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Erschienen in: Wiener klinisches Magazin 6/2017

14.09.2017 | Onkologie

Multimodale Therapie des kleinzelligen Lungenkarzinoms

Die Rolle der Strahlentherapie

verfasst von: Prof. Dr. Michael Flentje, Dr. Thomas Fischer

Erschienen in: Wiener klinisches Magazin | Ausgabe 6/2017

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Zusammenfassung

Hintergrund

Zum Zeitpunkt der Diagnosestellung kleinzelliges Lungenkarzinom (SCLC) sind etwa 30 % der Patienten im Stadium „limited disease“. Dies entspricht in der Maximalausbreitung dem befallenen Hemithorax, dem Mediastinum und den supraklavikulären Lymphknoten. Diese Patienten haben eine kurative Chance durch eine kombinierte thorakale Radiochemotherapie.

Ergebnisse

Die Gesamtbehandlungszeit und frühe thorakale Bestrahlung simultan zur Chemotherapie sind für den Therapieerfolg wichtig. Dagegen scheint eine Dosiseskalation über 45–50 Gy hinaus keinen eindeutigen Vorteil zu bieten. Weiterhin trägt als wichtige Säule auch die prophylaktische Bestrahlung des Gehirns (PCI) bei, die Rate intrakranieller Rezidive zu senken.

