Prävention, Diagnostik, Therapie und Nachsorge des Lungenkarzinoms

Wolfgang Schütte; Sylvia Gütz; Wiebke Nehls; Torsten Gerriet Blum; Wolfgang Brückl; Nina Buttmann-Schweiger; Reinhard Büttner; Petros Christopoulos; Sandra Delis; Karl M. Deppermann; Nikolas Dickgreber; Wilfried Eberhardt; Stephan Eggeling; Jochen Fleckenstein; Michael Flentje; Nikolaj Frost; Frank Griesinger; Christian Grohé; Andreas Gröschel; Matthias Guckenberger; Erich Hecker; Hans Hoffmann; Rudolf M. Huber; Klaus Junker; Hans-Ulrich Kauczor; Jens Kollmeier; Klaus Kraywinkel; Marcus Krüger; Christian Kugler; Miriam Möller; Ursula Nestle; Bernward Passlick; Joachim Pfannschmidt; Martin Reck; Niels Reinmuth; Christian Rübe; Robert Scheubel; Christian Schumann; Martin Sebastian; Monika Serke; Erich Stoelben; Martin Stuschke; Michael Thomas; Amanda Tufman; Dirk Vordermark; Cornelius Waller; Jürgen Wolf; Martin Wolf; Dag Wormanns

doi:10.1055/a-2029-0134

Pneumologie 2023; 77(10): 671-813
DOI: 10.1055/a-2029-0134

Leitlinie

Prävention, Diagnostik, Therapie und Nachsorge des Lungenkarzinoms

Interdisziplinäre S3-Leitlinie der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin und der Deutschen Krebsgesellschaft – KurzfassungPrevention, Diagnosis, Therapy, and Follow-up of Lung CancerInterdisciplinary Guideline of the German Respiratory Society and the German Cancer Society – Abridged Version

Wolfgang Schütte

¹Klinik für Innere Medizin II, Krankenhaus Martha Maria Halle-Dölau, Halle (Saale)

,

Sylvia Gütz

²St. Elisabeth-Krankenhaus Leipzig, Abteilung für Innere Medizin I, Leipzig

,

Wiebke Nehls

³Klinik für Palliativmedizin und Geriatrie, Helios Klinikum Emil von Behring

,

Torsten Gerriet Blum

⁴Helios Klinikum Emil von Behring, Klinik für Pneumologie, Lungenklinik Heckeshorn, Berlin

,

Wolfgang Brückl

⁵Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Klinikum Nürnberg Nord

,

Nina Buttmann-Schweiger

⁶Zentrum für Krebsregisterdaten, Robert-Koch-Institut, Berlin

,

Reinhard Büttner

⁷Institut für Allgemeine Pathologie und Pathologische Anatomie, Uniklinik Köln, Berlin

,

Petros Christopoulos

⁸Thoraxklinik am Univ.-Klinikum Heidelberg, Thorakale Onkologie, Heidelberg

,

Sandra Delis

⁹Helios Klinikum Emil von Behring, Klinik für Pneumologie, Lungenklinik Heckeshorn, Berlin

,

Karl M. Deppermann

¹⁰Klinik für Pneumologie, Sana Krankenhaus Gerresheim, Gerresheim

,

Nikolas Dickgreber

¹¹Klinik für Pneumologie, Thoraxonkologie und Beatmungsmedizin, Klinikum Rheine

,

Wilfried Eberhardt

¹²Universitätsmedizin Essen, Ruhrlandklinik, Essen

,

Stephan Eggeling

¹³Vivantes Netzwerk für Gesundheit, Klinikum Neukölln, Klinik für Thoraxchirurgie, Berlin

,

Jochen Fleckenstein

¹⁴Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg

,

Michael Flentje

¹⁵Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Würzburg, Würzburg

,

Nikolaj Frost

¹⁶Medizinische Klinik mit Schwerpunkt Infektiologie/Pneumologie, Charite Universitätsmedizin Berlin, Berlin

,

Frank Griesinger

¹⁷Klinik für Hämatologie und Onkologie, Pius-Hospital Oldenburg, Oldenburg

,

Christian Grohé

¹⁸Evangelische Lungenklinik, Klinik für Pneumologie, Berlin

,

Andreas Gröschel

¹⁹Klinik für Pneumologie und Beatmungsmedizin, Clemenshospital, Münster

,

Matthias Guckenberger

²⁰Klinik für Radio-Onkologie, Universitäts Spital Zürich, Zürich

,

Erich Hecker

²¹Thoraxzentrum Ruhrgebiet, Bochum

,

Hans Hoffmann

²²Klinikum Rechts der Isar, TU München, Sektion für Thoraxchirurgie, München

,

Rudolf M. Huber

²³Medizinische Klinik und Poliklinik V, Thorakale Onkologie, LMU Klinikum Munchen

,

Klaus Junker

²⁴Klinikum Oststadt Bremen, Institut für Pathologie, Bremen

,

Hans-Ulrich Kauczor

²⁵Klinikum der Universität Heidelberg, Abteilung Diagnostische Radiologie, Heidelberg

,

Jens Kollmeier

²⁶Helios Klinikum Emil von Behring, Klinik für Pneumologie, Lungenklinik Heckeshorn, Berlin

