Strahlentherapie des kleinzelligen Lungenkarzinoms

Radiotherapy for small cell lung cancer

Zusammenfassung

Hintergrund

Kleinzellige Lungenkarzinome („small cell lung cancer“, SCLC) sind aggressive Tumoren, die typischerweise in einem fortgeschrittenen Stadium diagnostiziert werden, mit einer sehr limitierenden Prognose. Fortschritte in der Diagnose und Therapie des SCLC in den letzten Jahrzehnten haben zu einer Verbesserung der Prognose bzw. des Überlebens geführt.

Ergebnisse

Bei SCLC im „limited stage“ (LS) ist die Therapie der Wahl eine kombinierte Radiochemotherapie (RCTx), entweder hyper- oder konventionell fraktioniert, gefolgt von einer prophylaktischen Ganzhirnbestrahlung (PCI), nach gutem Ansprechen auf die primäre Therapie. Die Chemotherapiekombination der ersten Wahl ist eine platinhaltige Zweierkombination mit Etoposid, die über zumindest 4 Zyklen durchgeführt wird. In der metastasierten Situation ist die Rolle der konsolidierenden Radiotherapie (RT) mediastinal und der PCI umstritten. Die Integration der Immuntherapie in Kombination mit der RCTx wird derzeit in mehreren Studien untersucht. Konzepte zur Vermeidung von neurokognitiven Einschränkungen wie z. B. die hippocampusschonende Ganzhirnbestrahlung sowie die Radiochirurgie beim SCLC werden ebenfalls in prospektiven Studien untersucht.

Schlussfolgerung

Die RT spielt eine wichtige Rolle in der Therapie des kleinzelligen Lungenkarzinoms.

Abstract

Background

Small cell lung cancers (SCLC) are aggressive tumors, which are typically diagnosed at a late stage with a limited prognosis. Advances in the diagnosis and therapy of SCLC over the past decades have led to a slight improvement in prognosis and survival.

Results

In limited stage (LS) SCLC, the treatment of choice is combined chemoradiation, either hyper- or conventionally fractionated, followed by a prophylactic cranial irradiation (PCI) in case of response after primary treatment. The chemotherapy combination of choice is a platinum-containing doublet with etoposide, over at least 4 cycles. In the metastatic setting, the role of consolidation mediastinal radiotherapy (RT) and PCI is controversial. The integration of immunotherapy in combination with chemoradiation is currently under investigation in several studies. Concepts for avoiding long-term neurocognitive side effects using whole-brain radiation with hippocampal sparring or radiosurgery in SCLC are also being investigated in prospective studies.

Conclusion

Radiotherapy plays an important role in the treatment of small cell lung cancer.

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Correspondence to PD. Dr. med. E. Gkika.

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E. Gkika, U. Nestle und A. L. Grosu geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Gkika, E., Nestle, U. & Grosu, A.L. Strahlentherapie des kleinzelligen Lungenkarzinoms. Onkologe (2021). https://doi.org/10.1007/s00761-021-00955-2

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Schlüsselwörter

  • SCLC
  • Kleinzelliges Lungenkarzinom
  • Radiochemotherapie
  • Prophylatische Ganzhirnbestrahlung
  • Immuntherapie

Keywords

  • SCLC
  • Small cell lung
  • Chemoradiation
  • PCI
  • Immunotherapy