Schlussfolgerung

Eine abgestimmte interdisziplinäre, multimodale Radiochemotherapie konnte sich in den letzten Jahren fest etablieren und ist essenziell für den Behandlungserfolg des kleinzelligen Lungenkarzinoms.
Literatur
1.
Zurück zum Zitat Arriagada R, Le Chevalier T, Borie F et al (1995) Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. J Natl Cancer Inst 87:183–190CrossRefPubMed Arriagada R, Le Chevalier T, Borie F et al (1995) Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. J Natl Cancer Inst 87:183–190CrossRefPubMed
2.
Zurück zum Zitat Arriagada R, Le Chevalier T, Riviere A et al (2002) Patterns of failure after prophylactic cranial irradiation in small-cell lung cancer: analysis of 505 randomized patients. Ann Oncol 13:748–754CrossRefPubMed Arriagada R, Le Chevalier T, Riviere A et al (2002) Patterns of failure after prophylactic cranial irradiation in small-cell lung cancer: analysis of 505 randomized patients. Ann Oncol 13:748–754CrossRefPubMed
3.
Zurück zum Zitat Arriagada R, Pellae-Cosset B, Ladron De Guevara JC et al (1991) Alternating radiotherapy and chemotherapy schedules in limited small cell lung cancer: analysis of local chest recurrences. Radiother Oncol 20:91–98CrossRefPubMed Arriagada R, Pellae-Cosset B, Ladron De Guevara JC et al (1991) Alternating radiotherapy and chemotherapy schedules in limited small cell lung cancer: analysis of local chest recurrences. Radiother Oncol 20:91–98CrossRefPubMed
4.
Zurück zum Zitat Auperin A, Arriagada R, Pignon JP et al (1999) Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. Prophylactic Cranial Irradiation Overview Collaborative Group. N Engl J Med 341:476–484CrossRefPubMed Auperin A, Arriagada R, Pignon JP et al (1999) Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. Prophylactic Cranial Irradiation Overview Collaborative Group. N Engl J Med 341:476–484CrossRefPubMed
5.
Zurück zum Zitat Baka S, Califano R, Ferraldeschi R et al (2008) Phase III randomised trial of doxorubicin-based chemotherapy compared with platinum-based chemotherapy in small-cell lung cancer. Br J Cancer 99:442–447CrossRefPubMedPubMedCentral Baka S, Califano R, Ferraldeschi R et al (2008) Phase III randomised trial of doxorubicin-based chemotherapy compared with platinum-based chemotherapy in small-cell lung cancer. Br J Cancer 99:442–447CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat Bradley JD, Dehdashti F, Mintun MA et al (2004) Positron emission tomography in limited-stage small-cell lung cancer: a prospective study. J Clin Oncol 22:3248–3254CrossRefPubMed Bradley JD, Dehdashti F, Mintun MA et al (2004) Positron emission tomography in limited-stage small-cell lung cancer: a prospective study. J Clin Oncol 22:3248–3254CrossRefPubMed
7.
Zurück zum Zitat Bunn PA Jr., Crowley J, Kelly K et al (1995) Chemoradiotherapy with or without granulocyte-macrophage colony-stimulating factor in the treatment of limited-stage small-cell lung cancer: a prospective phase III randomized study of the Southwest Oncology Group. J Clin Oncol 13:1632–1641CrossRefPubMed Bunn PA Jr., Crowley J, Kelly K et al (1995) Chemoradiotherapy with or without granulocyte-macrophage colony-stimulating factor in the treatment of limited-stage small-cell lung cancer: a prospective phase III randomized study of the Southwest Oncology Group. J Clin Oncol 13:1632–1641CrossRefPubMed
8.
Zurück zum Zitat De Ruysscher D, Lueza B, Le Pechoux C et al (2016) Impact of thoracic radiotherapy timing in limited-stage small-cell lung cancer: usefulness of the individual patient data meta-analysis. Ann Oncol 27:1818–1828CrossRefPubMedPubMedCentral De Ruysscher D, Lueza B, Le Pechoux C et al (2016) Impact of thoracic radiotherapy timing in limited-stage small-cell lung cancer: usefulness of the individual patient data meta-analysis. Ann Oncol 27:1818–1828CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat De Ruysscher D, Pijls-Johannesma M, Bentzen SM et al (2006) Time between the first day of chemotherapy and the last day of chest radiation is the most important predictor of survival in limited-disease small-cell lung cancer. J Clin Oncol 24:1057–1063CrossRefPubMed De Ruysscher D, Pijls-Johannesma M, Bentzen SM et al (2006) Time between the first day of chemotherapy and the last day of chest radiation is the most important predictor of survival in limited-disease small-cell lung cancer. J Clin Oncol 24:1057–1063CrossRefPubMed
