Potenziell kurative chirurgische Therapie beim oligometastasierten nicht-kleinzelligen Lungenkarzinom

Zusammenfassung

Das nicht-kleinzellige Lungenkarzinom ist eine der häufigsten Krebserkrankungen weltweit und damit auch eine der häufigsten krebsbedingten Todesursachen. Bei Erstdiagnose haben bereits rund 40 % aller Patienten Fernmetastasen (Tumorstadium UICC IV) und werden mit einer palliativen systemischen Chemotherapie und/oder Tyrosinkinase-Inhibition behandelt. Eine kleine Gruppe dieser Patienten weist jedoch nur eine einzige Fernmetastase auf. Diese kann synchron oder erst metachron auftreten und intrathorakal oder extrathorakal liegen. Im Gegensatz zu multiplen Metastasen, die Ausdruck einer diffusen systemischen Erkrankung sind und dementsprechend einer systemischen Therapie bedürfen, kann man das Auftreten singulärer Metastasen als noch begrenzte Erkrankung auffassen. Durch lokale Exzision der Metastasen und des Primärtumors haben die Patienten eine Chance auf Heilung. Eine Resektion des Primärtumors und der singulären Metastase kann die Überlebenswahrscheinlichkeit in vielen Fällen deutlich verbessern.

Abstract

Lung cancer is a leading cause of cancer related death worldwide. Non-small cell lung cancer (NSCLC) represents 85 % of all lung cancer cases and approximately 40 % of all patients impress with a metastatic disease at the time of diagnosis. Stage IV NSCLC has a poor prognosis and is incurable. The recommended standard therapy in this case is a palliative supportive systemic chemotherapy. However, a distinctive subgroup of patients with stage IV NSCLC appear clinically with an oligometastatic disease and may qualify for surgical therapy. There is evidence that patients with synchronous or metachronus solitary satellite nodules, either located intrapulmonary or extrapulmonary, benefit from surgical resection.

Schlüsselwörter

nicht-kleinzelliges Lungenkarzinom Stadium IV - NSCLC - singuläre Metastase - Resektion

