Skip to main content
SpringerLink
Log in

Lokaltherapie solitärer intrapulmonaler maligner Rundherde

Local treatment of solitary intrapulmonary, malignant nodules

  • Übersichten
  • Published:
Der Radiologe Aims and scope Submit manuscript

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.

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7

Literatur

  1. McKenna RJ, Houck W, Fuller CB (2006) Video-assisted thoracic surgery lobectomy: Experience with 1,100 cases. Ann Thorac Surg 81(2):421–425 (discussion 425–426)

    Article  PubMed  Google Scholar 

  2. Whitson BA, Groth SS, Duval SJ, Swanson SJ, Maddaus M (2008) Surgery for early-stage non-small cell lung cancer: A systematic review of the video-assisted thoracoscopic surgery versus thoracotomy approaches to lobectomy. Ann Thorac Surg 86(6):2008–2016 (discussion 2016–2018)

    Article  PubMed  Google Scholar 

  3. Altorki NK, Yip R, Hanaoka T, Bauer T, Aye R, Kohman L et al (2014) Sublobar resection is equivalent to lobectomy for clinical stage 1 A lung cancer in solid nodules. J Thorac Cardiovasc Surg 147(2):754–762 (discussion 762–764)

    Article  PubMed  Google Scholar 

  4. Cheng AM, Wood DE (2015) Minimally invasive resection of early lung cancers. Oncol (Williston Park) 29(3):160–166

    Google Scholar 

  5. Detterbeck FC, Grodzki T, Gleeson F, Robert JH (2010) Imaging requirements in the practice of pulmonary metastasectomy. J Thorac Oncol 5(6 Suppl 2):134–139

    Article  Google Scholar 

  6. Cerfolio RJ, Bryant AS, McCarty TP, Minnich DJ (2011) A prospective study to determine the incidence of non-imaged malignant pulmonary nodules in patients who undergo metastasectomy by thoracotomy with lung palpation. Ann Thorac Surg 91(6):1696–1700 (discussion 1700–1701)

    Article  PubMed  Google Scholar 

  7. Eckardt J, Licht PB (2014) Thoracoscopic or open surgery for pulmonary metastasectomy: an observer blinded study. Ann Thorac Surg 98(2):466–469 (discussion 469–470)

    Article  PubMed  Google Scholar 

  8. Alexander ES, Dupuy DE (2013) Lung cancer ablation: Technologies and techniques. Semin Intervent Radiol 30(2):141–150. doi:10.1055/s-0033-1342955

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lyons NJ, Pathak S, Daniels IR, Spiers A, Smart NJ (2015) Percutaneous management of pulmonary metastases arising from colorectal cancer; A systematic review. Eur J Surg Oncol 41(11):1447–1455

    Article  CAS  PubMed  Google Scholar 

  10. de Baère T, Aupérin A, Deschamps F, Chevallier P, Gaubert Y, Boige V, Fonck M, Escudier B, Palussiére J (2015) Radiofrequency ablation is a valid treatment option for lung metastases: Experience in 566 patients with 1037 metastases. Ann Oncol 26(5):987–991

    Article  PubMed  PubMed Central  Google Scholar 

  11. Jaskolka JD, Kachura JR, Hwang DM (2010) Pathologic assessment of radiofrequency ablation of pulmonary metastases. J Vasc Interv Radiol 21:1689–1696

    Article  PubMed  Google Scholar 

  12. Schneider T, Puderbach M, Kunz J, Bischof A, Giesel FL, Dienemann H, Herth FJ, Schnabel PA, Safi S, Hoffmann H, Heussel CP (2012) Simultaneous computed tomography-guided biopsy and radiofrequency ablation of solitary pulmonary malignancy in high-risk patients. Respiration 84:501–508

    Article  CAS  PubMed  Google Scholar 

  13. Smith SL, Bowers D, Jennings P, Soomal R (2016) Pulmonary radiofrequency ablation in a district general hospital: Is it a safe and effective treatment? Clin Radiol. doi:10.1016/j.crad.2016.03.021

    PubMed  Google Scholar 

  14. Lafuente S, Fuster D, Arguis P, Granados U, Perlaza P, Paredes P, Vollmer I, Sánchez M, Lomeña F (2016) Dual time-point 〈sup〉18〈/sup〉F-FDG PET/CT to assess response to radiofrequency ablation of lung metastases. Rev Esp Med Nucl Imagen Mol. doi:10.1016/j.remn.2015.12.002

    PubMed  Google Scholar 

  15. Lencioni R, Crocetti L, Cioni R (2008) Response to radiofrequency ablation of pulmonary tumours: A prospective, intention-to-treat, multicentre clinical trial (the rapture study). Lancet Oncol 9:621–628