10.
Zurück zum Zitat Fox W, Scadding JG (1973) Medical Research Council comparative trial of surgery and radiotherapy for primary treatment of small-celled or oat-celled carcinoma of bronchus. Ten-year follow-up. Lancet 2:63–65CrossRefPubMed Fox W, Scadding JG (1973) Medical Research Council comparative trial of surgery and radiotherapy for primary treatment of small-celled or oat-celled carcinoma of bronchus. Ten-year follow-up. Lancet 2:63–65CrossRefPubMed
11.
Zurück zum Zitat Green RA, Humphrey E, Close H et al (1969) Alkylating agents in bronchogenic carcinoma. Am J Med 46:516–525CrossRefPubMed Green RA, Humphrey E, Close H et al (1969) Alkylating agents in bronchogenic carcinoma. Am J Med 46:516–525CrossRefPubMed
12.
Zurück zum Zitat Hu X, Bao Y, Zhang L et al (2012) Omitting elective nodal irradiation and irradiating postinduction versus preinduction chemotherapy tumor extent for limited-stage small cell lung cancer: interim analysis of a prospective randomized noninferiority trial. Cancer 118:278–287CrossRefPubMed Hu X, Bao Y, Zhang L et al (2012) Omitting elective nodal irradiation and irradiating postinduction versus preinduction chemotherapy tumor extent for limited-stage small cell lung cancer: interim analysis of a prospective randomized noninferiority trial. Cancer 118:278–287CrossRefPubMed
13.
Zurück zum Zitat Jeremic B, Shibamoto Y, Nikolic N et al (1999) Role of radiation therapy in the combined-modality treatment of patients with extensive disease small-cell lung cancer: a randomized study. J Clin Oncol 17:2092–2099CrossRefPubMed Jeremic B, Shibamoto Y, Nikolic N et al (1999) Role of radiation therapy in the combined-modality treatment of patients with extensive disease small-cell lung cancer: a randomized study. J Clin Oncol 17:2092–2099CrossRefPubMed
14.
Zurück zum Zitat Kalemkerian GP (2012) Staging and imaging of small cell lung cancer. Cancer Imaging 11:253–258CrossRefPubMed Kalemkerian GP (2012) Staging and imaging of small cell lung cancer. Cancer Imaging 11:253–258CrossRefPubMed
15.
Zurück zum Zitat Kamel EM, Zwahlen D, Wyss MT et al (2003) Whole-body (18)F-FDG PET improves the management of patients with small cell lung cancer. J Nucl Med 44:1911–1917PubMed Kamel EM, Zwahlen D, Wyss MT et al (2003) Whole-body (18)F-FDG PET improves the management of patients with small cell lung cancer. J Nucl Med 44:1911–1917PubMed
16.
Zurück zum Zitat Kies MS, Mira JG, Crowley JJ et al (1987) Multimodal therapy for limited small-cell lung cancer: a randomized study of induction combination chemotherapy with or without thoracic radiation in complete responders; and with wide-field versus reduced-field radiation in partial responders: a Southwest Oncology Group Study. J Clin Oncol 5:592–600CrossRefPubMed Kies MS, Mira JG, Crowley JJ et al (1987) Multimodal therapy for limited small-cell lung cancer: a randomized study of induction combination chemotherapy with or without thoracic radiation in complete responders; and with wide-field versus reduced-field radiation in partial responders: a Southwest Oncology Group Study. J Clin Oncol 5:592–600CrossRefPubMed
17.
Zurück zum Zitat Komaki R, Paulus R, Ettinger DS et al (2012) Phase II study of accelerated high-dose radiotherapy with concurrent chemotherapy for patients with limited small-cell lung cancer: Radiation Therapy Oncology Group protocol 0239. Int J Radiat Oncol Biol Phys 83:e531–e536CrossRefPubMedPubMedCentral Komaki R, Paulus R, Ettinger DS et al (2012) Phase II study of accelerated high-dose radiotherapy with concurrent chemotherapy for patients with limited small-cell lung cancer: Radiation Therapy Oncology Group protocol 0239. Int J Radiat Oncol Biol Phys 83:e531–e536CrossRefPubMedPubMedCentral
18.