Keywords

non-small cell lung cancer stage IV - NSCLC - single metastasis - resection

• Literatur

• 1 Abdel-Raheem MM, Potti A, Becker WK et al. Late adrenal metastasis in operable non-small-cell lung carcinoma. Am J Clin Oncol 2002; 25: 81-83
• 2 Ambrogi V, Tonini G, Mineo TC. Prolonged survival after extracranial metastasectomy from synchronous resectable lung cancer. Ann Surg Oncol 2001; 8: 663-666
• 3 Anagnostis P, Karagiannis A, Tziomalos K et al. Adrenal incidentaloma: a diagnostic challenge. Hormones (Athens) 2009; 8: 163-184
• 4 Beitler AL, Urschel JD, Velagapudi SR et al. Surgical management of adrenal metastases from lung cancer. J Surg Oncol 1998; 69: 54-57
• 5 Billing PS, Miller DL, Allen MS et al. Surgical treatment of primary lung cancer with synchronous brain metastases. J Thorac Cardiovasc Surg 2001; 122: 548-553
• 6 Bonnette P, Puyo P, Gabriel C et al. Surgical management of non-small cell lung cancer with synchronous brain metastases. Chest 2001; 119: 1469-1475
• 7 Chang YL, Wu CT, Lee YC. Surgical treatment of synchronous multiple primary lung cancers: experience of 92 patients. J Thorac Cardiovasc Surg 2007; 134: 630-637
• 8 Chao JH, Phillips R, Nickson JJ. Roentgen-ray therapy of cerebral metastases. Cancer 1954; 7: 682-689
• 9 De Leyn P, Moons J, Vansteenkiste J et al. Survival after resection of synchronous bilateral lung cancer. Eur J Cardiothorac Surg 2008; 34: 1215-1222
• 10 Downey RJ, Ng KK, Kris MG et al. A phase II trial of chemotherapy and surgery for non-small cell lung cancer patients with a synchronous solitary metastasis. Lung Cancer 2002; 38: 193-197
• 11 Ettinghausen SE, Burt ME. Prospective evaluation of unilateral adrenal masses in patients with operable non-small-cell lung cancer. J Clin Oncol 1991; 9: 1462-1466
• 12 Feliciotti F, Paganini AM, Guerrieri M et al. Laparoscopic anterior adrenalectomy for the treatment of adrenal metastases. Surg Laparosc Endosc Percutan Tech 2003; 13: 328-333
• 13 Flickinger JC, Kondziolka D, Lunsford LD et al. A multi-institutional experience with stereotactic radiosurgery for solitary brain metastasis. Int J Radiat Oncol Biol Phys 1994; 28: 797-802
• 14 Fuller BG, Kaplan ID, Adler J et al. Stereotaxic radiosurgery for brain metastases: the importance of adjuvant whole brain irradiation. Int J Radiat Oncol Biol Phys 1992; 23: 413-418
• 15 Furak J, Trojan I, Szoke T et al. Lung cancer and its operable brain metastasis: survival rate and staging problems. Ann Thorac Surg 2005; 79: 241-247; discussion 241-247
• 16 Girard N, Deshpande C, Lau C et al. Comprehensive histologic assessment helps to differentiate multiple lung primary nonsmall cell carcinomas from metastases. Am J Surg Pathol 2009; 33: 1752-1764
• 17 Girard N, Ostrovnaya I, Lau C et al. Genomic and mutational profiling to assess clonal relationships between multiple non-small cell lung cancers. Clin Cancer Res 2009; 15: 5184-5190
• 18 Goldstraw P, Crowley J, Chansky K et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours. J Thorac Oncol 2007; 2: 706-714
• 19 Hooper RG, Tenholder MF, Underwood GH et al. Computed tomographic scanning of the brain in initial staging of bronchogenic carcinoma. Chest 1984; 85: 774-776
• 20 Iwasaki A, Shirakusa T, Yoshinaga Y et al. Evaluation of the treatment of non-small cell lung cancer with brain metastasis and the role of risk score as a survival predictor. Eur J Cardiothorac Surg 2004; 26: 488-493
• 21 Jemal A, Siegel R, Xu J et al. Cancer statistics, 2010. CA Cancer J Clin 2010; 60: 277-300
• 22 Khan AJ, Mehta PS, Zusag TW et al. Long term disease-free survival resulting from combined modality management of patients presenting with oligometastatic, non-small cell lung carcinoma (NSCLC). Radiother Oncol 2006; 81: 163-167
• 23 Kim HK, Choi YS, Kim K et al. Preoperative evaluation of adrenal lesions based on imaging studies and laparoscopic adrenalectomy in patients with otherwise operable lung cancer. Lung Cancer 2007; 58: 342-347
• 24 Kumar R, Xiu Y, Yu JQ et al. 18F-FDG PET in evaluation of adrenal lesions in patients with lung cancer. J Nucl Med 2004; 45: 2058-2062
• 25 Lassman AB, DeAngelis LM. Brain metastases. Neurol Clin 2003; 21: 1-23, vii
• 26 Macchiarini P, Buonaguidi R, Hardin M et al. Results and prognostic factors of surgery in the management of non-small cell lung cancer with solitary brain metastasis. Cancer 1991; 68: 300-304
