Ein gründliches mediastinales Staging ist von zentraler Bedeutung für die prognostische
Einschätzung und Therapieplanung bei Patienten mit nicht-kleinzelligem Lungenkarzinom
(NSCLC)
ohne Fernmetastasierung. Leitlinien zum mediastinalen Staging fordern konsequent die
Kombination aus radiologischen, nuklearmedizinischen und minimalinvasiven Methoden.
Technik und
Ergebnis der verschiedenen Methoden werden beschrieben und Algorithmen für unterschiedliche
onkologische Situationen vorgestellt.
Abstract
Thorough mediastinal staging is pivotal for prognostic assessment and treatment planning
in patients with non-small-cell lung cancer (NSCLC) without distant metastasis. It
aims to
answer the question of whether a technically and functionally feasible operation also
makes sense from an oncological point of view. In case of a nodal-free mediastinum,
primary
surgical therapy can be considered. If the ipsilateral mediastinal lymph nodes are
affected, multimodal therapy should be sought. Operating is usually no longer the
first step,
especially with extensive lymph node infestation. Surgery is recommended, if neoadjuvant
(radio-)chemotherapy has achieved downstaging or major response. If the contralateral
mediastinal lymph nodes are involved, curative surgery is no longer part of the therapeutic
concept. The therapy of choice in this situation is definitive chemo-radiotherapy.
Guidelines for mediastinal staging consistently require to combine radiological, nuclear
medicine and minimally invasive methods. Imaging with CT and PET allows an initial
assessment of the mediastinal status. In most cases it has to be complemented with
tissue confirmation. Echoendoscopic assessment of the mediastinum with needle biopsy
is the
minimally invasive method of first choice (“needle first”). Surgical staging methods
are reserved for situations, that cannot be satisfactorily clarified by echoendoscopy.
Technique and outcome of the different methods are described and algorithms are presented
for different oncological situations.
