Lungenkrebsscreening aktuell – Wo stehen wir 2013?

Zusammenfassung

Das Lungenkarzinom ist eine der führenden Todesursachen in Europa und den USA. Eine relativ gute Prognose bleibt jenen Patienten vorbehalten, bei denen das Lungenkarzinom in einem frühen Stadium entdeckt wird. Da das Lungenkarzinom sich jedoch erst sehr spät in seinem Verlauf durch klinische Symptome bemerkbar macht, sind die meisten Patienten zum Zeitpunkt der Diagnose in einem weit fortgeschrittenen Tumorstadium und können daher nur noch palliativ behandelt werden. Aus diesem Grund könnte eine Frühdiagnose durch Screening Leben retten. Das National Lung Screening Trial (NLST) konnte in einer prospektiven randomisierten Studie zeigen, dass durch ein Screening mit einer Niedrigdosis-CT (low dose, LD-CT) die Lungenkarzinommortalität um 20,0 % gesenkt werden kann. Die überaus positiven Daten des NLST konnten bisher nicht durch die ersten Daten der noch laufenden europäischen Studien bestätigt werden. Wenn auch die europäischen Studien eine Mortalitätsverbesserung durch ein LD-CT-Screening zeigen sollten, so müssen vor der Implementierung von Screeningprogrammen eine Reihe von Fragen beantwortet werden. Allen voran die genaue Definition jener Personengruppe, die am meisten von einem Screening profitieren würde und die Frage nach der Abklärung der vielen im Screening gefundenen Rundherde, von denen der größte Teil benigne ist. In diesem Review-Artikel werden die Resultate der NLST und der ersten Daten der europäischen Studien zusammengefasst und die noch offenen Fragen diskutiert.

Abstract

Lung cancer is one of the leading causes of death in Europe and the USA. A relatively good prognosis is limited to those patients in whom the tumor is detected at an early stage. As clinical symptoms of lung cancer are a late finding in the natural course of the disease, most of the patients are diagnosed at an advanced tumor stage when palliative care remains the only therapeutic option. For this reason, early diagnosis of lung cancer might save lives. The National Lung Screening Trial (NLST), in the U. S. A., provided evidence that screening with low-dose CT (LD-CT) is able to reduce lung cancer mortality by 20.0 %. The encouraging results of the NLST, however, could not be confirmed by the preliminary results of ongoing European trials. Even if the European trials are able to confirm a reduction in lung cancer mortality by LD-CT, a number of important questions must be answered before the implementation of nationwide screening programs. First of all, the population that might benefit from CT lung cancer screening has to be defined precisely. Furthermore, guidelines have to be established about how to manage screening participants with detected lung nodules, as the vast majority of these pulmonary nodules will prove to be benign. This review article summarizes the results of the NLST and the initial data from the European screening trials, and will discuss some of the major open questions in lung cancer screening with CT.