• 27 Mansmann G, Lau J, Balk E et al. The clinically inapparent adrenal mass: update in diagnosis and management. Endocr Rev 2004; 25: 309-340
• 28 Marsh JC, Gielda BT, Herskovic AM et al. Cognitive sparing during the administration of whole brain radiotherapy and prophylactic cranial irradiation. J Oncol 2010; 2010: 198208
• 29 Martini N, Melamed MR. Multiple primary lung cancers. J Thorac Cardiovasc Surg 1975; 70: 606-612
• 30 Mintz BJ, Tuhrim S, Alexander S et al. Intracranial metastases in the initial staging of bronchogenic carcinoma. Chest 1984; 86: 850-853
• 31 Mountain CF. Revisions in the International System for Staging Lung Cancer. Chest 1997; 111: 1710-1717
• 32 Mussi A, Pistolesi M, Lucchi M et al. Resection of single brain metastasis in non-small-cell lung cancer: prognostic factors. J Thorac Cardiovasc Surg 1996; 112: 146-153
• 33 Patchell RA, Tibbs PA, Walsh JW et al. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 1990; 322: 494-500
• 34 Pirzkall A, Debus J, Lohr F et al. Radiosurgery alone or in combination with whole-brain radiotherapy for brain metastases. J Clin Oncol 1998; 16: 3563-3569
• 35 Plönes T, Osei-Agyemang T, Krohn A et al. Surgical treatment of extrapulmonary oligometastatic non-small cell lung cancer. Indian J Surg 2012; 1-5
• 36 Porte HL, Roumilhac D, Graziana JP et al. Adrenalectomy for a solitary adrenal metastasis from lung cancer. Ann Thorac Surg 1998; 65: 331-335
• 37 Quint LE, Tummala S, Brisson LJ et al. Distribution of distant metastases from newly diagnosed non-small cell lung cancer. Ann Thorac Surg 1996; 62: 246-250
• 38 Ramalingam S, Belani C. Systemic chemotherapy for advanced non-small cell lung cancer: recent advances and future directions. Oncologist 2008; 13 (Suppl. 01) 5-13
• 39 Richards P, Mc KW. Intracranial metastases. Br Med J 1963; 1: 15-18
• 40 Rostad H, Strand TE, Naalsund A et al. Resected synchronous primary malignant lung tumors: a population-based study. Ann Thorac Surg 2008; 85: 204-209
• 41 Soffietti R, Ruda R, Mutani R. Management of brain metastases. J Neurol 2002; 249: 1357-1369
• 42 Tanvetyanon T, Robinson LA, Schell MJ et al. Outcomes of adrenalectomy for isolated synchronous versus metachronous adrenal metastases in non-small-cell lung cancer: a systematic review and pooled analysis. J Clin Oncol 2008; 26: 1142-1147
• 43 Thompson GB, Grant CS, van Heerden JA et al. Laparoscopic versus open posterior adrenalectomy: a case-control study of 100 patients. Surgery 1997; 122: 1132-1136
• 44 Trousse D, Barlesi F, Loundou A et al. Synchronous multiple primary lung cancer: an increasing clinical occurrence requiring multidisciplinary management. J Thorac Cardiovasc Surg 2007; 133: 1193-1200
• 45 Vansteenkiste JF, De Belie B, Deneffe GJ et al. Practical approach to patients presenting with multiple synchronous suspect lung lesions: a reflection on the current TNM classification based on 54 cases with complete follow-up. Lung Cancer 2001; 34: 169-175
• 46 Vecht CJ, Haaxma-Reiche H, Noordijk EM et al. Treatment of single brain metastasis: radiotherapy alone or combined with neurosurgery?. Ann Neurol 1993; 33: 583-590
• 47 Voltolini L, Rapicetta C, Luzzi L et al. Surgical treatment of synchronous multiple lung cancer located in a different lobe or lung: high survival in node-negative subgroup. Eur J Cardiothorac Surg 2010; 37: 1198-1204
• 48 Weiss MM, Kuipers EJ, Meuwissen SG et al. Comparative genomic hybridisation as a supportive tool in diagnostic pathology. J Clin Pathol 2003; 56: 522-527
• 49 William Jr WN, Lin HY, Lee JJ et al. Revisiting stage IIIB and IV non-small cell lung cancer: analysis of the surveillance, epidemiology, and end results data. Chest 2009; 136: 701-709
• 50 Wronski M, Arbit E, Burt M et al. Survival after surgical treatment of brain metastases from lung cancer: a follow-up study of 231 patients treated between 1976 and 1991. J Neurosurg 1995; 83: 605-616
• 51 Yoshino I, Yohena T, Kitajima M et al. Survival of non-small cell lung cancer patients with postoperative recurrence at distant organs. Ann Thorac Cardiovasc Surg 2001; 7: 204-209
• 52 Granone P, Margaritora S, D'Andrilli A et al. Non-small cell lung cancer with single brain metastasis: the role of surgical treatment. Eur J Cardiothorac Surg 2001; 20: 361-366