Zusammenfassung
Die moderne Systemtherapie mit Chemotherapie, zielgerichteter Therapie und Immuntherapie hat bei vielen Tumorerkrankungen in den letzten 15 Jahren zu einer deutlichen Verbesserung des Gesamtüberlebens geführt. Somit ist die operative Therapie von Lungenmetastasen und Lymphknotenmetastasen nicht nur wertvoll, um eine Heilung bei ausgesuchten Tumoren zu erreichen, sondern sie kann und muss eingesetzt werden, um im Falle einer umschriebenen Progredienz Spitzen des Tumorwachstums zu eliminieren. Diese können Ausdruck einer Tumorheterogenität sein, die von der Systemtherapie nicht erreicht werden. Abhängig von der Dynamik und der Ausdehnung der Metastasierung muss das therapeutische Vorgehen individuell im Tumorboard entschieden werden.
Abstract
Modern systemic therapy with chemotherapy, targeted therapy and immunotherapy has led to a significant improvement in the overall survival in many tumor diseases over the past 15 years. Thus, the surgical treatment of lung metastases and lymph node metastases is not only valuable to achieve a cure for selected tumors but it can and must be used to eliminate tumor growth peaks in the case of a circumscribed progression. These can be an expression of tumor heterogeneity that cannot be achieved by systemic therapy. Depending on the dynamics and extent of the metastasis, the therapeutic approach must be individually decided in the tumor board.
Literatur
Cheung FP, Alam NZ, Wright GM (2019) The past, present and future of pulmonary metastasectomy: a review article. Ann Thorac Cardiovasc Surg 25:129–141
Pfannschmidt J, Egerer G, Bischof M, Thomas M, Dienemann H (2012) Surgical intervention for pulmonary metastases. Dtsch Arztebl Int 109:645–651
Hattori N, Kanemitsu Y, Komori K, Shimizu Y, Sano T, Senda Y, Mitsudomi T, Fukui T (2013) Outcomes after hepatic and pulmonary metastasectomies compared with pulmonary metastasectomy alone in patients with colorectal cancer metastasis to liver and lungs. World J Surg 37:1315–1321
Zhao Y, Li J, Li C, Fan J, Liu L (2017) Prognostic factors for overall survival after lung metastasectomy in renal cell cancer patients: a systematic review and meta-analysis. Int J Surg 41:70–77
Fan J, Chen D, Du H, Shen C, Che G (2015) Prognostic factors for resection of isolated pulmonary metastases in breast cancer patients: a systematic review and meta-analysis. J Thorac Dis 7:1441–1451
International Human Genome Sequencing Consortium (2004) Finishing the euchromatic sequence of the human genome. Nature 431:931–945
Cancer Genome Atlas Research Network, Weinstein JN, Collisson EA, Mills GB, Shaw KR, Ozenberger BA, Ellrott K, Shmulevich I, Sander C, Stuart JM (2013) The Cancer Genome Atlas Pan-Cancer analysis project. Nat Genet 10:1113–1120
Rosenberg SA, Yang JC, Restifo NP (2004) Cancer immunotherapy: moving beyond current vaccines. Nat Med 10:909–915
Ribas A (2012) Tumor immunology directed at PD1. N Engl J Med 366:2517–2519
Huggins C, Hodges V (1941) I. The effect of castration, of estrogen and of androgen injection on serum phosphatases in metastatic carcinoma of the prostate. Cancer Res 1:291–297
Kistner RW, Smith OW (1960) Observations on the use of a non-steroidal estrogen antagonist: MER-25. Surg Forum 10:725
Schiller JH, Harrington D, Belani CP, Langer C, Sandler A, Krook J, Zhu J, Johnson DH, Eastern Cooperative Oncology Group (2002) Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer. N Engl J Med 346:92–98
Soria JC, Ohe Y, Vansteenkiste J, Reungwetwattana T, Chewaskulyong B, Lee KH, Dechaphunkul A, Imamura F, Nogami N, Kurata T, Okamoto I, Zhou C, Cho BC, Cheng Y, Cho EK, Voon PJ, Planchard D, Su WC, Gray JE, Lee SM, Hodge R, Marotti M, Rukazenkov Y, Ramalingam SS, FLAURA Investigators (2018) Osimertinib in untreated EGFR-mutated advanced non-small-cell lung cancer. N Engl J Med 378:113–125