    Article  PubMed  Google Scholar 

  16. Tavares E Castro A, Freitas S, Portilha A, Alves F, Caseiro-Alves F (2015) Efficacy and safety of percutaneous radiofrequency thermal ablation in the treatment of lung cancer lesions. Acta Med Port 28(1):63–69

    Article  PubMed  Google Scholar 

  17. Leksell L (1951) The stereotaxic method and radiosurgery of the brain. Acta Chir Scand 102(4):316–319

    CAS  PubMed  Google Scholar 

  18. Wahlers B et al (2000) High-dose, stereotactic, one-time radiotherapy with curative intent for peripheral lung cancer. Pneumologie 54(11):486–488

    Article  CAS  PubMed  Google Scholar 

  19. Guckenberger M et al (2013) Safety and efficacy of stereotactic body radiotherapy for stage 1 non-small-cell lung cancer in routine clinical practice: A patterns-of-care and outcome analysis. J Thorac Oncol 8(8):1050–1058

    Article  CAS  PubMed  Google Scholar 

  20. Rieber J et al (2016) Stereotactic body radiotherapy (SBRT) for medically inoperable lung metastases – A pooled analysis of the German working group “stereotactic radiotherapy”. Lung Cancer 97:51–58

    Article  PubMed  Google Scholar 

  21. Guckenberger M et al (2014) Definition of stereotactic body radiotherapy: principles and practice for the treatment of stage I non-small cell lung cancer. Strahlenther Onkol 190(1):26–33

    Article  CAS  PubMed  Google Scholar 

  22. Haasbeek CJ et al (2010) Outcomes of stereotactic ablative radiotherapy for centrally located early-stage lung cancer. J Thorac Oncol 6(12):2036–2043

    Article  Google Scholar 

  23. De Ruysscher D et al (2014) High-dose re-irradiation following radical radiotherapy for non-small-cell lung cancer. Lancet Oncol 15(13):620–624

    Article  Google Scholar 

  24. Palma D et al (2011) Curative treatment of Stage I non-small-cell lung cancer in patients with severe COPD: Stereotactic radiotherapy outcomes and systematic review. Int J Radiat Oncol Biol Phys 82(3):1149–1156

    Article  PubMed  Google Scholar 

  25. Fischer-Valuck BW et al (2015) Comparison of stereotactic body radiation therapy for biopsy-proven versus radiographically diagnosed early-stage non-small lung cancer: A single-institution experience. Tumori 101(3):287–293

    Article  PubMed  Google Scholar 

  26. Senthi S et al (2012) Patterns of disease recurrence after stereotactic ablative radiotherapy for early stage non-small-cell lung cancer: A retrospective analysis. Lancet Oncol 13(8):802–809

    Article  PubMed  Google Scholar 

  27. Grills IS et al (2010) Outcomes after stereotactic lung radiotherapy or wedge resection for stage I non-small-cell lung cancer. J Clin Oncol 28(6):928–935

    Article  PubMed  Google Scholar 

  28. Renaud S et al (2013) Is radiofrequency ablation or stereotactic ablative radiotherapy the best treatment for radically treatable primary lung cancer unfit for surgery? Interact Cardiovasc Thorac Surg 16(1):68–73

    Article  PubMed  Google Scholar 

  29. Verstegen NE et al (2013) Stage I‑II non-small-cell lung cancer treated using either stereotactic ablative radiotherapy (SABR) or lobectomy by video-assisted thoracoscopic surgery (VATS): Outcomes of a propensity score-matched analysis. Ann Oncol 24(6):1543–1548

    Article  CAS  PubMed  Google Scholar 

  30. Chang JY et al (2015) Stereotactic ablative radiotherapy versus lobectomy for operable stage I non-small-cell lung cancer: A pooled analysis of two randomised trials. Lancet Oncol 16(6):630–637

    Article  PubMed  PubMed Central  Google Scholar 

  31. Bongers EM et al (2011) Incidence and risk factors for chest wall toxicity after risk-adapted stereotactic radiotherapy for early-stage lung cancer. J Thorac Oncol 6(12):2052–2057

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Abteilung Thoraxchirurgie, Thoraxklinik, Universitätsklinikum Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Deutschland

    J. Op den Winkel, F. Eichhorn &  H. Dienemann

  2. Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Heidelberg, 69120, Heidelberg, Deutschland

    S. Rieken

  3. TLRC-H – Translational Lung Research Center Heidelberg, Heidelberg, Deutschland

    H. Dienemann

Authors
  1. J. Op den Winkel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Eichhorn
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Rieken
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. Dienemann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. Dienemann.

Ethics declarations

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.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Op den Winkel, J., Eichhorn, F., Rieken, S. et al. Lokaltherapie solitärer intrapulmonaler maligner Rundherde. Radiologe 57, 97–104 (2017). https://doi.org/10.1007/s00117-016-0200-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00117-016-0200-0

Schlüsselwörter

Keywords

Search

Navigation