Zusammenfassung
Die stereotaktische Strahlentherapie des nichtkleinzelligen Lungenkarzinoms im Stadium I (SBRT) hat sich als Standardbehandlung für funktionell inoperable Patienten durchgesetzt. Mit hohen lokalen Kontrollraten von regelmäßig annähernd 90 % und einem hohen krankheitsspezifischen (aktuarischen) Überleben nach 5 Jahren von etwa 75 % wurde mit der SBRT als nichtinvasiver Behandlung ein erheblicher Fortschritt erzielt. Ihre Anwendung ist mittlerweile flächendeckend etabliert, stellt jedoch hohe Ansprüche an die technisch-apparative Ausstattung und Qualitätssicherung in den einzelnen Zentren. Die Wahl entsprechender Fraktionierungsschemata hängt dabei insbesondere von der Unterscheidung zwischen zentraler und peripherer Tumorlokalisation ab. Mit entsprechend angepassten Dosisregimen ist die Behandlungsverträglichkeit insgesamt sehr gut. Bezüglich der postinterventionellen Morbidität und Mortalität ist die SBRT sublobären Resektionen bei Patienten mit fortgeschrittener COPD (Chronic Occlusive Pulmonary Disease, GOLD III oder IV) überlegen. Für das operable Stadium I zeigte sich in kleineren Kollektiven (insbesondere auch in der Auswertung von zwei abgebrochenen prospektiv-randomisierten Studien), dass die Behandlungsergebnisse der SBRT bei entsprechend limitierter klinischer Evidenz an jene von leitliniengerecht (lobär) resezierten Patienten heranreichen. Aussichtsreiche laufende klinische Studien prüfen u. a. die SBRT als Boost nach Radiochemotherapie im Stadium III sowie die Kombination von SBRT und immuntherapeutischen Ansätzen im Stadium I.
Abstract
For patients with inoperable stage I non-small cell lung cancer (NSCLC) stereotactic body radiotherapy (SBRT) has evolved as the standard of care. As a non-invasive method, SBRT has led to a significant progress with high local control rates regularly amounting to nearly 90% and a high disease-specific (actuarial) survival after 5 years of approximately 75%. The application of SBRT has now been widely adopted in many radiation units; however, its use places high demands on the technical apparative equipment and a sophisticated quality assurance in the individual centers. The choice of appropriate fractionation schemes depends primarily on the distinction between a central and a peripheral tumor location. With appropriately adjusted dose regimens very good treatment tolerance can be achieved. In comparison to sublobar resection for patients with advanced chronic obstructive pulmonary disease (COPD, GOLD III or IV), SBRT is superior in terms of post-interventional morbidity and mortality. For the operable stage I the results of SBRT treatment in small collectives are as effective as those of patients who received a guideline-conform lobar resection. This is the conclusion of the analysis of two prospective randomized trials, which were terminated early; however, clinical evidence is still limited in this context. Promising currently running clinical trials are examining the application of SBRT as a boost after chemoradiotherapy in stage III NSCLC and also the combination of SBRT and immunotherapeutic approaches in stage I.
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J. Fleckenstein und C. Rübe geben an, dass kein Interessenkonflikt besteht.
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Fleckenstein, J., Rübe, C. Stereotaktische Strahlentherapie im Stadium I des nichtkleinzelligen Lungenkarzinoms. Onkologe 24, 967–973 (2018). https://doi.org/10.1007/s00761-018-0458-0
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DOI: https://doi.org/10.1007/s00761-018-0458-0
Schlüsselwörter
- Lungenkrebs
- „Chronic Obstructive Pulmonary Disease“
- Lungenstereotaxie
- definitive Radiotherapie
- Nichtinvasive Behandlung