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Strahlentherapie des lokal fortgeschrittenen Lungenkarzinoms

Radiotherapy of localised advanced lung cancer

  • Leitthema
  • Published:
Der Pneumologe Aims and scope

Zusammenfassung

Die simultane Radio-/Chemotherapie ist eine Behandlung für Patienten in gutem Allgemeinzustand mit lokal fortgeschrittenem nichtkleinzelligem Bronchialkarzinom ab dem Stadium IIIA3. Der Nutzen einer zusätzlichen (konsolidierenden oder Induktions-)Chemotherapie ist nicht abschließend geklärt. Nach Resultaten bisheriger Phase-III-Studien ist hier jedoch eher Zurückhaltung angezeigt. Unklar ist bislang auch der Stellenwert neuerer „targeted therapies“ im Zusammenwirken mit einer Bestrahlung. In den letzten Jahren in die klinische Routine eingeführte Verfahren wie die FDG-PET und EBUS ermöglichen eine bessere Detektion von Metastasen und Abgrenzung zum Normalgewebe und dadurch neue Zielvolumenkonzepte („Involved-field-Bestrahlung“). Weiterentwicklungen der technischen Möglichkeiten bei Planung und Durchführung der Therapie (IMRT) ermöglichen Dosiserhöhungen bei gleichzeitig besserer Schonung von Risikoorganen mit der Hoffnung auf weitere Verbesserung für diese immer noch zumeist ungünstig verlaufende Erkrankung.

Abstract

Combined radio-chemotherapy treatment is suitable for patients in good general health with localised advanced non-small cell lung cancer from stage IIIA3 onwards. The benefit of additional (consolidating or inductive) chemotherapy has not been conclusively determined. Results of recent phase III studies, however, suggest caution. Similarly undefined to date is the benefit of novel targeted therapies in combination with radiotherapy. Procedures introduced into clinical routine in recent years, such as FDG-PET and EBUS, enable improved detection of metastases and their differentiation from normal tissue and thus new target volume concepts (PET-CT/involved-field radiotherapy). The ongoing development of technical options for the planning and implementation of this therapy (IMRT) allows dosage increases without harming organs at risk and provides hope of greater improvements in the treatment of a disease which generally still has an unfavourable course.

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Literatur

  1. Albain KS, Crowley JJ, Turrisi AT et al (2002) Concurrent cisplatin, etoposide, and chest radiotherapy in pathologic stage IIIB non-small-cell lung cancer: a Southwest Oncology Group phase II study, SWOG 9019. J Clin Oncol 20:3454–3460

    Article  PubMed  CAS  Google Scholar 

  2. Albain KS, Swann RS, Rusch VW et al (2009) Radiotherapy plus chemotherapy with or without surgical resection for stage III non-small-cell lung cancer: a phase III randomised controlled trial. Lancet 374:379–386

    Article  PubMed  CAS  Google Scholar 

  3. Aupérin A, Le Péchoux C, Rolland E et al (2010) Meta-analysis of concomitant versus sequential radiochemotherapy in locally advanced non-small-cell lung cancer. J Clin Oncol 28:2181–2190

    Article  PubMed  Google Scholar 

  4. Beckmann G, Fietkau R, Huber RM et al (2006) Oral vinorelbine and cisplatin with concomitant radiotherapy in stage III non-small cell lung cancer (NSCLC): a feasibility study. Onkologie 29:137–142

    Article  PubMed  CAS  Google Scholar 

  5. Belani CP, Choy H, Bonomi P et al (2005) Combined chemoradiotherapy regimens of paclitaxel and carboplatin for locally advanced non-small-cell lung cancer: a randomized phase II locally advanced multi-modality protocol. J Clin Oncol 23:5883–5891

    Article  PubMed  CAS  Google Scholar 

  6. Blumenschein GR, Paulus R, Curran WJ et al (2011) Phase II study of cetuximab in combination with chemoradiation in patients with stage IIIA/B non-small-cell lung cancer: RTOG 0324. J Clin Oncol 29:2312–2318

