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Der Klinikarzt 2016; 45(03): 148-151
DOI: 10.1055/s-0042-103299
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© Georg Thieme Verlag Stuttgart · New York

Strahlentherapie beim Lungenkarzinom – Teil eines interdisziplinären Therapiekonzeptes

Radiotherapy in lung cancer – Part of interdisciplinary therapies
Tobias Bölling
1   Zentrum für Strahlentherapie Rheine-Osnabrück, Franziskus-Hospital Harderberg, Georgsmarienhütte
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Publication History

Publication Date:
08 April 2016 (online)

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Die Strahlentherapie ist seit langem ein elementarer Bestandteil der interdisziplinären Therapie von Lungenkrebserkrankungen und bietet heutzutage durch eine Vielzahl technischer Innovationen eine große Bandbreite unterschiedlicher Therapieoptionen. Für kleinzellige Karzinome kommt die Bestrahlung als definitive Radiochemotherapie bei lokal begrenzten Tumoren zum Einsatz, in metastasierten Situationen mit Ansprechen auf eine Chemotherapie kann eine additive thorakale Bestrahlung mit prophylaktischer Hirnschädelbestrahlung einen Überlebensvorteil bringen. Der Stellenwert der prophylaktischen Schädelbestrahlung wird kontrovers diskutiert. Beim nicht-kleinzelligen Lungenkarzinom bieten stereotaktische Verfahren eine Alternative zur Operation im frühen Stadium, bei lokal fortgeschrittenen Erkrankungen ist die optimale Kombination aus Operation, Chemotherapie und Bestrahlung Gegenstand vielfältiger Diskussionen. Inoperable Tumore werden mit einer definitiven Radiochemotherapie, oder im Falle deutlicher Ko-Morbidität, mit einer alleinigen Bestrahlung behandelt. In der Palliativsituation kann die Bestrahlung zur Linderung von Symptomen wie Schmerz oder Bronchuskompression beitragen. Stereotaktische Bestrahlungen von Hirnmetastasen bieten hohe lokale Kontrollraten bei vergleichsweise geringer Morbidität. Entscheidend für die Therapie ist die Einbindung der Bestrahlung in ein interdisziplinäres Therapiekonzept.

Radiotherapy has played a pivotal role in interdisciplinary therapies of lung cancer for a long time and offers a broad variety of therapy options using a plenty of technical innovations. In patients suffering from small cell lung cancer (SCLC), radiotherapy in combination with chemotherapy is used in localized tumors. In metastasized patients who respond to chemotherapy, an additional thoracic radiation in combination with prophylactic cranial irradiation (PCI) prolongs survival. The value of PCI is under discussion. Early stages of non-small cell lung cancer (NSCLC) can be treated by surgery or stereotactic radiotherapy either, locally advanced diseases are treated with a combination of surgery, chemotherapy and radiation. However, timing and sequence of these approaches are discussed controversially. Tumors that cannot be removed surgically are treated by radiochemotherapy or (in case of co-morbidity) radiation alone. In palliative situations radiotherapy can be used to reduce symptoms like pain or compression of airways. Stereotactic radiation of brain metastases show high local control rates with little morbidity. Radiotherapy should be performed as part of an interdisciplinary therapy concept.

Key words

Lung cancer - radiotherapy - stereotactic irradiation - radiochemotherapy - palliative irradiation
 