Zurück zum Zitat Le Pechoux C, Dunant A, Senan S et al (2009) Standard-dose versus higher-dose prophylactic cranial irradiation (PCI) in patients with limited-stage small-cell lung cancer in complete remission after chemotherapy and thoracic radiotherapy (PCI 99-01, EORTC 22003-08004, RTOG 0212, and IFCT 99-01): a randomised clinical trial. Lancet Oncol 10:467–474CrossRefPubMed Le Pechoux C, Dunant A, Senan S et al (2009) Standard-dose versus higher-dose prophylactic cranial irradiation (PCI) in patients with limited-stage small-cell lung cancer in complete remission after chemotherapy and thoracic radiotherapy (PCI 99-01, EORTC 22003-08004, RTOG 0212, and IFCT 99-01): a randomised clinical trial. Lancet Oncol 10:467–474CrossRefPubMed
19.
Zurück zum Zitat Liengswangwong V, Bonner JA, Shaw EG et al (1994) Limited-stage small-cell lung cancer: patterns of intrathoracic recurrence and the implications for thoracic radiotherapy. J Clin Oncol 12:496–502CrossRefPubMed Liengswangwong V, Bonner JA, Shaw EG et al (1994) Limited-stage small-cell lung cancer: patterns of intrathoracic recurrence and the implications for thoracic radiotherapy. J Clin Oncol 12:496–502CrossRefPubMed
20.
Zurück zum Zitat Murray N, Coy P, Pater JL et al (1993) Importance of timing for thoracic irradiation in the combined modality treatment of limited-stage small-cell lung cancer. The National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 11:336–344CrossRefPubMed Murray N, Coy P, Pater JL et al (1993) Importance of timing for thoracic irradiation in the combined modality treatment of limited-stage small-cell lung cancer. The National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 11:336–344CrossRefPubMed
22.
Zurück zum Zitat Pignon JP, Arriagada R, Ihde DC et al (1992) A meta-analysis of thoracic radiotherapy for small-cell lung cancer. N Engl J Med 327:1618–1624CrossRefPubMed Pignon JP, Arriagada R, Ihde DC et al (1992) A meta-analysis of thoracic radiotherapy for small-cell lung cancer. N Engl J Med 327:1618–1624CrossRefPubMed
23.
Zurück zum Zitat Postmus PE, Haaxma-Reiche H, Smit EF et al (2000) Treatment of brain metastases of small-cell lung cancer: comparing teniposide and teniposide with whole-brain radiotherapy – a phase III study of the European Organization for the Research and Treatment of Cancer Lung Cancer Cooperative Group. J Clin Oncol 18:3400–3408CrossRefPubMed Postmus PE, Haaxma-Reiche H, Smit EF et al (2000) Treatment of brain metastases of small-cell lung cancer: comparing teniposide and teniposide with whole-brain radiotherapy – a phase III study of the European Organization for the Research and Treatment of Cancer Lung Cancer Cooperative Group. J Clin Oncol 18:3400–3408CrossRefPubMed
24.
Zurück zum Zitat Postmus PE, Splinter TA, Palmen FM et al (1992) Comparison of two carboplatin-containing regimens with standard chemotherapy for small cell lung cancer in a randomised phase II study. The EORTC Lung Cancer Cooperative group. Eur J Cancer 28:96–100CrossRefPubMed Postmus PE, Splinter TA, Palmen FM et al (1992) Comparison of two carboplatin-containing regimens with standard chemotherapy for small cell lung cancer in a randomised phase II study. The EORTC Lung Cancer Cooperative group. Eur J Cancer 28:96–100CrossRefPubMed
25.
Zurück zum Zitat Santarpia M, Daffina MG, Karachaliou N et al (2016) Targeted drugs in small-cell lung cancer. Transl Lung Cancer Res 5:51–70PubMedPubMedCentral Santarpia M, Daffina MG, Karachaliou N et al (2016) Targeted drugs in small-cell lung cancer. Transl Lung Cancer Res 5:51–70PubMedPubMedCentral
26.
Zurück zum Zitat Slotman B, Faivre-Finn C, Kramer G et al (2007) Prophylactic cranial irradiation in extensive small-cell lung cancer. N Engl J Med 357:664–672CrossRefPubMed Slotman B, Faivre-Finn C, Kramer G et al (2007) Prophylactic cranial irradiation in extensive small-cell lung cancer. N Engl J Med 357:664–672CrossRefPubMed
27.
Zurück zum Zitat Slotman BJ, Van Tinteren H, Praag JO et al (2015) Use of thoracic radiotherapy for extensive stage small-cell lung cancer: a phase 3 randomised controlled trial. Lancet 385:36–42CrossRefPubMed Slotman BJ, Van Tinteren H, Praag JO et al (2015) Use of thoracic radiotherapy for extensive stage small-cell lung cancer: a phase 3 randomised controlled trial. Lancet 385:36–42CrossRefPubMed
