Der Onkologe

, Volume 16, Issue 6, pp 615–628

Lungenkarzinom

CME Weiterbildung · Zertifizierte Fortbildung

Zusammenfassung

Das Lungenkarzinom ist weltweit die am häufigsten zum Tode führende Krebserkrankung. Da Frühsymptome des Tumors extrem selten sind, liegt bei sich symptomatisch vorstellenden Patienten meist ein fortgeschrittenes Tumorstadium vor. Anhand einer strukturierten Diagnostik wird der Tumor klassifiziert und einer entsprechenden Therapie zugeführt. Bei lokoregional begrenztem nichtkleinzelligem Bronchialkarzinom (NSCLC) ist die chirurgische Therapie indiziert. Nach kompletter Tumorresektion im Stadium (IB)–II sowie im inzidentellen Stadium IIIA sollte eine platinbasierte adjuvante Kombinationschemotherapie empfohlen werden. Eine definitive Radiochemotherapie ist bei prognostisch inoperablem, lokal fortgeschrittenem, nichtkleinzelligem Lungenkarzinom Standardtherapie. Die Rolle der „targeted“-Therapie wird intensiv untersucht.

Schlüsselwörter

Lungenkarzinom Zigarettenrauchen Tumorstadium  Nichtkleinzelliges Lungenkarzinom (NSCLC) Multimodale Therapie 

Non-small cell lung cancer

Abstract

Lung cancer is the most frequent form of cancer leading to death worldwide. Since early symptoms of the tumor are extremely rare, advanced tumor stage can as a rule be assumed when a patient presents with symptoms. The tumor is classified on the basis of structured diagnostic findings, followed by the appropriate treatment. Surgery is indicated for locoregionally circumscribed non-small cell lung cancer (NSCLC). After complete tumor resection in stage IB, IIA and IIIA (incidental), adjuvant platinum-based combination chemotherapy is recommended. Definitive radiochemotherapy is the standard treatment for patients with locally advanced non-small cell lung cancer deemed inoperable based on prognosis. The role of targeted therapy is currently the subject of intensive investigation.

Keywords

Lung cancer Cigarette smoking Tumor stage Non-small lung cell carcinoma (NSCLC) Multimodal treatment 

