Die Strahlentherapie als komplexe hochtechnisierte Behandlungsmethode unterliegt zahlreichen gesetzlich vorgeschriebenen qualitätssichernden Maßnahmen. Medizinische Qualitätskontrollen zielen auf die Einhaltung von Therapiestandards und adäquate Dokumentation der durchgeführten Therapie ab. Das Ineinandergreifen der verschiedenen an der Behandlung beteiligten Berufsgruppen im Prozessablauf der Strahlentherapie ist als Qualitätskette aufzufassen, deren Komplexität mit den üblichen Verfahren der kennzahlenbasierten Qualitätssicherung nicht überprüfbar ist. Aus diesem Grund wurden im Rahmen der Strahlenschutzgesetzgebung sog. ärztliche Stellen flächendeckend etabliert. Die zunehmende Digitalisierung und Vernetzung aller Teilprozesse hat in den letzten 20 Jahren erheblich zur Therapiesicherheit beigetragen. Dennoch verbleiben einige wenige Schnittstellen als vulnerable Prozessschritte, allen voran die Patientenidentifikation während der strahlentherapeutischen Serienbehandlung. Hier können sinnvoll neue elektronische Verfahren wie das Barcoding mit wenig Aufwand in das bestehende Sicherheitssystem für die klinische Routine implementiert werden. Einen wichtigen Baustein zur Bewertung der Ergebnisqualität für die Radioonkologie stellt die strahlentherapeutische Nachsorge dar. Die abnehmende Akzeptanz dieser speziellen, meist auf 5 Jahre angelegten Maßnahme bei Patienten im Verlauf erfordert ein gewisses Umdenken in Richtung Individualisierung der „Nachsorgepläne“. Die Einführung standardisierter Fragebögen bei speziellen Patientengruppen (sog. strukturierte Nachfrage) kann hier eine sinnvolle Alternative zur herkömmlichen strahlentherapeutischen Nachsorge sein.

BACKGROUND:Giant cell tumor of the bone (GCTB) is a benign or sometimes semi-malignant neoplasm accounting for 5% of all primary bone tumors. This type of tumor has been historically considered as radioresistant, but nowadays radiotherapy (RT) is used in unresectable, recurrent or incompletely resected cases. Since the value of RT is not well defined, a national cohort study was conducted.PATIENTS AND METHODS:Six German institutions collected data from 35 patients treated during the last 35 years and analyzed them.RESULTS:From 1975-2010 16 male and 19 female patients with 39 lesions were irradiated for GCTB. The median age was 30 years and the median follow-up 65 months. Nineteen patients had undergone RT for recurrent or unresectable disease and 16 patients for non-in-sano resection. The actuarial 5-year overall and disease-free survival rates were 90% and 59%, respectively.CONCLUSION:RT is an easy, safe and effective method for the treatment of GCTB. It may provide an attractive alternative to mutilating surgery.

Giant cell tumors (GCT) of the bone are rare semi-malignant tumors accounting for less than 5% of all primary bone tumors. Historically, GCT was considered to be radioresistant. Nowadays radiotherapy (RT) is sporadically used in unresectable, recurrent or incompletely resected case. Since the value of RT is not well defined and in other oncological subdisciplines there are many obstacles against RT, the German Cooperative Group on Radiotherapy for Benign Diseases (GCG-BD) performed a national cohort study. Six cooperating German institutions collected the clinical features, treatment concepatients, and outcome data of all patients with GCT referred to local RT during the last 40 years. Study end points were pain relief after RT, symptomatic and radiological response, recurrent disease activity, and treatment-related side effects. Median follow-up was 65 (6-358) months. A comprehensive literature review with 86 published studies (1960 – 2011) representing 687 patients was used for comparison. From 1970 to 2011, 56 patients with 62 lesions were irradiated for GCT. There were 32 female and 24 male patients. Median age was 32 (12 – 71) years. Sites of involvement: cervical spine (n = 6), thoracic and lumbar spine (n = 22), sacrum/pelvis (n = 12), temporal bone (n = 2), humerus (n = 4), femur (n = 3), knee (n = 3), jaw (n = 1), and hand (n = 3). Thirty-one patients had undergone RT for primary or recurrent gross tumor disease and 25 after incomplete or intralesional resection. Radiotherapy was performed with a median total dose of 42 (35 – 60) Gy. Overall, 51 of 62 tumors (82.3%) were controlled locally. Six patients (10.7%) developed distant metastasis. The actuarial 5-year overall and disease-free survival rate was 91% and 74%, respectively, and the actuarial 5-year local control and distant metastasis-free survival rate was 78% and 89%, respectively. Univariate analysis of overall, disease-free survival, and local control showed no influence of gender, age, or previous treatment on the treatment outcome. But surgical resection, no gross tumor disease, tumor size less than 10 cm, and an RT dose of more than 42 Gy were favorable prognostic factors. No acute and late radiogenic side effects > Grade 2 (RTOG/EORTC) were observed, and particularly no secondary malignancies. In comparison, the literature review revealed a similar local control rate with a mean of 79%. This study comprises one of the largest databases of cases reported for RT in GCT. RT is an easy, save, and effective method of treatment in GCT. Total doses of minimum 42 Gy result in a better tumor control. RT is effective as an adjuvant measure and even in unresectable cases, RT gives satisfactory results and can be a reasonable alternative to mutilating surgery.