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Spinale Mammakarzinommetastasen aus Sicht der Wirbelsäulenchirurgie

Prädiktoren auf Molekularebene zur Wahl der adäquaten Therapiestrategie

Metastatic breast cancer in the spine

Molecular predictors for choosing adequate treatment strategies

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Zusammenfassung

Das Mammakarzinom ist die häufigste maligne Erkrankung der Frau und die Wirbelsäule dabei der am häufigsten von Metastasen betroffene Teil des Skelettsystems. Aktuelle onkologische Behandlungsstrategien erzielten gerade im letzten Jahrzehnt deutliche Fortschritte hinsichtlich der Überlebenszeit, sodass die Therapie der Wirbelkörpermetastasen zusehends im Fokus des Wirbelsäulenchirurgen steht. Zur Evaluation der Prognose und Wahl der Therapiestrategie sind unterschiedliche Scores beschrieben, welche jedoch lediglich die Tumorentitäten und nicht die tumorspezifischen Phänotypen unterscheiden. Das Mammakarzinom wird seit der Jahrtausendwende in fünf intrinsische Subtypen mit unterschiedlicher Überlebenserwartung klassifiziert. Ziel dieser Arbeit ist die Beschreibung molekularer Prädiktoren bezüglich der Malignität des Mammakarzinoms, um die zu erwartende Überlebenszeit und die Invasivität der Therapie hinsichtlich spinaler Metastasen optimiert abschätzen zu können.

Abstract

Breast cancer is the most common malignancy affecting women and the spinal column is most likely affected by metastases. Modern oncologic treatment options have significantly prolonged survival times in the last decade. Therefore, treatment of vertebral metastases has been of special interest in spine surgery. Different scores are described to evaluate prognosis and to choose correct treatment strategies, which however only differentiate tumor entities and not specific tumor phenotypes. Breast cancer has been classified into five intrinsic subtypes with different survival rates since the turn of the millennium. The aim of this review was to describe molecular predictors of breast cancer malignancy and to better estimate expected survival times and invasiveness of therapies with regard to spinal metastases.

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Abbreviations

ER:

Östrogenrezeptor

HER:

Human Epidermal Growth Factor Receptor

PgR:

Progesteronrezeptor

RFA:

Radiofrequenzablation

SINS:

Spine Instability Neoplastic Score

T-DMI:

Trastuzumab-Emtansin

ÜLZ:

Überlebenszeit

WBB:

Weinstein-Boriani-Biagini-Klassifikation

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Authors and Affiliations

  1. Zentrum für Wirbelsäulenchirurgie, Klinik für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland

    D. Adler, H. Almansour &  M. Akbar

  2. Pathologisches Institut, Universität Heidelberg, Heidelberg, Deutschland

    M. Kriegsmann &  P. Sinn

  3. Nationales Centrum für Tumorerkrankungen, Sektion Gynäkologische Onkologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    A. Schneeweiss

  4. Sektion Orthopädische Onkologie und Septische Orthopädische Chirurgie, Klinik für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    B. Lehner

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  1. D. Adler
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  2. M. Kriegsmann
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  3. P. Sinn
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  5. H. Almansour
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  7. M. Akbar
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Correspondence to M. Akbar.

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Interessenkonflikt

D. Adler, M. Kriegsmann, P. Sinn, A. Schneeweiss, H. Almansour, B. Lehner und M. Akbar geben an, dass kein Interessenkonflikt besteht. Die Autoren versichern, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt oder abgebildet ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Adler, D., Kriegsmann, M., Sinn, P. et al. Spinale Mammakarzinommetastasen aus Sicht der Wirbelsäulenchirurgie. Orthopäde 47, 594–603 (2018). https://doi.org/10.1007/s00132-018-3540-9

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