Multimodale Therapie des kleinzelligen und nichtkleinzelligen Lungenkarzinoms

Zusammenfassung

Kleinzellige Lungenkarzinome (SCLC) sprechen gut und schnell auf eine Chemotherapie an, daher ist die Chemotherapie Therapie der Wahl beim SCLC. An der Standardchemotherapie Platin/Etoposid hat sich im letzten Jahrzehnt nichts geändert. Bei nur lokal ausgedehnter Erkrankung (LD) sollte die Chemotherapie um die Bestrahlung ergänzt werden. Nichtkleinzellige Lungenkarzinome werden stadienadaptiert behandelt: in den frühen Stadien I und II wird operiert und adjuvant chemotherapiert, im lokal fortgeschrittenen Stadium III multimodal behandelt mit Bestrahlung und Chemotherapie, wenn möglich auch operiert, im Stadium IV wird in palliativer Absicht chemotherapiert. Neue biologisch zielgerichtete „targeted” Therapien sind in der Zweitlinientherapie etabliert und werden zukünftig das therapeutische Spektrum, auch in der Erstlinientherapie, bereichern. Die kurativen Chancen beim Lungenkarzinom sind gering mit einem Gesamt-5-Jahresüberleben von 15 %. Viele Patienten bedürfen daher einer palliativen Bestrahlung und einer intensiven symptomatische Therapie von nikotinassoziierten oder tumorbedingten pulmonal-funktionellen Einschränkungen.

Abstract

Lung cancer is divided into two types: non-small cell and small cell lung cancer. Small-cell lung cancer is a very aggressive rapid growing tumour type treated primarily with chemotherapy and, in the minority of patients with limited disease, with radiotherapy. Non-small cell lung cancer is treated in a multidisciplinary way with surgery, radiotherapy and chemotherapy depending on stage. Surgery is the mainstay of treatment for early stage non-small cell lung cancer patients. Adjuvant therapy has become state of the art in stage II and IIIA patients and must be considered in stage IB. Stage III patients should be treated in a multimodal way with radiotherapy and chemotherapy, and, if possible, with surgery. Treatment for every stage III patient should be discussed in a multidisciplinary team. Stage IV patients in good performance status will benefit from a combination chemotherapy, preferably platinum-based. Second line therapy has become standard and targeted therapies are under evaluation and are common in second line chemotherapy.

Schlüsselwörter

kleinzelliges Lungenkarzinom - nichtkleinzelliges Lungenkarzinom - Chemotherapie - Radiochemotherapie

Key words

small cell lung cancer - non small cell lung cancert - chemotherapy - radiochemotherapy

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