Der Radiologe

, Volume 57, Issue 2, pp 97–104 | Cite as

Lokaltherapie solitärer intrapulmonaler maligner Rundherde

  • J. Op den Winkel
  • F. Eichhorn
  • S. Rieken
  • H. Dienemann
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Zusammenfassung

Definition

Intrapulmonale Rundherde stellen in der Regel einen Zufallsbefund im Röntgenbild oder Computertomogramm des Thorax dar. Sie sind definiert als relativ gut abgegrenzte Läsionen von bis zu 3 cm Durchmesser, die allseits von Lungengewebe umgeben sind. Die Wahrscheinlichkeit für das Vorliegen eines malignen Tumors steigt mit ihrer Größe. Rundherde ab 1 cm Durchmesser bedürfen der aktiven Abklärung.

Therapie

Zur Behandlung solitärer maligner Tumoren steht für Patienten ohne nennenswert erhöhtes Operations- und Narkoserisiko der chirurgische Eingriff an erster Stelle. Patienten, die aus funktionellen Gründen für einen solchen nicht geeignet sind, können mit Radiofrequenzablation (RFA) oder Einzeitbestrahlung (SBRT) behandelt werden. In diesen Fällen müssen vor Therapiebeginn die Malignität nachgewiesen oder zumindest über einen begrenzten Zeitraum eine Größenzunahme der Läsion dokumentiert worden sein.

Outcome

In Bezug auf die lokale Tumorfreiheit ist die Operation unter den Voraussetzungen einer R0-Resektion den anderen Verfahren überlegen.

Schlüsselwörter

Lungenkrebs Lungenrundherd Operation Radiofrequenzablation Einzeitbestrahlung 

Local treatment of solitary intrapulmonary, malignant nodules

Abstract

Definition

Intrapulmonary nodules generally represent an incidental finding in the roentgenogram or computed tomography (CT) scan of the chest. They are defined as single, well-circumscribed, radiographic opaque lesions that measures up to 3 cm in diameter and are surrounded completely by aerated lung. The probability of malignancy directly correlates with increasing diameter. Lesions that have a diameter of 1 cm or larger require direct evaluation.

Therapy

Surgery is the first option for patients with a malignant lesion, given an acceptable perioperative risk; for high-risk patients either radiofrequency ablation (RFA) or stereotactic body radiation therapy (SBRT) should be offered. In these cases the malignant histology has to be established beforehand or verified by radiologic proven growth.

Outcome

Complete surgical resection is superior to RFA and SBRT with respect to local tumor control.

Keywords

Cancer of the lung Pulmonary coin lesion Surgery Catheter ablation Stereotactic body radiotherapy 
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Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

J. Op den Winkel, F. Eichhorn und H. Dienemann geben an, dass kein Interessenkonflikt besteht. S. Rieken erhielt Vortragshonorare sowie Kostenerstattungen für Kongressreisen und -teilnahmen von ELEKTA, Accuray, AstraZeneca, Brystol Myers Squibb, DGP, DKG, DEGRO und dem Berufsverband der Pharmaberater.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag Berlin 2016

Authors and Affiliations

  • J. Op den Winkel
    • 1
  • F. Eichhorn
    • 1
  • S. Rieken
    • 2
  • H. Dienemann
    • 1
    • 3
  1. 1.Abteilung Thoraxchirurgie, ThoraxklinikUniversitätsklinikum HeidelbergHeidelbergDeutschland
  2. 2.Klinik für Strahlentherapie und RadioonkologieUniversitätsklinikum HeidelbergHeidelbergDeutschland
  3. 3.TLRC-H – Translational Lung Research Center HeidelbergHeidelbergDeutschland

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