Reck M, Rodríguez-Abreu D, Robinson AG, Hui R, Csőszi T, Fülöp A, Gottfried M, Peled N, Tafreshi A, Cuffe S, O’Brien M, Rao S, Hotta K, Leiby MA, Lubiniecki GM, Shentu Y, Rangwala R, Brahmer JR, KEYNOTE-024 Investigators (2016) Pembrolizumab versus chemotherapy for PD-L1-positive non-small-cell lung cancer. N Engl J Med 375:1823–1833
Socinski MA, Jotte RM, Cappuzzo F, Orlandi F, Stroyakovskiy D, Nogami N, Rodríguez-Abreu D, Moro-Sibilot D, Thomas CA, Barlesi F, Finley G, Kelsch C, Lee A, Coleman S, Deng Y, Shen Y, Kowanetz M, Lopez-Chavez A, Sandler A, Reck M, IMpower150 Study Group (2018) Atezolizumab for First-Line Treatment of Metastatic Nonsquamous NSCLC. N Engl J Med 378:2288–2301
Loupakis F, Cremolini C, Masi G, Lonardi S, Zagonel V, Salvatore L, Cortesi E, Tomasello G, Ronzoni M, Spadi R, Zaniboni A, Tonini G, Buonadonna A, Amoroso D, Chiara S, Carlomagno C, Boni C, Allegrini G, Boni L, Falcone A (2014) Initial therapy with FOLFOXIRI and bevacizumab for metastatic colorectal cancer. N Engl J Med 371:1609–1618
Finn RS, Martin M, Rugo HS, Jones S, Im SA, Gelmon K, Harbeck N, Lipatov ON, Walshe JM, Moulder S, Gauthier E, Lu DR, Randolph S, Diéras V, Slamon DJ (2016) Palbociclib and letrozole in advanced breast cancer. N Engl J Med 375:1925–1936
Swain SM, Baselga J, Kim SB, Ro J, Semiglazov V, Campone M, Ciruelos E, Ferrero JM, Schneeweiss A, Heeson S, Clark E, Ross G, Benyunes MC, Cortés J, CLEOPATRA Study Group (2015) Pertuzumab, trastuzumab, and docetaxel in HER2-positive metastatic breast cancer. N Engl J Med 372:724–734
Sartor O, Bono JS (2018) Metastatic prostate cancer. N Engl J Med 378:645–657
Conroy T, Desseigne F, Ychou M, Bouché O, Guimbaud R, Bécouarn Y, Adenis A, Raoul JL, Gourgou-Bourgade S, de la Fouchardière C, Bennouna J, Bachet JB, Khemissa-Akouz F, Péré-Vergé D, Delbaldo C, Assenat E, Chauffert B, Michel P, Montoto-Grillot C, Ducreux M, Groupe Tumeurs Digestives of Unicancer; PRODIGE Intergroup (2011) FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 364:1817–1825
Gerlinger M, Rowan AJ, Horswell S, Math M, Larkin J, Endesfelder D, Gronroos E, Martinez P, Matthews N, Stewart A, Tarpey P, Varela I, Phillimore B, Begum S, McDonald NQ, Butler A, Jones D, Raine K, Latimer C, Santos CR, Nohadani M, Eklund AC, Spencer-Dene B, Clark G, Pickering L, Stamp G, Gore M, Szallasi Z, Downward J, Futreal PA, Swanton C (2012) Intratumor heterogeneity and branched evolution revealed by multiregion sequencing. N Engl J Med 366:883–892
Tran E, Robbins PF, Lu YC, Prickett TD, Gartner JJ, Jia L, Pasetto A, Zheng Z, Ray S, Groh EM, Kriley IR, Rosenberg SA (2016) T‑Cell Transfer Therapy Targeting Mutant KRAS in Cancer. N Engl J Med 375:2255–2262
Kaufman B, Shapira-Frommer R, Schmutzler RK, Audeh MW, Friedlander M, Balmaña J, Mitchell G, Fried G, Stemmer SM, Hubert A, Rosengarten O, Steiner M, Loman N, Bowen K, Fielding A, Domchek SM (2015) Olaparib monotherapy in patients with advanced cancer and a germline BRCA1/2 mutation. J Clin Oncol 33:244–250
Goncalves MD, Hopkins BD, Cantley LC (2018) Phosphatidylinositol 3‑Kinase, growth disorders, and cancer. N Engl J Med 379:2052–2062
Drilon A, Laetsch TW, Kummar S, DuBois SG, Lassen UN, Demetri GD, Nathenson M, Doebele RC, Farago AF, Pappo AS, Turpin B, Dowlati A, Brose MS, Mascarenhas L, Federman N, Berlin J, El-Deiry WS, Baik C, Deeken J, Boni V, Nagasubramanian R, Taylor M, Rudzinski ER, Meric-Bernstam F, Sohal DPS, Ma PC, Raez LE, Hechtman JF, Benayed R, Ladanyi M, Tuch BB, Ebata K, Cruickshank S, Ku NC, Cox MC, Hawkins DS, Hong DS, Hyman DM (2018) Efficacy of larotrectinib in TRK fusion-positive cancers in adults and children. N Engl J Med 378:731–739
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Ko, YD. Die Rolle der Systemtherapie bei Lungenmetastasen mit Lymphknotenbefall. Chirurg 90, 997–1002 (2019). https://doi.org/10.1007/s00104-019-01045-1
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DOI: https://doi.org/10.1007/s00104-019-01045-1