Lokaltherapie im Stadium IV bei Oligopersistenz oder Progression

Zusammenfassung

Oligopersistenz und Oligoprogress stellen definierte Situationen des metastasierten Lungenkarzinoms dar. Oligopersistenz bedeutet das Verbleiben weniger Metastasen unter einer wirksamen Systemtherapie. Unter Oligoprogress versteht man eine weitgehend kontrollierte Tumorerkrankung mit einigen Metastasen, die einen erneuten Progress aufweisen. In der Situation Oligopersistenz soll durch ergänzende lokal ablative Maßnahmen aller verbliebenen Läsionen eine vollständige Tumorkontrolle mit Verbesserung der Prognose bis zur Heilung erzielt werden. In der Situation Oligoprogress zielen lokal ablative Maßnahmen darauf ab, erneut eine vollständige Kontrolle der Tumorerkrankung unter Fortführung der etablierten Systemtherapie herzustellen. Die Konzepte gehen auf Überlegungen zurück, die bereits vor mehr als 30 Jahren unter dem Begriff der Oligometastasierung von Hellman und Weichselbaum in der Onkologie eingeführt wurden. Insbesondere durch zielgerichtete Therapien des molekular alterierten Lungenkarzinoms und Chemo-Immuntherapie-Regime mit hohen Ansprechraten und langer Ansprechdauer haben multimodale Therapiekonzepte in der Situation der Oligopersistenz und Oligoprogression an Bedeutung gewonnen. Es wird die verfügbare Evidenz dargelegt und durch Fallbeispiele aus dem eigenen Zentrum ergänzt.

Abstract

Oligopersistent and oligoprogressive disease are defined as distinct situations of metastastatic lung cancer. Oligopersistence describes a situation in which a limited number of metastases remain following effective systemic therapy. Oligoprogression represents a largely controlled tumour disease with a few metastases showing significant progression. In the oligopersistence, treatment aims to establish complete tumour control with subsequent improvement of the prognosis by means of additional local ablative treatment of all remaining lesions. In the oligoprogressive situation, local ablative treatment aims to reestablish complete tumour control while continuing systemic therapy. The concepts are based on ideas that were introduced in oncology more than 30 years ago by Hellman and Weichselbaum by using the term oligometastases. Multimodal therapy concepts have gained importance in the situation of oligopersistence and oligoprogression, particularly due to molecular targeted therapies for oncogene-driven lung cancer and chemo-immunotherapy regimes with high response rates and long response duration. The available evidence will be presented and explained by case studies.

Schlüsselwörter

Lungenkarzinom - Oligopersistenz - Oligoprogression

Keywords

lung cancer - oligopersistence - oligoprogression

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