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Das kleinzellige Bronchialkarzinom

Small cell lung cancer

  • Übersicht
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Summary

With about 20% of all lung cancers small cell lung cancer (SCLC) represents a major subset of this entity. Although therapeutic improvements did not receive as much attention as in non small cell lung cancer (NSCLC), many small steps of clinical progress have been achieved within the last 20 years. An optimal treatment should be based on an interdisciplinary treatment plan. The standard treatment in localized stages represents combined radiation and chemotherapy. Cisplatin and etoposide are in this concern considered as a gold standard. 3D-planned conformal radiotherapy should start as early as possible and should be applied concomitantly to chemotherapy and in certain cases even in a hyperfractionated treatment protocol. In very early stages surgical resection could be an option in selected cases. In advanced stages a platinum-based doublet offers high response rates. As already established in limited disease prophylactic cranial irradiation is now also indicated in extensive disease in case of any tumor remission. In the second line treatment and in patients with reduced performance status topotecan is recommended. Similar as in NSCLC pemetrexed might become an alternative treatment option in the second line setting. In the field of new targeted therapies bevacizumab achieved the most promising results. The present review highlights historical milestones and up-to-date trends in radiotherapy, chemotherapy and surgery. Furthermore, the role of experimental strategies and the management of certain special clinical situations are discussed.

Zusammenfassung

Das kleinzellige Bronchialkarzinom (Small Cell Lung Cancer, SCLC) stellt mit ungefähr 20% einen wesentlichen Teil der Bronchialkarzinome dar. Beim SCLC konnten in den letzten zwanzig Jahren viele klinisch relevante Verbesserungen erzielt werden. Im Vergleich zum nichtkleinzelligen Bronchialkarzinom (Non Small Cell Lung Cancer, NSCLC) gelingt der Fortschritt hier jedoch nur in kleinen Schritten. Die Grundlage einer optimalen Behandlung beinhaltet heute eine interdisziplinäre Therapieplanung. Im lokalisierten Stadium stellt die Radiochemotherapie die Standardbehandlung dar. Dabei gilt eine platinhältige Kombinationstherapie nach wie vor als Goldstandard. Eine moderne dreidimensional geplante Strahlentherapie sollte so früh wie möglich konkordant zur Chemotherapie und im Einzelfall sogar hyperfraktioniert erfolgen. Im Frühstadium ist im Einzelfall auch eine operative Sanierung zu erwägen. Im fortgeschrittenen Stadium zeigt eine platinhältige Kombinationschemotherapie die besten Resultate. Bei Tumorremission ist sowohl im Frühstadium als auch im fortgeschrittenen Stadium eine prophylaktische Schädelbestrahlung indiziert. In der Zweitliniensituation und bei reduziertem Allgemeinzustand wird der Einsatz von Topotecan empfohlen. Pemetrexed könnte sich ähnlich wie beim NSCLC ebenfalls in der Zweitlinientherapieals Alternative etablieren. Bei den gezielten Tumortherapien sind die Daten zu Bevacizumab erfolgversprechend. In dieser Übersichtsarbeit werden die historischen Meilensteine und die aktuellen Trends der Chemotherapie, Strahlentherapie und Chirurgie beleuchtet. Weiters wird die Bedeutung experimenteller Therapieansätze und das Management spezieller klinischer Situationen diskutiert.

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Authors and Affiliations

  1. Abteilung für Innere Medizin, Landeskrankenhaus Hochzirl, Hochzirl, Austria

    Stefan Hoschek

  2. Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Innsbruck, Universitätsklinik für Innere Medizin, Innsbruck, Austria

    Ursula Hoschek-Risslegger

  3. Abteilung für Innere Medizin, Onkologie, Landeskrankenhaus Natters, Natters, Austria

    Michael Fiegl

  4. Abteilung für Innere Medizin, BKH Kufstein, Kufstein, Austria

    August Zabernigg

  5. Klinische Abteilung für Allgemeine Innere Medizin, Schwerpunkt Onkologie, Medizinische Universität Innsbruck, Universitätsklinik für Innere Medizin, Innsbruck, Austria

    Georg Pall & Wolfgang Hilbe

  6. Universitätsklinik für Strahlentherapie, Medizinische Universität Innsbruck, Innsbruck, Austria

    Thomas Auberger

  7. Klinische Abteilung für Hämatologie und Onkologie, Medizinische Universität Innsbruck, Universitätsklinik für Innere Medizin, Innsbruck, Austria

    Eberhard Gunsilius

  8. Abteilung für Herz-Thoraxchirurgie, Medizinische Universität Innsbruck, Universitätsklinik für Chirurgie, Natters, Austria

    Thomas Schmid

  9. Abteilung für Pulmologie, Landeskrankenhaus Natters, Natters, Austria

    Herbert Jamnig

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  1. Stefan Hoschek
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  2. Ursula Hoschek-Risslegger
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  3. Michael Fiegl
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  4. August Zabernigg
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  5. Georg Pall
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  10. Wolfgang Hilbe
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Correspondence to Wolfgang Hilbe.

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Hoschek, S., Hoschek-Risslegger, U., Fiegl, M. et al. Das kleinzellige Bronchialkarzinom. Wien Klin Wochenschr 119, 697–710 (2007). https://doi.org/10.1007/s00508-007-0913-1

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  • DOI: https://doi.org/10.1007/s00508-007-0913-1

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