Ein wichtiger Teil im Behandlungskonzept - Die Chemotherapie des Bronchialkarzinoms

Zusammenfassung

In den vergangenen Jahren ist der Stellenwert der Chemotherapie im Behandlungskonzept des nichtkleinzelligen Bronchialkarzinoms deutlich gestiegen. Sie wird zum einen in den frühen Stadien I B bis III A mit kurativem Potenzial in Ergänzung zur Operation präoperativ oder adjuvant eingesetzt. In naher Zukunft wird diese Kombination in dieser Situation wohl zum Standardverfahren werden. Im Stadium III B wird die Chemotherapie bei Inoperabilität - wenn der Leistungsindex des Patienten es erlaubt - in Kombination mit der Radiotherapie verabreicht. Die große Domäne der Chemotherapie ist jedoch das disseminierte Stadium IV. Bei Patienten mit gutem Leistungsindex gilt eine cisplatinbasierte Zweifachbehandlung als Therapie der ersten Wahl. Als Alternative bieten sich inzwischen platinfreie Kombinationen an. Bei älteren Patienten, Patienten mit reduziertem Allgemeinzustand und Patienten, die bereits eine Zweit- oder Drittlinientherapie erhalten, wird eine Monochemotherapie empfohlen. Jedoch können einige ältere Patienten durchaus von einer Kombinationschemotherapie profitieren. Die Remissionsraten der Kombinationschemotherapie liegen „nur” zwischen 25 und 40 %. Die durchschnittliche Verlängerung der Überlebenszeit beträgt lediglich zwei Monate. Bis zu zwei Drittel der Patienten im fortgeschrittenen Stadium profitieren allerdings von der Chemotherapie mit einer Abnahme tumorbedingter Symptome und einer Verbesserung ihrer Leistungsfähigkeit.

Summary

In the last several years the importance of chemotherapy in the treatment of non-small cell lung cancer has increased substantially. In the early stages from I B to III A chemotherapy is used in a curative manner in combination with surgery either before surgery or as an adjuvant therapy. Most likely this combination will become a standard of treatment. Inoperable patients with stage III B are given chemotherapy according to their level of fitness in combination with radiotherapy. The largest domain of chemotherapy is in the treatment of disseminated stage IV non-small cell lung cancer. Patients with a good performance status are given cisplatin-based double combinations as the first line of treatment. Combinations without platin-derivatives have been an option in the last several years. Monochemotherapies are given to older patients, to those with a reduced level of fitness and those given second and third line therapy. This does not rule out the fact that older patients can benefit from combination therapies. The remission rates for combination chemotherapies lie between 25 and 40 %. Survival rates are lengthened on average only by two months. But up to two-thirds of all patients with advanced stages benefit from chemotherapy due to decreased tumor dependent symptoms and an increase in level of fitness.

Key Words

small cell lung cancer - non-small cell lung cancer - chemotherapy in multimodal concepts - palliative monotherapy - palliative polytherapy

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1 adjuvant lung project italy

2 international adjuvant lung cancer trial

Anschrift des Verfassers