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Behandlung des fortgeschrittenen nichtkleinzelligen Bronchialkarzinoms —eine Literaturrecherche der letzten 5 Jahre

Therapy of advanced non-small-cell carcinoma of the lung — a review of the last 5 years

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Summary

In the course of a metaanalysis concerning adjuvant therapy and the therapy of inoperable non-small-cell carcinoma of the lung, undertaken from 1. 1. 1985 to 1. 5. 1990, 376 publications were evaluated on a point system based on a decicion tree. Out of a maximum of 71 obtainable points only 5.4% of the publications on adjuvant therapy and only 7.3% of publications on palliative therapy obtained more than 45 points. Regarding inoperable cases X-ray therapy with a median survival of 11 months and satisfactory life quality demonstrated the best results. Significant increases in survival are also possible with chemotherapy (7.4 months) in standard-dose pair combinations which, however, are associated with negative side effects on the treated patients. Immune and radio-chemotherapy cannot be recommended on account of treatment toxicity without a gain in life quality. Adjuvant therapy shows no life-prolonging effect. Consequently surgical treatment remains the first choice of therapy.

Zusammenfassung

Im Rahmen einer Metastudie über adjuvante Therapie und die Therapie der inoperablen nichtkleinzelligen Bronchialkarzinome wurden vom 1. 1. 1985–1. 5. 1990 376 Artikel anhand eines Entscheidungsstammbaumes mit Punkten bewertet. Von maximal 71 Punkten lagen nur 5,4% der Artikel zur adjuvanten Therapie und 7,3% der Publikationen zur Therapie der inoperablen Fallen uber 45 Punkten. Bei den inoperablen Fällen hat die Radiotherapie mit bis zu 11 Monaten medianer Überlebenszeit bei zufriedenstellender Lebensqualität die besten Ergebnisse gezeigt. Die Chemotherapie ermöglicht bei einer Ansprechrate von 13–30% in normdosierten Zweierkombinationen ebenfalls signifikante Steigerungen der Überlebenszeit (7,4 Monate), die im Hinblick auf die Lebensqualität der behandelten Patien ten mit belastenden Nebenwirkungen verbunden sind. Immuntherapie oder Chemo-Radiokombinationsbehandlung können aufgrund der Behandlungstoxizität bei fehlendem Lebensgewinn in den untersuchten Konzepten nicht empfohlen werden. Die adjuvante Therapie bleibt ohne lebensverlängernden Effekt. Hier bleibt die alleinige chirurgische Behandlung die Therapie der Wahl.

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Verzeichnis der Veröffentlichungen mit mehr als 45 Punkten Chemotherapie

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  1. Chirurgische Universitätsklinik zu Köln, Joseph-Stelzmann-StraBe 9, W-5000, Köln 41, Bundesrepublik Deutschland

    A. Prokop, J. M. Miller &  H. Pichlmaier

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Prokop, A., Miller, J.M. & Pichlmaier, H. Behandlung des fortgeschrittenen nichtkleinzelligen Bronchialkarzinoms —eine Literaturrecherche der letzten 5 Jahre. Langenbecks Arch Chir 376, 32–37 (1991). https://doi.org/10.1007/BF00205125

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