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Chirurgische Therapie im Stadium I und II des nichtkleinzelligen Lungenkarzinoms

Surgical treatment of stage I and II non-small cell lung cancer

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Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

In den vergangenen Jahrzehnten hat sich die Prognose des Lungenkarzinoms trotz moderner Diagnostik und multimodaler Therapiestrategien kaum verbessert. Ein großer Anteil der Patienten mit einem nichtkleinzelligen Lungenkarzinom (NSCLC; 57 %) haben zum Zeitpunkt der Diagnose Fernmetastasen und nur etwa 40 % der Patienten sind in einem potenziell operablen Tumorstadium.

Material und Methoden

Diese Arbeit basiert auf einer selektiven Literaturrecherche in der Datenbank PubMed sowie eigenen Erfahrungen zum Thema des Artikels.

Ergebnisse

Für Patienten in einem frühen Tumorstadium, Stadium I und II nach der Klassifikation der Tumorstadien in der 8. Ausgabe der Union for International Cancer Control (UICC), ist die chirurgische anatomische Tumorresektion in Kombination mit einer systematischen mediastinalen und hilären Lymphknotendissektion das Therapieverfahren der Wahl. Mit dem klassischen Resektionsverfahren der Lobektomie (Bilobektomie, Pneumonektomie) in Verbindung mit einer systematischen Lymphadenektomie lassen sich Fünfjahresüberlebensraten von über 80 % im Frühstadium IA bzw. 48 % im Stadium II erzielen. Neben der offenen chirurgischen Resektion konnten weltweit minimal-invasive, videoassistierte thorakoskopische Resektionsverfahren (VATS, „video-assisted thoracic surgery“) im Stadium I und II erfolgreich etabliert werden. Im Stadium II kann eine adjuvante Chemotherapie das Überleben positiv beeinflussen.

Diskussion

Ob zielgerichtete Krebstherapien (sog. „targeted therapies“) oder eine Immuntherapie im neoadjuvanten oder adjuvanten Therapiekonzept beim NSCLC im Frühstadium das Überleben der Patienten verbessern, wird momentan in Studien untersucht.

Abstract

Background

Despite modern diagnostics and multimodal treatment strategies, overall survival of lung cancer could not be significantly improved in recent decades. The majority of patients with non-small cell lung cancer (NSCLC) have distant metastases at the time of diagnosis (57%) and only approximately 40% of patients are in a potentially curable tumor stage.

Material and methods

A systematic literature search concerning original research and review articles on surgery of NSCLC in stages I and II was carried out in the PubMed database.

Results

For patients in an early tumor stage, stages I and II tumors according to the 8th edition of the Union for International Cancer Control (UICC) tumor stage classification, surgical removal of the tumor remains the therapeutic gold standard. By complete anatomical resection (lobectomy, bilobectomy or pneumonectomy) combined with a systematic mediastinal and hilar lymphadenectomy, 5‑year survival rates of more than 80% in early stage IA and 48% in stage II can be achieved. In addition to open surgical resection, video-assisted, minimally invasive thoracoscopic (VATS) resection was successfully implemented worldwide for the treatment of NSCLC patients in stages I and II. For patients with stage II NSCLC, adjuvant chemotherapy was shown to improve the overall survival.

Discussion

Whether targeted therapies or immunotherapy in a neoadjuvant or adjuvant treatment modality further improve the survival of NSCLC patients in the multimodal treatment of early stage NSCLC, is currently under investigation in randomized studies.

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Authors and Affiliations

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

    Laura V. Klotz &  Hauke Winter

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  1. Laura V. Klotz
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  2. Hauke Winter
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Correspondence to Hauke Winter.

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L.V. Klotz und H. Winter geben an, dass kein Interessenkonflikt besteht.

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

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Klotz, L.V., Winter, H. Chirurgische Therapie im Stadium I und II des nichtkleinzelligen Lungenkarzinoms. Onkologe 24, 1009–1014 (2018). https://doi.org/10.1007/s00761-018-0471-3

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