,

Klaus Kraywinkel

²⁷Zentrum für Krebsregisterdaten, Robert-Koch-Institut, Berlin

,

Marcus Krüger

²⁸Klinik für Thoraxchirurgie, Krankenhaus Martha-Maria Halle-Dölau, Halle-Dölau

,

Christian Kugler

²⁹LungenClinic Groshansdorf, Med. Abteilung Thoraxchirurgie

,

Miriam Möller

³⁰Krankenhaus Martha-Maria Halle-Dölau, Klinik für Innere Medizin II, Halle-Dölau

,

Ursula Nestle

³¹Kliniken Maria Hilf, Klinik für Strahlentherapie, Mönchengladbach

,

Bernward Passlick

³²Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Freiburg

,

Joachim Pfannschmidt

³³Klinik für Thoraxchirurgie, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin

,

Martin Reck

³⁴Lungeclinic Grosshansdorf, Pneumologisch-onkologische Abteilung, Grosshansdorf

,

Niels Reinmuth

³⁵Klinik für Pneumologie, Thorakale Onkologie, Asklepios Lungenklinik Gauting, Gauting

,

Christian Rübe

³⁶Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Homburg

,

Robert Scheubel

³⁷Klinik für Thoraxchirurgie, Fachkliniken Wangen, Wangen

,

Christian Schumann

³⁸Klinikum Kempten, Allgäu, Klinik für Pneumologie

,

Martin Sebastian

³⁹Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt

,

Monika Serke

⁴⁰Zentrum für Pneumologie und Thoraxchirurgie, Lungenklinik Hemer, Hemer

,

Erich Stoelben

⁴¹St. Hildegardis Köln, Thoraxklinik Köln, Köln

,

Martin Stuschke

⁴²Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Essen, Essen

,

Michael Thomas

⁴³Thoraxklinik am Univ.-Klinikum Heidelberg, Thorakale Onkologie, Heidelberg

,

Amanda Tufman

⁴⁴Medizinische Klinik und Poliklinik V, Thorakale Onkologie, LMU Klinikum München

,

Dirk Vordermark

⁴⁵Universitätsklinik und Poliklinik für Strahlentherapie, Universitätsklinikum Halle, Halle

,

Cornelius Waller

⁴⁶Klinik für Innere Medizin I, Universitätsklinikum Freiburg, Freiburg

,

Jürgen Wolf

⁴⁷Innere Medizin I, Uniklinik Köln, Köln

,

Martin Wolf

⁴⁸Klinikum Kassel, Klinik für Onkologie und Hämatologie, Kassel

,

Dag Wormanns

⁴⁹Evangelische Lungenklinik, Radiologisches Institut, Berlin

› Institutsangaben

Abstract

Zusammenfassung

Die aktuelle Fassung der Leitlinie Lungenkarzinom trägt der Dynamik der Informationen in diesem Fachbereich Rechnung. Insbesondere gelten folgenden Empfehlungen:

Die Vorstellung aller neu diagnostizierten Patienten im interdisziplinären pneumoonkologischen Tumorboard ist verpflichtend, das CT-Screening für asymptomatische Risikopersonen (nach Zulassung durch die Behörden), Vorgehen beim inzidentellen Lungenrundherd (außerhalb von Screeningprogrammen), molekulare Testung aller NSCLC unabhängig vom Subtyp, in frühen Stadien auf EGFR-Mutationen und in der Rezidivsituation, adjuvante TKI-Therapie bei Vorliegen einer EGFR-Mutation, adjuvante Konsolidierung mit Checkpointinhibitor bei PD-L1 ≥ 50%, Erhebung des PD-L1-Status, nach Radiochemotherapie bei PD-L1-pos. Tumoren Konsolidierung mit Checkpointinhibitor, adjuvante Konsolidierung mit Checkpointinhibitor bei PD-L1 ≥ 50% im Stadium IIIA, Erweiterung des therapeutischen Spektrums bei PD-L1 ≥ 50%, unabhängig von PD-L1Status, neue zielgerichtete Therapieoptionen sowie die Einführung der Immunchemotherapie in der SCLC Erstlinie.

Um eine zeitnahe Umsetzung künftiger Neuerungen zu gewährleisten, wurde die Umstellung auf eine „living guideline“ für das Lungenkarzinom befürwortet.

Abstract

The current S3 Lung Cancer Guidelines are edited with fundamental changes to the previous edition based on the dynamic influx of information to this field:

The recommendations include de novo a mandatory case presentation for all patients with lung cancer in a multidisciplinary tumor board before initiation of treatment, furthermore CT-Screening for asymptomatic patients at risk (after federal approval), recommendations for incidental lung nodule management , molecular testing of all NSCLC independent of subtypes, EGFR-mutations in resectable early stage lung cancer in relapsed or recurrent disease, adjuvant TKI-therapy in the presence of common EGFR-mutations, adjuvant consolidation treatment with checkpoint inhibitors in resected lung cancer with PD-L1 ≥ 50%, obligatory evaluation of PD-L1-status, consolidation treatment with checkpoint inhibition after radiochemotherapy in patients with PD-L1-pos. tumor, adjuvant consolidation treatment with checkpoint inhibition in patients withPD-L1 ≥ 50% stage IIIA and treatment options in PD-L1 ≥ 50% tumors independent of PD-L1status and targeted therapy and treatment option immune chemotherapy in first line SCLC patients.

Based on the current dynamic status of information in this field and the turnaround time required to implement new options, a transformation to a „living guideline“ was proposed.

Volltext

Referenzen

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