Schlüsselwörter

Screening - Lungenkarzinom - bildgebende Verfahren

Key words

screening - lung cancer - imaging

• Literatur

• 1 de Hoop B, Schaefer-Prokop C, Gietema HA et al. Screening for lung cancer with digital chest radiography: sensitivity and number of secondary work-up CT examinations. Radiology 2010; 255: 629-637
• 2 Brett GZ. The value of lung cancer detection by six-monthly chest radiographs. Thorax 1968; 23: 414-420
• 3 Wilde J. A 10 year follow-up of semi-annual screening for early detection of lung cancer in the Erfurt County, GDR. Eur Respir J 1989; 2: 656-662
• 4 Frost JK, Ball jr. WC, Levin ML et al. Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Johns Hopkins study. Am Rev Respir Dis 1984; 130: 549-554
• 5 Fontana RS, Sanderson DR, Taylor WF et al. Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Mayo Clinic study. Am Rev Respir Dis 1984; 130: 561-565
• 6 Kubik A, Polak J. Lung cancer detection. Results of a randomized prospective study in Czechoslovakia. Cancer 1986; 57: 2427-2437
• 7 Diederich S, Wormanns D, Heindel W. Lung cancer screening with low-dose CT. Eur J Radiol 2003; 45: 2-7
• 8 Henschke CI, McCauley DI, Yankelevitz DF et al. Early Lung Cancer Action Project: overall design and findings from baseline screening. Lancet 1999; 354: 99-105
• 9 Nawa T, Nakagawa T, Kusano S et al. Lung cancer screening using low-dose spiral CT: results of baseline and 1-year follow-up studies. Chest 2002; 122: 15-20
• 10 Chong S, Lee KS, Chung MJ et al. Lung cancer screening with low-dose helical CT in Korea: experiences at the Samsung Medical Center. J Korean Med Sci 2005; 20: 402-408
• 11 New York Early Lung Cancer Action Project Investigators. CT Screening for lung cancer: diagnoses resulting from the New York Early Lung Cancer Action Project. Radiology 2007; 243: 239-249
• 12 Aberle DR, Adams AM, Berg CD et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011; 365: 395-409
• 13 Wender R, Fontham ET, Barrera jr. E et al. American Cancer Society lung cancer screening guidelines. CA Cancer J Clin 2013; 63: 107-117
• 14 Detterbeck FC, Mazzone PJ, Naidich DP et al. Screening for lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143: e78S-92S
• 15 National Lung Screening Trial Research Team. The National Lung Screening Trial: overview and study design. Radiology 2011; 258: 243-253
• 16 Bach PB, Mirkin JN, Oliver TK et al. Benefits and harms of CT screening for lung cancer: a systematic review. JAMA 2012; 307: 2418-2429
• 17 Infante M, Cavuto S, Lutman FR et al. A randomized study of lung cancer screening with spiral computed tomography: three-year results from the DANTE trial. Am J Respir Crit Care Med 2009; 180: 445-453
• 18 Pastorino U, Rossi M, Rosato V et al. Annual or biennial CT screening versus observation in heavy smokers: 5-year results of the MILD trial. Eur J Cancer Prev 2012; 21: 308-315
• 19 Saghir Z, Dirksen A, Ashraf H et al. CT screening for lung cancer brings forward early disease. The randomised Danish Lung Cancer Screening Trial: status after five annual screening rounds with low-dose CT. Thorax 2012; 67: 296-301
• 20 van Klaveren RJ, Oudkerk M, Prokop M et al. Management of lung nodules detected by volume CT scanning. N Engl J Med 2009; 361: 2221-2229
• 21 Aberle DR, Abtin F, Brown K. Computed tomography screening for lung cancer: has it finally arrived? Implications of the national lung screening trial. J Clin Oncol 2013; 31: 1002-1008
• 22 Baldwin DR, Duffy SW, Wald NJ et al. UK Lung Screen (UKLS) nodule management protocol: modelling of a single screen randomised controlled trial of low-dose CT screening for lung cancer. Thorax 2011; 66: 308-313
• 23 Cassidy A, Myles JP, van Tongeren M et al. The LLP risk model: an individual risk prediction model for lung cancer. Br J Cancer 2008; 98: 270-276
• 24 Tammemagi MC, Katki HA, Hocking WG et al. Selection criteria for lung-cancer screening. N Engl J Med 2013; 368: 728-736
• 25 Infante M, Lutman FR, Cavuto S et al. Lung cancer screening with spiral CT: baseline results of the randomized DANTE trial. Lung Cancer 2008; 59: 355-363
• 26 van den Bergh KA, Essink-Bot ML, Bunge EM et al. Impact of computed tomography screening for lung cancer on participants in a randomized controlled trial (NELSON trial). Cancer 2008; 113: 396-404
• 27 Lopes Pegna A, Picozzi G, Mascalchi M et al. Design, recruitment and baseline results of the ITALUNG trial for lung cancer screening with low-dose CT. Lung Cancer 2009; 64: 34-40
• 28 Pedersen JH, Ashraf H, Dirksen A et al. The Danish randomized lung cancer CT screening trial–overall design and results of the prevalence round. J Thorac Oncol 2009; 4: 608-614
• 29 Pastorino U, Bellomi M, Landoni C et al. Early lung-cancer detection with spiral CT and positron emission tomography in heavy smokers: 2-year results. Lancet 2003; 362: 593-597
• 30 Becker N, Motsch E, Gross ML et al. Randomized study on early detection of lung cancer with MSCT in Germany: study design and results of the first screening round. J Cancer Res Clin Oncol 2012; 138: 1475-1486