Zentralbl Chir 2017; 142(S 01): S44-S50
DOI: 10.1055/s-0043-115642
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Aktuelle Indikationen zur operativen Therapie beim kleinzelligen Lungenkarzinom

Current Indications for Surgery in Small Cell Lung Cancer
Wolfgang Jungraithmayr
1   Klinik für Thoraxchirurgie, Universitätsspital Zürich, Schweiz
2   Klinik für Thoraxchirurgie, Medizinische Hochschule Brandenburg, Campus Ruppiner Kliniken, Deutschland
› Author Affiliations
Further Information

Publication History

Publication Date:
03 August 2017 (online)

Zusammenfassung

Das kleinzellige Bronchialkarzinom ist durch ein aggressives und schnelles Wachstum mit Tendenz zur frühen Metastasierung charakterisiert und weist eine der ungünstigsten Prognosen unter allen Malignomen auf. Aufgrund seiner hohen Sensitivität für Strahlen- und Chemotherapie stellt die Radiochemotherapie immer noch den Hauptpfeiler der Therapie dar. Allerdings haben in den letzten Jahren eine Reihe von retrospektiven Arbeiten sowie größere Fallserien gezeigt, dass eine Operation im multimodalen Konzept zu einem relevanten Überlebensvorteil sowie einer verbesserten lokalen Tumorkontrolle führen kann. Empfohlen werden kann eine Operation bei Manifestation des kleinzelligen Karzinoms in Form eines singulären peripheren Herdes, bei einem frühen Tumorstadium (T1 – 2, N0, M0), bei Vorliegen von kombiniert-histologischen Tumortypen, aber auch in ausgewählten Fällen bei einer Persistenz des kleinzelligen Karzinoms nach Chemotherapieresistenz. Aufgrund dessen, dass wir heute über eine Immuntherapie mittels Checkpoint-Inhibitoren nun auch bei dem kleinzelligen Karzinom verfügen, sollte auch unter diesem Aspekt eine Resektion erwogen werden, da die Expression bestimmter Checkpoint-Rezeptoren einen relevanten Einfluss auf Therapie und Prognose besitzt. Um allerdings die genannten Kriterien zugunsten einer Operation verbindlich und zuverlässig formulieren zu können, bedarf es randomisierter, kontrollierter Studien.

Abstract

Small cell lung cancer (SCLC) is characterised by an aggressive and rapid growth, with a tendency towards early metastatic spread. It has one of the worst prognoses of all malignancies. Though radio-chemotherapy is still considered the mainstay of therapy due to its high sensitivity, increasing evidence, supported by a number of retrospective analyses and large case series, suggests that surgery may play a significant role in the treatment of SCLC within a multimodality treatment concept. In this context, surgery can provide overall survival benefit and improve local control in selected cases. Currently, an operation can be recommended if the SCLC manifests as a single peripheral node, in early cancer stages (T1 – 2, N0, M0), in cases of mixed histological tumour types but also in selected cases in chemotherapy-resistant tumors. In the light of the current availability of immunotherapy by checkpoint inhibitors, resection of SCLC should also be considered on the basis of the expression of checkpoint receptors that might have relevant impact on therapy and prognosis of the course of SCLC. In order to fulfil the above-mentioned criteria and to provide a higher level of evidence and to develop guidelines, randomised controlled trials need to be performed.

 
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