Perspektiven in Diagnostik und Therapie des oligometastasierten Lungenkarzinoms

Zusammenfassung

Das Stadium der Oligometastasierung ist definiert als eine klinisch und radiologisch an Anzahl und Tumorvolumen limitierte und im Verlauf stabile Metastasierung. Ist das Metastasierungsausmaß auf 1 oder 2 Organsysteme und die Anzahl der Metastasen auf maximal 5 Metastasen begrenzt, so können unterschiedliche lokal ablative Verfahren, wie die chirurgische Resektion und stereotaktische Strahlentherapie, ihre Berechtigung haben. Die biologischen Grundlagen der Oligometastasierung als eines intermediären Tumorstadiums sind heute noch weitestgehend unverstanden. Da aussagekräftige prädiktive Biomarker fehlen, beruht die Patientenauswahl weiterhin auf etablierten klinischen Prognosefaktoren. Hierzu zählen der thorakale Lymphknotenstatus des primären Lungenkarzinoms und das zeitliche Auftreten der Metastasierung als synchron oder metachron. Vor jeder Operation oder lokal ablativen Strahlentherapie mit kurativem Ansatz muss stets eine weitergehende Polymetastasierung mittels FDG-PET/CT und MRT des Schädels ausgeschlossen werden. Neben publizierten retrospektiven Fallserien finden sich aktuell 3 prospektiv randomisierte Studien, die einen signifikanten Behandlungsvorteil hinsichtlich des progressionsfreien Überlebens der Patienten mit lokal ablativer Therapie gegenüber der Vergleichskohorte belegen. Ein günstiger Effekt auf das Langzeitüberleben nach lokal ablativer Therapie ist ebenso wahrscheinlich. Zur zukünftigen Festlegung des Stellenwertes lokal ablativer Verfahren innerhalb moderner onkologischer Therapiekonzepte unter Einschluss der Immuntherapie und molekular stratifizierter Behandlungen sind weitere Phase III-Studien in Entwicklung.

Abstract

Oligometastatic disease is defined as an intermediary disease state with a limited number and volume of metastatic lesions. In the presence of five or fewer lesions, confined to two or fewer organ systems, local ablative therapy including stereotactic radiotherapy and surgical resection, may be justified. The biological bases of this intermediary disease state are not entirely understood. In the absence of reliable biomarkers, patient selection for local ablative therapy still relies on such clinical prognostic factors as thoracic lymph node status and whether the metastases in question are synchronous or metachronous. Any local ablative intervention – whether surgical resection or stereotacic radiotherapy – must be preceded by FDG-PET/CT and cMRT to exclude frank metastatic disease. In addition to various retrospective case studies, three prospective randomized studies suggest significantly greater progression free survival following local ablative therapy. A positive effect on overall survival seems just as likely. In the age of immune therapies and treatment stratification based on molecular markers the future of local ablative treatments in the context of modern oncology is not entirely well defined; further phase III studies are being developed.

Schlüsselwörter

lokal ablative Therapie - Oligometastasierung - Lungenkarzinom - Thoraxonkologie

Keywords

local ablative therapy - oligometastases - lung cancer - thoracic oncology

Publication History

Article published online:
08 April 2021

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