Das kleinzellige Bronchialkarzinom

Wiener klinische Wochenschrift - Tập 119 - Trang 697-710 - 2007
Stefan Hoschek1, Ursula Hoschek-Risslegger2, Michael Fiegl3, August Zabernigg4, Georg Pall5, Thomas Auberger6, Eberhard Gunsilius7, Thomas Schmid8, Herbert Jamnig9, Wolfgang Hilbe5
1Abteilung für Innere Medizin, Landeskrankenhaus Hochzirl, Hochzirl, Austria
2Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Innsbruck, Universitätsklinik für Innere Medizin, Innsbruck, Austria
3Abteilung für Innere Medizin, Onkologie, Landeskrankenhaus Natters, Natters, Austria
4Abteilung für Innere Medizin, BKH Kufstein, Kufstein, Austria
5Klinische Abteilung für Allgemeine Innere Medizin, Schwerpunkt Onkologie, Medizinische Universität Innsbruck, Universitätsklinik für Innere Medizin, Innsbruck, Austria
6Universitätsklinik für Strahlentherapie, Medizinische Universität Innsbruck, Innsbruck, Austria
7Klinische Abteilung für Hämatologie und Onkologie, Medizinische Universität Innsbruck, Universitätsklinik für Innere Medizin, Innsbruck, Austria
8Abteilung für Herz-Thoraxchirurgie, Medizinische Universität Innsbruck, Universitätsklinik für Chirurgie, Natters, Austria
9Abteilung für Pulmologie, Landeskrankenhaus Natters, Natters, Austria

Tóm tắt

Das kleinzellige Bronchialkarzinom (Small Cell Lung Cancer, SCLC) stellt mit ungefähr 20% einen wesentlichen Teil der Bronchialkarzinome dar. Beim SCLC konnten in den letzten zwanzig Jahren viele klinisch relevante Verbesserungen erzielt werden. Im Vergleich zum nichtkleinzelligen Bronchialkarzinom (Non Small Cell Lung Cancer, NSCLC) gelingt der Fortschritt hier jedoch nur in kleinen Schritten. Die Grundlage einer optimalen Behandlung beinhaltet heute eine interdisziplinäre Therapieplanung. Im lokalisierten Stadium stellt die Radiochemotherapie die Standardbehandlung dar. Dabei gilt eine platinhältige Kombinationstherapie nach wie vor als Goldstandard. Eine moderne dreidimensional geplante Strahlentherapie sollte so früh wie möglich konkordant zur Chemotherapie und im Einzelfall sogar hyperfraktioniert erfolgen. Im Frühstadium ist im Einzelfall auch eine operative Sanierung zu erwägen. Im fortgeschrittenen Stadium zeigt eine platinhältige Kombinationschemotherapie die besten Resultate. Bei Tumorremission ist sowohl im Frühstadium als auch im fortgeschrittenen Stadium eine prophylaktische Schädelbestrahlung indiziert. In der Zweitliniensituation und bei reduziertem Allgemeinzustand wird der Einsatz von Topotecan empfohlen. Pemetrexed könnte sich ähnlich wie beim NSCLC ebenfalls in der Zweitlinientherapieals Alternative etablieren. Bei den gezielten Tumortherapien sind die Daten zu Bevacizumab erfolgversprechend. In dieser Übersichtsarbeit werden die historischen Meilensteine und die aktuellen Trends der Chemotherapie, Strahlentherapie und Chirurgie beleuchtet. Weiters wird die Bedeutung experimenteller Therapieansätze und das Management spezieller klinischer Situationen diskutiert.

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