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Oligometastatische Erkrankung des nichtkleinzelligen Lungenkarzinoms

Oligometastatic disease of non-small cell lung cancer

  • Leitthema
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Seit langer Zeit war bekannt, dass Patienten mit isolierten ZNS oder Nebennierenmetastasen einer potentiell kurativen Therapie zugeführt werden können. Diese Daten konnten in retrospektiven und z. T. prospektiven Studien bestätigt und auf weitere Organe ausgedehnt werden. Diese Erkenntnisse führten zur Definition eines neuen Stadiums M1b in der 8. UICC Klassifikation.

Methode

Eine selektive Literaturrecherche wurde durchgeführt.

Ergebnisse

Obgleich zum jetzigen Zeitpunkt Daten zum Gesamtüberleben noch nicht vorliegen, so ergibt sich aus den bisherigen prospektiven Daten ein einheitliches Bild, welches für die Anwendung von lokaltherapeutischen Maßnahmen in diesem Kontext spricht. Ungeklärt bleiben in diesen Studien jedoch noch die richtige Sequenz der Therapie, die Wahl der Behandlungsmodalitäten sowie die Bedeutung von Lymphknotenmetastasen. Das NSCLC metastasiert üblicherweise in die Leber, Lunge, Nebenniere, das Hirn sowie in die Knochen. Interessanterweise finden sich stark unterschiedliche klinische Verläufe in Abhängigkeit der Metastasenlokalisation und einem synchronen oder metachronen auftreten der Metastasen. Beim Vorliegen von Nebennierenmetastasen ist die solitäre ipsilaterale Manifestation mit den längsten Überlebensraten assoziiert. Zur Therapie der Nebennierenmetastase bieten sich sowohl die stereotaktische Bestrahlung als auch die chirurgische Resektion an. Standardtherapie bei Fehlen einer entsprechenden ALK(„anaplastic lymphoma kinase“)- bzw. EGFR(„epithelial growth factor receptor“)-Treibermutation stellt aktuell noch die platinhaltige Kombinationschemotherapie dar. Bei isolierten ZNS(zentrales Nervensystem)-Metastasen sollte Patienten eine stereotaktische Präzisionsstrahlentherapie oder eine Operation mit anschließender Tumorbettnachbestrahlung angeboten werden. Bei solitären Knochenmetastasen ohne Rückenmarkkompression bietet sich die lokal ablative Radiotherapie als durchaus gleichwertige und in vielen Fällen weniger langfristig körperlich einschränkende Therapiemaßnahme im Vergleich zu operativ-resezierenden Maßnahmen an.

Abstract

Background

It has been known for a long time that patients with isolated CNS or adrenal metastases have a chance for cure in some casese. These data were corroborated in retrospective and prospective studies and extended to more metastatic sites. Oligometastatic stage has been incorporated recently in the new UICC 8 classification.

Method

A selective literature search was carried out.

Results

Although at the current point in time data on total survival are not yet available, there is a uniform picture from the previous prospective data, which is indicative for the application of local therapeutic measures in this context; however, even in these studies the correct sequence of treatment, the choice of treatment modality and the importance of lymph node metastases within the framework of oligometastasization remain unexplained. The NSCLC normally metastasizes in the liver, lungs, adrenal glands, the brain and in bones. Interestingly, there are very different clinical courses depending on the localization of metastases and a synchronous or metachronous occurrence of metastases. When adrenal gland metastases occur the solitary ipsilateral manifestation is associated with the longest survival rates. Stereotactic radiation therapy and surgical resection are appropriate for treatment of adrenal metastases. The standard treatment in the case of a lack of appropriate anaplastic lymphoma kinase (ALK) or epithelial growth factor receptor (EGFR) driver mutations is currently still platinum-based combination chemotherapy. In cases of isolated central nervous system (CNS) metastases patients should be offered stereotactic precision radiation therapy or surgery with subsequent tumor bed adjunct irradiation. For solitary bone metastasis without spinal cord compression, local ablative radiotherapy is an absolutely equivalent and in many cases less physically limiting therapeutic measure in the long term in comparison to surgical resection.

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Authors and Affiliations

  1. Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland

    Severin Schmid & Bernward Passlick

  2. Strahlentherapie und Radioonkologie, Universität Essen, Essen, Deutschland

    Martin Stuschke

  3. Universitätsklinik Innere Medizin-Onkologie, Pius-Hospital, Universitätsmedizin Oldenburg, Oldenburg, Deutschland

    Frank Griesinger

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  1. Severin Schmid
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Correspondence to Frank Griesinger.

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Schmid, S., Passlick, B., Stuschke, M. et al. Oligometastatische Erkrankung des nichtkleinzelligen Lungenkarzinoms. Onkologe 24, 992–1002 (2018). https://doi.org/10.1007/s00761-018-0485-x

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