Hirnmetastasen

Zusammenfassung

Zerebrale Metastasen bei Patienten mit Lungenkarzinom im Stadium der Metastasierung finden sich bereits bei mehr als 30% Patienten zum Zeitpunkt der Erstdiagnose und manifestieren sich im Verlauf der Erkrankung bei 2 von 3 Patienten. Die zerebrale Krankheitsmanifestation wurde lange Zeit als prognostisch ungünstig eingestuft. Betroffene Patienten wurden regelhaft von Therapiestudien unter Berücksichtigung der ungünstigen Prognose ausgeschlossen. Im Kontext zielgerichteter molekularer Therapiestrategien und etablierter immunonkologischer Systemtherapien stellt die Blut-Hirn-Schranke mittlerweile keine unüberwindbare Barriere mehr dar. Die Therapie von Hirnmetastasen erfordert aber stets die Betreuung in einem interdisziplinären Team und muss als Zentrumsaufgabe angesehen werden. Unter Berücksichtigung von Anzahl, Größe und Lokalisation der Hirnmetastasen, Neurologie und Allgemeinzustand, Komorbiditäten, potenzieller Lebenserwartung und Wunsch des Patienten, aber auch Tumorbiologie inklusive molekularer Veränderungen, extrakranieller Tumorlast und Verfügbarkeit einer ZNS-wirksamen Therapie erfolgt die differenzierte Therapieentscheidung. Hierbei werden mittlerweile häufig Systemtherapien sowie lokale neurochirurgische und strahlentherapeutische Therapiekonzepte kombiniert im Sinne optimierter und prognoseverbessernder Therapiestrategien.

Abstract

Cerebral metastases in patients with metastatic lung cancer are found in more than 30% of patients at baseline and manifest themselves in two out of three patients during disease evolution. For a long time, the cerebral manifestation of the disease was classified as prognostically unfavorable and hence such patients were regularly excluded from therapy studies. In the context of targeted molecular therapy strategies and established immuno-oncological systemic therapies, the blood-brain barrier no longer represents an insurmountable barrier. However, the treatment of brain metastases requires decision making in a multidisciplinary team within dedicated lung cancer and/or oncology centers. The differentiated treatment decision is based on the number, size and location of the brain metastases, neurology and general condition, comorbidities, potential life expectancy and the patient’s wishes, but also tumor biology including molecular targets, extra-cranial tumor burden and availability of a CNS-effective therapy. Systemic therapies as well as neurosurgical and radiotherapeutic concepts are now often combined for optimized and prognosis-improving therapeutic strategies.

Schlüsselwörter

Lungenkarzinom - zerebrale Metastasen - Präzisionsonkologie

Keywords

lung cancer - cerebral metastases - precision oncology

Publication History

Received: 29 November 2023

Accepted after revision: 02 January 2024

Article published online:
03 March 2025

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