Literatur

  1. 1.
    Adamietz IA (2010) NSCLC: Palliative procedures in stage IV. Radiotherapy. In: Heide J, Schmittel A, Kaiser D, Hinkelbein W (eds) Controversies in the treatment of lung cancer. Karger, Basel, pp 164–172Google Scholar
  2. 2.
    Albain KS, Jablons D, Werner-Wasik A et al (2006) Stage II non-small-cell lung cancer. Tailored therapies for a complex disease. Educational Book. American Society of Clinical Oncology, Alexandria, 453–462Google Scholar
  3. 3.
    Albain KS, Swann RS, Rusch VW et al (2009) Radiotherapy plus chemotherapy with or without surgical resection for stage III non-small-cell lung cancer: a phase III randomised controlled trial. Lancet 374:379–386CrossRefPubMedGoogle Scholar
  4. 4.
    Arriagada R, Bergman B, Dunant A et al (2004) Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer. N Engl J Med 350:351–360CrossRefPubMedGoogle Scholar
  5. 5.
    Berlin NI, Buncher CR, Fontana RS et al (1984) The National Cancer Institute cooperative early lung cancer detection program. Results of the initial screen (prevalence). Early lung cancer detection: Introduction. Am Rev Respir Dis 130:545–549PubMedGoogle Scholar
  6. 6.
    Bollmann A, Blankenburg T, Haerting J et al (2004) Survival of patients in clinical stages I–IIIb of non-small-cell lung cancer treated with radiation therapy alone. Results of a population-based study in Southern Saxony-Anhalt. Strahlenther Onkol 180:488–496CrossRefPubMedGoogle Scholar
  7. 7.
    Bonomi PD. (2010) Implications of key trials in advanced nonsmall cell lung cancer. Cancer 16:1155–1164CrossRefGoogle Scholar
  8. 8.
    Curran WJ, Scott CB, Langer CJ et al (2003) Long-term benefit is observed in a phase III comparison of sequential vs. concurrent chemo-radiation for patients with unresectable stage III NSCLC: RTOG 9410 (abstr #621). J Clin Oncol [Suppl 1] 22:621Google Scholar
  9. 9.
    Depierre A, Milleron B, Moro-Sibilot D et al (2002) Preoperative chemotherapy followed by surgery compared with primary surgery in resectable stage I (except T1N0), II, and IIIa non-small-cell lung cancer. J Clin Oncol 20:247–253CrossRefPubMedGoogle Scholar
  10. 10.
    Eberhardt W (2003) Induction therapy before surgery in stage III non-small-cell lung cancer. IASLC Brugges consensus. Lung Cancer [Suppl 1] 42:9–14Google Scholar
  11. 11.
    Eberhardt W, Thomas M, Stuschke M et al (2006) Multimodale Behandlung des operablen lokal fortgeschrittenen nichtkleinzelligen Lungenkarzinoms. Onkologe 12:746–752CrossRefGoogle Scholar
  12. 12.
    Fischer B, Lassen U, Mortensen J et al (2009) Preoperative staging of lung cancer with combined PET-CT. N Engl J Med 361:32–39CrossRefPubMedGoogle Scholar
  13. 13.
    Fischer BM, Eberhardt W, Buhl R et al (2006) Molekular zielgerichtete Therapie des nichtkleinzelligen Lungenkarzinoms. Onkologe 12:769–779CrossRefGoogle Scholar
  14. 14.
    Fleckenstein J, Appold S, Rübe C (2006) Palliative Radiotherapie beim nichtkleinzelligen Lungenkarzinom. Onkologe 12:780–785CrossRefGoogle Scholar
  15. 15.
    Fournel P, Robinet G, Thomas P et al (2005) Randomized phase III trial of sequential chemoradiotherapy compared with concurrent chemoradiotherapy in locally advanced non-small-cell lung cancer: Groupe Lyon-Saint-Etienne d’Oncologie Thoracique-Groupe Francais de Pneumo-Cancerologie NPC 95–01 study. J Clin Oncol 23:5910–5917CrossRefPubMedGoogle Scholar
  16. 16.
    Furuse K, Fukuoka M, Kawahara M et al (1999) Phase III study of concurrent versus sequential thoracic radiotherapy in combination with mitomycin, vindesine, and cisplatin in unresectable stage III non-small-cell lung cancer. J Clin Oncol 17:2692–2699PubMedGoogle Scholar
  17. 17.
    Hammond EC, Selikoff IJ, Seidman H (1979) Asbestos exposure, cigarette smoking and death rates. Ann N Y Acad Sci 330:473–490CrossRefPubMedGoogle Scholar
  18. 18.
    Herth FJF (2005) Diagnostische Bronchoskopie. Pneumologe 2:83–92CrossRefGoogle Scholar
  19. 19.
    Herth FJF, Dienemann H (2006) Diagnostik und Stadieneinteilung beim Lungenkarzinom. Onkologe 12:719–727CrossRefGoogle Scholar
  20. 20.
    Hoffmann H, Dienemann H, Passlick B (2006) Chirurgische Therapie des nichtkleinzelligen Lungenkarzinoms. Stadium I/II. Onkologe 12:728–736CrossRefGoogle Scholar
  21. 21.
    Huber RM, Reck M (2006) Supportive Therapie des nichtkleinzelligen Lungenkarzinoms. Onkologe 12:786–791CrossRefGoogle Scholar
  22. 22.
    Lahm H, Fischer JR (2003) Molekulargenetische Aspekte. In: Drings P, Dienemann H, Wannenmacher M (Hrsg) Management des Lungenkarzinoms. Springer, Berlin Heidelberg New York, S 21–35Google Scholar
