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Strahlentherapie des Bronchialkarzinoms

Radiotherapy in lung cancer

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Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Die Strahlentherapie ist sowohl beim nicht-kleinzelligen, als auch beim kleinzelligen Bronchialkarzinom neben Chirurgie und Chemotherapie eine zentrale Behandlungsmodalität. Sie wird beim nicht-kleinzelligen Bronchialkarzinom in den Frühstadien unter adjuvanter Intention eingesetzt. Bei fortgeschrittenen, jedoch lokal begrenzten Tumorstadien, ist sie wesentlicher Bestandteil innerhalb multimodaler Therapiekonzepte. Der Effekt der Radiotherapie wird hierbei durch die Kombination mit Zytostatika oder auch zielgerichteten biologischen Substanzen, z. B. Tyrosinkinaseinhibitoren, verstärkt. Indikationen für eine Strahlentherapie beim nicht-kleinzelligen Karzinom sind somit die definitive Therapie und eine prä- sowie postoperative Radiatio.

Beim kleinzelligen Bronchialkarzinom erfolgt im Stadium „limited disease“ die Radiotherapie frühzeitig parallel zur definitiven Systemtherapie. Zusätzlich kommt ihr eine wesentliche Bedeutung in der Prophylaxe von Hirnfiliae als Ganzhirnbestrahlung zu.

In der palliativen Erkrankungssituation lindert eine Bestrahlung lokale Beschwerden oder hilft bei poststenotischen Komplikationen wie Atelektasen und Entzündungen.

Abstract

Radiation therapy (RT) plays a major role in the treatment of patients with small cell cancer (SCLC) and non-small cell lung cancer (NSCLC). Postoperative RT is used primarily for early-stage NSCLC patients in case of mediastinal lymph node involvement.

For patients with locally advanced disease (stages IIIA and IIIB), concurrent chemotherapy and irradiation remains the standard of care. Cytotoxic agents and biologic therapies such as tyrosine kinase inhibitors have been incorporated into multimodal treatment strategies for further improvement of radiosensitivity.

Thoracic radiation therapy is an established treatment in the management of limited-stage small cell lung cancer. There is increasing evidence in the literature in favor of early concurrent chemoradiation therapy. Increasing data support the use of prophylactic cranial irradiation (PCI) to prevent intracranial relapse and to improve survival.

Palliative RT is useful for patients with metastatic disease, causing symptoms such as dyspnea, cough, hemoptysis, postobstructive pneumonia, and pain.

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  1. Klinik für Radioonkologie und Strahlentherapie, Städtisches Klinikum Braunschweig gGmbH, Celler Str. 38, 38114, Braunschweig, Deutschland

    M. Becker-Schiebe & W. Hoffmann

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  1. M. Becker-Schiebe
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  2. W. Hoffmann
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Correspondence to M. Becker-Schiebe.

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Becker-Schiebe, M., Hoffmann, W. Strahlentherapie des Bronchialkarzinoms. Z Herz- Thorax- Gefäßchir 23, 305–310 (2009). https://doi.org/10.1007/s00398-009-0742-9

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  • DOI: https://doi.org/10.1007/s00398-009-0742-9

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