[Percutaneous radiotherapy--indications for and differentiation from surgical treatment of metastases]

One third up to half of the patients treated by the radiation oncologist are referred for palliative radiation therapy because of distant metastases, mostly for painful bone or symptomatic brain metastases. As malignant cells are often disseminating long before diagnosis and therapy of the primary tumor, solitary metastases occur very seldom. A single and good resectable brain metastasis is a well-known indication for surgical intervention, especially at infratentorial location. In spherical metastases below a size of 3 cm stereotaxic radio-surgery can be alternatively considered, especially at paramedian location. Bone metastases need more often a surgical therapy, e.g. an impending or already happened fracture of long hollow bones, or radio-resistent tumors of hands and feet. Surgical therapy of metastatic vertebrae are often demanding enormous efforts and skills. Indications for surgery are osteolytical metastases with potential static problems, highly advanced destruction and most of all symptoms of spinal cord compression. The radiation oncologist is well advised to make sure of the surgeon's partnership in regard to the treatment of metastases.