  • Literatur

  • 1 van Loon J, De Ruysscher D, Wanders R et al. Selective nodal irradiation on basis of (18)FDG-PET scans in limited disease small-cell lung cancer: a prospective study. Int J Radiat Oncol Biol Phys 2010; 77: 329-336
    CrossrefPubMedGoogle Scholar
  • 2 De Ruysscher D, Pijls-Johannesma M, Bentzen SM et al. Time between the first day of chemotherapy and the last day of chest radiation is the most important predictor of survival in limited-disease small cell lung cancer. J Clin Oncol 2006; 23: 1057-1063
    PubMedGoogle Scholar
  • 3 Davey P, Ennis M, Aviv R. Prophylactic cranial irradiation (PCI). Still a no-brainer?. Lung cancer 2015; 89: 4-7
    CrossrefPubMedGoogle Scholar
  • 4 Slotman BJ, van Tinteren H, Praag JO et al. Use of thoracic radiotherapy for extensive stage small-cell lung cancer: a phase 3 randomised controlled trial. Lancet 2015; 385: 36-42
    CrossrefPubMedGoogle Scholar
  • 5 Seto T, Takahashi T, Yamanaka T et al. Prophylactic cranial irradiation (PCI) has a detrimental effect on the overall survival (OS) of patients (pts) with extensive disease small cell lung cancer (ED-SCLC): Results of a Japanese randomized phase III trial. J Clin Oncol abstr 7503 2014; 32 (Suppl. 01)
    PubMedGoogle Scholar
  • 6 Zimmermann FB, Geinitz H, Schill S et al. Stereotactic hypofractionated radiotherapy in stage I (T1-2 N0 M0) non-small-cell lung cancer (NSCLC). Acta Oncol 2006; 45: 796-801
    CrossrefPubMedGoogle Scholar
  • 7 Grills IS, Mangona VX, Welsh R et al. Outcomes after stereotactic lung radiotherapy or wedge resection for stage I non-small cell lung cancer. J Clin Oncol 2010; 28: 928-935
    CrossrefPubMedGoogle Scholar
  • 8 Chang JY, Senan S, Paul MA et al. Stereotactic ablative radiotherapy versus lobectomy for operable stage I non-small-cell-lung cancer: a pooled analysis of two randomised trials. Lancet Oncol 2015; 16: 630-637
    CrossrefPubMedGoogle Scholar
  • 9 Inoue T, Shimizu S, Onimaru R et al. Clinical outcomes of stereotactic body radiotherapy for small lung lesions clinically diagnosed as primary lung cancer on radiologic examination. Int J Radiat Oncol Biol Phys 2009; 75: 683-687
    CrossrefPubMedGoogle Scholar
  • 10 Eberhardt WEE, Pöttgen C, Gauler TC et al. Phase III study of surgery versus definitive concurrent chemoradiotherapy boost in patients with resectable stage IIIA (N2) and selected IIIB non-small-cell lung cancer after induction chemotherapy and concurrent chemoradiotherapy (ESPATUE). J Clin Oncol published ahead of print. DOI: 10.1200/JCO.2015.62.6812. 2013; 33
    PubMedGoogle Scholar
  • 11 Thomas M, Rübe C, Hoffknecht P et al. Effect of preoperative chemoradiation in addition to preoperative chemotherapy: a randomized trial in stage III non-small-cell lung cancer. Lancet Oncol 2008; 9: 607-608
    CrossrefPubMedGoogle Scholar
  • 12 Shah AA, Berry MF, Tzao C et al. Induction chemoradiation is not superior to induction chemotherapy alone in stage IIIa lung cancer. Ann Thorac Surg 2012; 93: 1807-1812
    CrossrefPubMedGoogle Scholar
  • 13 Bradley JD, Paulus R, Komaki R et al. Standard-dose versus high-dose conformal radiotherapy with concurrent and consolidation carboplatin plus paclitaxel with or without cetuximab for patients with stage IIIA or IIIB non-small-cell lung cancer (RTOG 0617): a randomised, two-by-two factorial phase 3 study. Lancet Oncol 2015; 16: 187-199
    CrossrefPubMedGoogle Scholar
  • 14 Yuan S, Sun X, Li M et al. A randomized study of involved-field irradiation versus elective nodal irraidation in combination with concurrent chemotherapy for inoperable stage III nonsmall cell lung cancer. Am J Clin Oncol 2007; 30: 239-244
    CrossrefPubMedGoogle Scholar
  • 15 Kocher M, Soffietti R, Abacioglu U et al. Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952-26001 study. J ClinOncol 2011; 29: 134-141
    CrossrefPubMedGoogle Scholar