28.
Zurück zum Zitat Sundstrom S, Bremnes RM, Kaasa S et al (2002) Cisplatin and etoposide regimen is superior to cyclophosphamide, epirubicin, and vincristine regimen in small-cell lung cancer: results from a randomized phase III trial with 5 years’ follow-up. J Clin Oncol 20:4665–4672CrossRefPubMed Sundstrom S, Bremnes RM, Kaasa S et al (2002) Cisplatin and etoposide regimen is superior to cyclophosphamide, epirubicin, and vincristine regimen in small-cell lung cancer: results from a randomized phase III trial with 5 years’ follow-up. J Clin Oncol 20:4665–4672CrossRefPubMed
29.
Zurück zum Zitat Takada M, Fukuoka M, Kawahara M et al (2002) Phase III study of concurrent versus sequential thoracic radiotherapy in combination with cisplatin and etoposide for limited-stage small-cell lung cancer: results of the Japan Clinical Oncology Group Study 9104. J Clin Oncol 20:3054–3060CrossRefPubMed Takada M, Fukuoka M, Kawahara M et al (2002) Phase III study of concurrent versus sequential thoracic radiotherapy in combination with cisplatin and etoposide for limited-stage small-cell lung cancer: results of the Japan Clinical Oncology Group Study 9104. J Clin Oncol 20:3054–3060CrossRefPubMed
30.
Zurück zum Zitat Turrisi AT 3rd, Kim K, Blum R et al (1999) Twice-daily compared with once-daily thoracic radiotherapy in limited small-cell lung cancer treated concurrently with cisplatin and etoposide. N Engl J Med 340:265–271CrossRefPubMed Turrisi AT 3rd, Kim K, Blum R et al (1999) Twice-daily compared with once-daily thoracic radiotherapy in limited small-cell lung cancer treated concurrently with cisplatin and etoposide. N Engl J Med 340:265–271CrossRefPubMed
31.
Zurück zum Zitat Videtic GM, Belderbos JS, Spring Kong FM et al (2008) Report from the International Atomic Energy Agency (IAEA) consultants’ meeting on elective nodal irradiation in lung cancer: small-cell lung cancer (SCLC). Int J Radiat Oncol Biol Phys 72:327–334CrossRefPubMed Videtic GM, Belderbos JS, Spring Kong FM et al (2008) Report from the International Atomic Energy Agency (IAEA) consultants’ meeting on elective nodal irradiation in lung cancer: small-cell lung cancer (SCLC). Int J Radiat Oncol Biol Phys 72:327–334CrossRefPubMed
32.
Zurück zum Zitat Videtic GM, Stitt LW, Dar AR et al (2003) Continued cigarette smoking by patients receiving concurrent chemoradiotherapy for limited-stage small-cell lung cancer is associated with decreased survival. J Clin Oncol 21:1544–1549CrossRefPubMed Videtic GM, Stitt LW, Dar AR et al (2003) Continued cigarette smoking by patients receiving concurrent chemoradiotherapy for limited-stage small-cell lung cancer is associated with decreased survival. J Clin Oncol 21:1544–1549CrossRefPubMed
33.
Zurück zum Zitat Wolfson AH, Bae K, Komaki R et al (2011) Primary analysis of a phase II randomized trial Radiation Therapy Oncology Group (RTOG) 0212: impact of different total doses and schedules of prophylactic cranial irradiation on chronic neurotoxicity and quality of life for patients with limited-disease small-cell lung cancer. Int J Radiat Oncol Biol Phys 81:77–84CrossRefPubMed Wolfson AH, Bae K, Komaki R et al (2011) Primary analysis of a phase II randomized trial Radiation Therapy Oncology Group (RTOG) 0212: impact of different total doses and schedules of prophylactic cranial irradiation on chronic neurotoxicity and quality of life for patients with limited-disease small-cell lung cancer. Int J Radiat Oncol Biol Phys 81:77–84CrossRefPubMed
Metadaten
Titel
Multimodale Therapie des kleinzelligen Lungenkarzinoms
Die Rolle der Strahlentherapie
verfasst von
Prof. Dr. Michael Flentje
Dr. Thomas Fischer
Publikationsdatum
14.09.2017
Verlag
Springer Vienna
Erschienen in
Wiener klinisches Magazin / Ausgabe 6/2017
Print ISSN: 1869-1757
Elektronische ISSN: 1613-7817
DOI
https://doi.org/10.1007/s00740-017-0190-1

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