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Therapieoptionen bei Sarkomen an der Wirbelsäule

Individuelle und interdisziplinäre Behandlungsstrategie für ein heterogenes Krankheitsbild

Treatment options for sarcomas of the spine

A heterogenic disease picture which requires an individual and interdisciplinary treatment concept

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Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Sarkome an der Wirbelsäule stellen aufgrund ihrer Heterogenität, Seltenheit und anatomischen Lage eine große Herausforderung für die Behandelnden dar.

Fragestellung

Diskutiert werden die Behandlungsmöglichkeiten (State-of-the-art).

Material und Methode

Es werden die aktuelle Literatur, Expertenmeinungen und Konsensempfehlungen internationaler Expertengremien diskutiert.

Ergebnisse

Es gibt folgende Konsensus-Empfehlungen: a) Osteosarkom: kombinierte Therapie: neoadjuvante Chemotherapie/En-bloc-Resektion/Strahlenresistenz; b) Ewing-Sarkom: kombinierte Therapie: neo- und adjuvante Chemotherapie/Restaging und Bestimmung des Regressionsgrads vor En-bloc-Resektion zwingend/En-bloc-Resektion und/oder Radiotherapie; c) Chondrosarkom: wenn möglich En-bloc-Resektion. Intensitätsmodulierte Radiotherapie scheint selektiv eine primäre oder adjuvante Option zu sein.

Etablierte Operationsverfahren (En-bloc-Resektion) kombiniert mit neuen Techniken (Implantate, Materialen/3D-Navigation), präziseren Bestrahlungsoptionen (intensitätsmodulierte Photonenbestrahlung) und Anwendung von Partikelstrahlung lassen eine Verbesserung der Therapieergebnisse erwarten.

Schlussfolgerung

Das beste Outcome haben Patienten, welche von Beginn an (bereits zur Biopsie) einem ausgewiesenen Tumorzentrum zugewiesen werden. Das Behandlungskonzept ist immer multidisziplinär.

Abstract

Background

Due to their heterogeneity, rareness and anatomical location, the treatment of sarcomas of the spine is a challenging task for the treating team.

Objective

Therapy options: state of the art.

Methods

The current literature, expert opinions and consensus recommendations from international expert committees are discussed.

Results

Consensus recommendations: a) osteosarcoma: combined therapy, neoadjuvant chemotherapy, en bloc resection, radiation resistance. b) Ewing sarcoma: combined therapy, neoadjuvant and adjuvant chemotherapy, re-staging and determination of the degree of regression before en bloc resection if feasible and/or radiotherapy. c) Chondrosarcoma: en bloc resection if feasible. Intensity-modulated radiotherapy in selected cases might be a primary or adjunct option. En bloc techniques for tumors of the spine are well established. In combination with new techniques (implant materials/3D navigation) and advanced options in radiotherapy (intensity-modulated radiation/proton beam/carbon ion) there might be a chance for further improvement in the outcome of treatment in the future.

Conclusion

The best treatment outcome is seen in patients who have been included in a multidisciplinary oncological team in a designated tumor center right from the very beginning (starting with the biopsy).

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Danksagung

Für die wertvolle Unterstützung: PD Dr. med. Andreas Krieg, Leiter Sarkomzentrum Basel; Prof. Stefan Schären, Chefarzt Spinale Chirurgie, Leitung Wirbelsäulenzentrum, Universitätsspital Basel; Dr. med. Ludwig Weh.

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Authors and Affiliations

  1. Spinale Chirurgie, Universitätsspital Basel, Spitalstrasse 21, 4031, Basel, Schweiz

    Cordula Netzer

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  1. Cordula Netzer
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Correspondence to Cordula Netzer.

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C. Netzer gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine vom Autor durchgeführten Studien an Menschen oder Tieren.

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Netzer, C. Therapieoptionen bei Sarkomen an der Wirbelsäule. Onkologe 24, 224–230 (2018). https://doi.org/10.1007/s00761-017-0329-0

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