Operative therapie skeletaler komplikationen beim multiplen myelom

For multiple myelomas, with follow-up of more than 10 years in many cases, a permanent reconstruction should be sought during surgical treatment of osseous lesions. The general condition and long-term prognosis of the patient must be taken into consideration both by the choice of surgical method and the timing. A broad or even radical resection is not necessary for multiple myeloma for oncological reasons. The functional result depends strongly on the selected method of reconstruction. The operative treatment of pathological fractures of the extremities is superior to all conservative, radiotherapeutic and medicinal forms of treatment with respect to amelioration of pain, functional result and walking ability. After marginal or intralesional resection a sufficiently high-dose radiation therapy of the total operation area including the access routes must be carried out. Solitary plasmocytoma of bone offers the possibility of a local curative treatment by adequate resection and sufficient high-dose radiation therapy with knowledge of the exact extent and malignancy of the tumor, particularly for lesions of the peripheral skeleton. Further improvement of the serological and imaging diagnostics, in particular by the increased use of magnetic resonance imaging (MRI), will simplify the therapeutically important differentiation into solitary and systemic plasmocytoma, in order to avoid superfluous treatment by excessive resection and reconstruction of plasmocytomas which are already systemic.