    Article  PubMed  CAS  Google Scholar 

  7. Brunelli A, Charloux A, Bolliger CT et al (2009) The European Respiratory Society and European Society of Thoracic Surgeons clinical guidelines for evaluating fitness for radical treatment (surgery and chemoradiotherapy) in patients with lung cancer. Eur J Cardiothorac Surg 36:181–184

    Article  PubMed  Google Scholar 

  8. Chen AB, Neville BA, Sher DJ et al (2011) Survival outcomes after radiation therapy for stage III non-small-cell lung cancer after adoption of computed tomography-based simulation. J Clin Oncol 29:2305–2311

    Article  PubMed  Google Scholar 

  9. Fleckenstein J, Hellwig D, Kremp S et al (2011) F-18-FDG-PET confined radiotherapy of locally advanced NSCLC with concomitant chemotherapy: results of the PET-PLAN Pilot Trial. Int J Radiat Oncol Biol Phys (im Druck)

  10. Ghafoori P, Marks LB, Vujaskovic Z et al (2008) Radiation-induced lung injury. Assessment, management, and prevention. Oncology (Williston Park) 22:37–47, discussion 52–33

    Google Scholar 

  11. Goeckenjan G, Sitter H, Thomas M et al (2011) Prävention, Diagnostik, Therapie und Nachsorge des Lungenkarzinoms. Pneumologie 65:e51, e75

    Article  PubMed  CAS  Google Scholar 

  12. Hanna N, Neubauer M, Yiannoutsos C et al (2008) Phase III study of cisplatin, etoposide, and concurrent chest radiation with or without consolidation docetaxel in patients with inoperable stage III non-small-cell lung cancer: The Hoosier Oncology Group and U.S. Oncology. J Clin Oncol 26:5755–5760

    Article  PubMed  CAS  Google Scholar 

  13. Huber RM, Flentje M, Schmidt M et al (2006) Simultaneous chemoradiotherapy compared with radiotherapy alone after induction chemotherapy in inoperable stage IIIA or IIIB non-small-cell lung cancer: study CTRT99/97 by the Bronchial Carcinoma Therapy Group. J Clin Oncol 24:4397–4404

    Article  PubMed  CAS  Google Scholar 

  14. Jeremić B, Miličić B, Milisavljevic S (2011) Clinical prognostic factors in patients with locally advanced (stage III) nonsmall cell lung cancer treated with hyperfractionated radiation therapy with and without concurrent chemotherapy. Cancer 117:2995–3003

    Article  PubMed  Google Scholar 

  15. Kelly K, Chansky K, Gaspar LE et al (2008) Phase III trial of maintenance Gefitinib or placebo after concurrent chemoradiotherapy and docetaxel consolidation in inoperable stage III non-small-cell lung cancer: SWOG S0023. J Clin Oncol 26:2450–2456

    Article  PubMed  CAS  Google Scholar 

  16. Kramer GWPM, Legrand CL, Van Schil P et al (2006) Quality assurance of thoracic radiotherapy in EORTC 08941: a randomised trial of surgery versus thoracic radiotherapy in patients with stage IIIA non-small-cell lung cancer (NSCLC) after response to induction chemotherapy. Eur J Cancer 42:1391–1398

    Article  PubMed  Google Scholar 

  17. Muirhead R, Featherstone C, Duffton A et al (2010) The potential clinical benefit of respiratory gated radiotherapy (RGRT) in non-small cell lung cancer (NSCLC). Radiother Oncol 95:172–177

    Article  PubMed  Google Scholar 

  18. Partridge M, Ramos M, Sardaro A et al (2011) Dose escalation for non-small cell lung cancer: analysis and modelling of published literature. Radiother Oncol 99:6–11