  23. 23.
    Lieven H von, Burkhardt E (2001) Postoperative radiotherapy of NSCLC – outcome after 3-D treatment planning. Strahlenther Onkol 177:302–306CrossRefGoogle Scholar
  24. 24.
    Meerbeeck JP van, Kramer G, Van Schil PE et al (2005) EORTC-Lung Cancer Group. A randomized trial of radical surgery (S) versus thoracic radiotherapy (TRT) in patients (pts) with stage IIIA-N2 non-small cell lung cancer (NSCLC) after response to induction chemotherapy (ICT) (EORTC 08941). J Clin Oncol [Suppl 1] 23:7015Google Scholar
  25. 25.
    Mok TS, Wu YL, Thongprasert S et al (2009) Gefitinib or carboplatin-paclitaxel in pulmonary adenocarcinoma. N Engl J Med 361:947–957CrossRefPubMedGoogle Scholar
  26. 26.
    Niederle N, Schlag PM (2006) Nichtkleinzelliges Lungenkarzinom. Diagnostik und stadiengerechte Therapie. Onkologe 12:717–718CrossRefGoogle Scholar
  27. 27.
    NSCLC Meta-Analyses Collaborative Group (2008) Chemotherapy in addition to supportive care improves survival in advanced non-small-cell lung cancer: a systematic review and meta-analysis of individual patient data from 16 randomized controlled trials. J Clin Oncol 26:4617–4625CrossRefGoogle Scholar
  28. 28.
    NSCLC Meta-Analyses Collaborative Group (2010) Adjuvant chemotherapy, with or without postoperative radiotherapy, in operable non-small-cell lung cancer: two meta-analyses of individual patient data. Lancet 375:1267–1277CrossRefGoogle Scholar
  29. 29.
    Pirker R, Pereira JR, Szczesna A et al (2009) Cetuximab plus chemotherapy in patients with advanced non-small-cell lung cancer (FLEX): an open-label randomised phase III trial. Lancet 373:1525–1531CrossRefPubMedGoogle Scholar
  30. 30.
    Reck M, Deppermann KM, Gatzemeier U et al (2006) Nichtkleinzelliges Lungenkarzinom. Palliative Chemotherapie im Stadium IV und bei Patienten mit Komorbidität. Onkologe 12:761–768CrossRefGoogle Scholar
  31. 31.
    Robinson L, Wagner H, Ruckdeschel J (2003) Treatment of stage III A non-small cell lung cancer. Chest 123:202–220CrossRefGoogle Scholar
  32. 32.
    Siegel BA, Dehdashti F (2005) Oncologic PET/CT: current status and controversies. Eur Radiol 15:127–132CrossRefGoogle Scholar
  33. 33.
    Spiro SG, Porter JC (2002) Lung cancer – where are we today? Current advances in staging and nonsurgical treatment. Am J Respir Crit Care Med 166:1166–1196CrossRefPubMedGoogle Scholar
  34. 34.
    Strauss GM, Herndon JE 2nd, Maddaus MA et al (2008) Adjuvant paclitaxel plus carboplatin compared with observation in stage IB non-small-cell lung cancer: CALGB 9633 with the Cancer and Leukemia Group B, Radiation Therapy Oncology Group, and North Central Cancer Treatment Group Study Groups. J Clin Oncol 26:5043–5051CrossRefPubMedGoogle Scholar
  35. 35.
    Stuschke M, Huber RM, Flentje M et al (2006) Nichtkleinzelliges Lungenkarzinom im Stadium III. Onkologe 12:753–760CrossRefGoogle Scholar
  36. 36.
    Thomas M, Macha HN, Ukena D et al (2004) Cisplatin/etoposide (PE) followed by twice-daily chemoradiation (hfRT/CT) versus PE alone before surgery in stage III non-small cell lung cancer (NSCLC): A randomized phase III trial of the German Lung Cancer Cooperative Group (GLCCG). J Clin Oncol [Suppl] 22:7004Google Scholar
  37. 37.
    Thomas M, Dienemann H, Branscheid D et al (2006) Neoadjuvante/adjuvante Therapie in den frühen Stadien des nichtkleinzelligen Lungenkarzinoms. Onkologe 12:737–745CrossRefGoogle Scholar
  38. 38.
    US Environmental Protection Agency (USEPA) (1992) Respiratory health effects of passive smoking: lung cancer and other disorders. EPA/600/6–006 F. US Environmental Protection Agency, WashingtonGoogle Scholar
  39. 39.
    Winton T, Livingston R, Johnson D et al (2005) Vinorelbine plus cisplatin vs. observation in resected non-small-cell lung cancer. N Engl J Med 352:2589–2597CrossRefPubMedGoogle Scholar
  40. 40.
    Wittekind C, Meyer HJ (2010) TNM Klassifikation maligner Tumoren. Wiley-Blackwell, New York, S 129–135Google Scholar
  41. 41.
    Zatloukal P, Petruzelka L, Zemanova M et al (2004) Concurrent versus sequential chemoradiotherapy with cisplatin and vinorelbine in locally advanced non-small cell lung cancer: a randomized study. Lung Cancer 46:87–98CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  1. 1.Klinik für Strahlentherapie und RadioonkologieRuhr-Universität BochumHerneDeutschland
  2. 2.Medizinische Klinik IIIKlinikum LeverkusenLeverkusenDeutschland

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