Strahlentherapie beim Lungenkarzinom – Teil eines interdisziplinären Therapiekonzeptes

Die Strahlentherapie ist seit langem ein elementarer Bestandteil der interdisziplinären Therapie von Lungenkrebserkrankungen und bietet heutzutage durch eine Vielzahl technischer Innovationen eine große Bandbreite unterschiedlicher Therapieoptionen. Für kleinzellige Karzinome kommt die Bestrahlung als definitive Radiochemotherapie bei lokal begrenzten Tumoren zum Einsatz, in metastasierten Situationen mit Ansprechen auf eine Chemotherapie kann eine additive thorakale Bestrahlung mit prophylaktischer Hirnschädelbestrahlung einen Überlebensvorteil bringen. Der Stellenwert der prophylaktischen Schädelbestrahlung wird kontrovers diskutiert. Beim nicht-kleinzelligen Lungenkarzinom bieten stereotaktische Verfahren eine Alternative zur Operation im frühen Stadium, bei lokal fortgeschrittenen Erkrankungen ist die optimale Kombination aus Operation, Chemotherapie und Bestrahlung Gegenstand vielfältiger Diskussionen. Inoperable Tumore werden mit einer definitiven Radiochemotherapie, oder im Falle deutlicher Ko-Morbidität, mit einer alleinigen Bestrahlung behandelt. In der Palliativsituation kann die Bestrahlung zur Linderung von Symptomen wie Schmerz oder Bronchuskompression beitragen. Stereotaktische Bestrahlungen von Hirnmetastasen bieten hohe lokale Kontrollraten bei vergleichsweise geringer Morbidität. Entscheidend für die Therapie ist die Einbindung der Bestrahlung in ein interdisziplinäres Therapiekonzept.

Radiotherapy has played a pivotal role in interdisciplinary therapies of lung cancer for a long time and offers a broad variety of therapy options using a plenty of technical innovations. In patients suffering from small cell lung cancer (SCLC), radiotherapy in combination with chemotherapy is used in localized tumors. In metastasized patients who respond to chemotherapy, an additional thoracic radiation in combination with prophylactic cranial irradiation (PCI) prolongs survival. The value of PCI is under discussion. Early stages of non-small cell lung cancer (NSCLC) can be treated by surgery or stereotactic radiotherapy either, locally advanced diseases are treated with a combination of surgery, chemotherapy and radiation. However, timing and sequence of these approaches are discussed controversially. Tumors that cannot be removed surgically are treated by radiochemotherapy or (in case of co-morbidity) radiation alone. In palliative situations radiotherapy can be used to reduce symptoms like pain or compression of airways. Stereotactic radiation of brain metastases show high local control rates with little morbidity. Radiotherapy should be performed as part of an interdisciplinary therapy concept.

Key words

Lung cancer - radiotherapy - stereotactic irradiation - radiochemotherapy - palliative irradiation

• Literatur

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