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CC BY-NC-ND 4.0 · Pneumologie 2021; 75(10): 776-794
DOI: 10.1055/a-1404-1562
Originalarbeit

Die aktuelle Therapie des asbestassoziierten malignen Pleuramesothelioms – Ein Experten-Konsensuspapier

The Current Therapy of Asbestos-Associated Malignant Pleural Mesothelioma – An Expert Consensus Paper
C. Aigner 
1   Klinik für Thoraxchirurgie und thorakale Endoskopie, Universitätsmedizin Essen − Ruhrlandklinik
,
T. Brüning
2   Institut für Prävention und Arbeitsmedizin der Deutschen Gesetzlichen Unfallversicherung (DGUV) – Institut der Ruhr-Universität Bochum
,
W. E. E. Eberhardt 
3   Innere Klinik (Tumorforschung), Westdeutsches Tumorzentrum, Ruhrlandklinik, Universitätsmedizin Essen
,
M. Härter 
4   Institut und Poliklinik für Medizinische Psychologie und Institut für Psychotherapie (IfP), Universitätsklinikum Hamburg-Eppendorf
,
H.-P. Kaelberlah 
5   Strahlentherapie, MVZ an der Lungenklinik Hemer
,
M. Metzenmacher 
3   Innere Klinik (Tumorforschung), Westdeutsches Tumorzentrum, Ruhrlandklinik, Universitätsmedizin Essen
,
R. Shah 
6   Internistische Onkologie der Thoraxtumoren, Thoraxklinik − Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL)
,
C. Taube 
7   Klinik für Pneumologie, Universitätsmedizin Essen – Ruhrlandklinik
,
M. Thomas 
6   Internistische Onkologie der Thoraxtumoren, Thoraxklinik − Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL)
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Zusammenfassung

Asbestverursachte maligne Mesotheliome gehören in Deutschland mit etwa 1000 jährlichen Neuerkrankungen zu den häufigen arbeitsbedingten Krebserkrankungen. Die Prognose ist oftmals schlecht, da die Erkrankung lange symptomlos bleibt und deshalb meist erst als Zufallsbefund in bereits fortgeschrittenen Stadien diagnostiziert wird.

Die deutsche gesetzliche Unfallversicherung (DGUV) hat in den letzten Jahren erhebliche Anstrengungen unternommen, eine Vorverlagerung des Diagnosezeitpunkts zu erreichen, um die Erkrankung möglichst in Frühstadien zu detektieren. Die aus diesen Bestrebungen resultierenden neuen medizinisch-wissenschaftlichen Erkenntnisse zeigen, dass die Kombination der Biomarker Calretinin und Mesothelin in einer Hochrisikogruppe die Vorverlegung der Diagnose um bis zu 12 Monaten ermöglicht.

Die Diagnose eines Mesothelioms im Frühstadium wird idealerweise von der individuell bestmöglichen Therapie gefolgt. Die Standardtherapie basiert auf operativer Entfernung des Tumors und Chemotherapie, ergänzt um Strahlentherapie und Psychoonkologie. In den letzten Jahren wurden einige neue Therapieansätze entwickelt. Die Übersicht stellt den aktuellen Stand der Therapie des Mesothelioms, basierend auf den internationalen Leitlinien und neuen Studien, dar.

Abstract

Asbestos-related mesotheliomas belong to the group of the most frequent occupational diseases in Germany, reaching about 1,000 new cases per year. The disease has a dismal prognosis because most tumors remain asymptomatic for a long time and therefore are diagnosed as incidental findings at later stages.

During the last decade the German Social Accident Insurance (DGUV) has made considerable efforts to prepone the diagnosis in order to detect the disease at earliest possible stages. These efforts resulted in new findings showing that, in a high-risk group, a combination of the biomarkers calretinin and mesothelin was able to advance the diagnosis up to 12 months.

Ideally, the diagnosis of a mesothelioma at an early stage has to be accompanied by the best possible individualized therapy. Standard therapeutic strategies are surgery and chemotherapy, added by radiotherapy and psycho-oncology. In recent years, several new therapeutic avenues are being explored. This review comprehensively presents both old and new therapeutic options in mesothelioma, based on international Leitlinien and new studies.



Publication History

Received: 05 November 2020

Accepted: 26 February 2021

Article published online:
04 May 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
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