighted MR imaging for differentiation of benign fracture edema and tumor infiltration of the vertebral body. AJR Am J Roentgenol 2001; 176: 351-358
- 11 Wu LM, Gu HY, Zheng J et al. Diagnostic value of whole-body magnetic resonance imaging for bone metastases: a systematic review and meta-analysis. J Magn Reson Imaging 2011; 34: 128-135
- 12 Boellaard R, OʼDoherty MJ, Weber WA et al. FDG PET and PET/CT: EANM procedure guidelines for tumour PET imaging: version 1.0. Eur J Nucl Med Mol Imaging 2010; 37: 181-200
- 13 Buck AK, Herrmann K, Stargardt T et al. Economic evaluation of PET and PET/CT in oncology: evidence and methodologic approaches. J Nucl Med 2010; 51: 401-412
- 14 Evangelista L, Panunzio A, Polverosi R et al. Early bone marrow metastasis detection: the additional value of FDG-PET/CT vs. CT imaging. Biomed Pharmacother 2012; 66: 448-453
- 15 Datir A, Pechon P, Saifuddin A. Imaging-guided percutaneous biopsy of pathologic fractures: a retrospective analysis of 129 cases. AJR Am J Roentgenol 2009; 193: 504-508
- 16 Saad F, Chen YM, Gleason DM et al. Continuing benefit of zoledronic acid in preventing skeletal complications in patients with bone metastases. Clin Genitourin Cancer 2007; 5: 390-396
- 17 Lipton A, Fizazi K, Stopeck AT et al. Superiority of denosumab to zoledronic acid for prevention of skeletal-related events: a combined analysis of 3 pivotal, randomised, phase 3 trials. Eur J Cancer 2012; 48: 3082-3092
- 18 Brady D, Parker CC, OʼSullivan JM. Bone-targeting radiopharmaceuticals including radium-223. Cancer J 2013; 19: 71-78
- 19 Koswig S, Budach V. [Remineralization and pain relief in bone metastases after after different radiotherapy fractions (10 times 3 Gy vs. 1 time 8 Gy). A prospective study]. Strahlenther Onkol 1999; 175: 500-508
- 20 Patchell RA, Tibbs PA, Regine WF 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
- 21 Bartels RH, van der Linden YM, van der Graaf WT. Spinal extradural metastasis: review of current treatment options. CA Cancer J Clin 2008; 58: 245-259
- 22 Lemke DM, Hacein-Bey L. Metastatic compression fractures – vertebroplasty for pain control. J Neurosci Nurs 2003; 35: 50-55