    Article  PubMed  Google Scholar 

  19. Pijls-Johannesma M, Houben R, Boersma L et al (2009) High-dose radiotherapy or concurrent chemo-radiation in lung cancer patients only induces a temporary, reversible decline in QoL. Radiother Oncol 91:443–448

    Article  PubMed  Google Scholar 

  20. Provencio M, Sánchez A, Garrido P et al (2010) New molecular targeted therapies integrated with radiation therapy in lung cancer. Clin Lung Cancer 11:91–97

    Article  PubMed  CAS  Google Scholar 

  21. Reinfuss M, Mucha-Małecka A, Walasek T et al (2011) Palliative thoracic radiotherapy in non-small cell lung cancer. An analysis of 1250 patients. Palliation of symptoms, tolerance and toxicity. Lung Cancer 71:344–349

    Article  PubMed  Google Scholar 

  22. Robinson LA, Ruckdeschel JC, Wagner H et al (2007) Treatment of non-small cell lung cancer-stage IIIA*. Chest 132:243S–265S

    Article  PubMed  Google Scholar 

  23. Rodrigues G, Macbeth F, Burmeister B et al (2011) Consensus statement on palliative lung radiotherapy: third international consensus workshop on palliative radiotherapy and symptom control. Clin Lung Cancer (im Druck)

  24. Rosenzweig KE, Sura S, Jackson A et al (2007) Involved-field radiation therapy for inoperable non-small-cell lung cancer. J Clin Oncol 25:5557–5561

    Article  PubMed  Google Scholar 

  25. Semrau S, Klautke G, Virchow JC et al (2008) Impact of comorbidity and age on the outcome of patients with inoperable NSCLC treated with concurrent chemoradiotherapy. Respir Med 102:210–218

    Article  PubMed  CAS  Google Scholar 

  26. Stinchcombe TE, Hodgson L, Herndon JEI et al (2009) Treatment outcomes of different prognostic groups of patients on cancer and leukemia group B trial 39801: induction chemotherapy followed by chemoradiotherapy compared with chemoradiotherapy alone for unresectable stage III non-small cell lung cancer. J Thorac Oncol 4:1117–1125

    Article  PubMed  Google Scholar 

  27. Sulman EP, Komaki R, Klopp AH et al (2009) Exclusion of elective nodal irradiation is associated with minimal elective nodal failure in non-small cell lung cancer. Radiat Oncol 4:5

    Article  PubMed  Google Scholar 

  28. Van Meerbeeck JP, Kramer GW, Van Schil PE et al (2007) Randomized controlled trial of resection versus radiotherapy after induction chemotherapy in stage IIIA-N2 non-small-cell lung cancer. J Natl Cancer Inst 99:442–450

    Article  Google Scholar 

  29. Vogelius IS, Westerly DC, Cannon GM et al (2011) Intensity-modulated radiotherapy might increase pneumonitis risk relative to three-dimensional conformal radiotherapy in patients receiving combined chemotherapy and radiotherapy: a modeling study of dose dumping. Int J Radiat Oncol Biol Phys 80:893–899

    Article  PubMed  Google Scholar 

  30. Yang F, Wang J (2011) Role of surgery for stage IIIA-N2 non-small cell lung cancer. Thoracic Cancer 2:90–94

    Article  Google Scholar 

  31. Yuan S, Sun X, Li M et al (2007) A randomized study of involved-field irradiation versus elective nodal irradiation in combination with concurrent chemotherapy for inoperable stage III non small cell lung cancer. Am J Clin Oncol 30:239–244

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Würzburg, Josef-Schneiderstr. 11, 97082, Würzburg, Deutschland

    M. Flentje & P. Kleine

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  1. M. Flentje
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  2. P. Kleine
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Correspondence to M. Flentje.

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Flentje, M., Kleine, P. Strahlentherapie des lokal fortgeschrittenen Lungenkarzinoms. Pneumologe 9, 28–34 (2012). https://doi.org/10.1007/s10405-011-0499-1

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