Hirnmetastasen beim Lungenkarzinom

Zusammenfassung

Die zerebrale Metastasierung ist eine häufige, insbesondere beim kleinzelligen und nicht-kleinzelligen Lungenkarzinom vorkommende Tumormanifestation. Die Hirnmetastasierung bestimmt oftmals die Prognose des Patienten und bedarf daher einer raschen Therapie. Unter Berücksichtigung der Tumorentität, der vorangegangenen Therapien, des Alters und Allgemeinzustandes des Patienten, der Anzahl der Metastasen sowie der extrazerebralen Tumoraktivität müssen für den Patienten individuelle, multimodale Behandlungspläne erstellt werden.

Am längsten überleben Patienten mit nicht-kleinzelligem Bronchialkarzinom und solitärer zerebraler Raumforderung nach kompletter Resektion oder stereotaktischer Radiochirurgie. Der alleinigen Ganzhirnbestrahlung sind diese Verfahren mit bis zu doppelt so langen Überlebenszeiten deutlich überlegen. Bei multiplen zerebralen Metastasen ist die Ganzhirnbestrahlung die Therapie der Wahl. Sie sollte ebenfalls bei Patienten mit kleinzelligem Bronchialkarzinom Anwendung finden, wo eine Rolle aggressiverer lokaler Therapiemaßnahmen bisher nicht definiert ist. Die systemische Chemotherapie gewinnt beim kleinzelligen und nicht-kleinzelligen Bronchialkarzinom zunehmend an Stellenwert, wobei eine Effektivitätssteigerung durch die simultane Anwendung von Chemo- und Strahlentherapie derzeit in Studien geprüft wird.

Diese Arbeit gibt eine Übersicht über Klinik und Diagnostik sowie daraus ableitbare interdisziplinäre Konzepte für die Behandlung zerebraler Metastasen beim Bronchialkarzinom.

Summary

Cerebral metastases are a frequent complication of lung cancer. They often determine patients’ prognosis and need urgent therapeutic intervention. Based on histologic type, former therapies, age and performance of the patient, the number of cerebral lesions and the extracerebral tumour activity, individualized treatments are applied.

For patients who suffer from non-small cell lung cancer and a single CNS lesion the best results can be achieved if they are surgically resected or receive radiosurgery. Their survival time can be markedly increased in comparison to patients who undergo whole brain irradiation. If multiple metastases are seen in CT or MRI, whole brain irradiation is the therapy to choose. Furthermore it should be initiated if small cell lung cancer metastasizes to the brain. More aggressive local treatment options appear promising, but a clear role for them has not yet been defined. Systemic chemotherapy gains more attention in the treatment of small and non-small cell lung cancer with brain metastases. How to increase the efficacy through simultaneous application of chemo- and radiotherapy is tested in current trials.

This article gives an overview on clinical presentation and diagnosis of cerebral metastases in lung cancer and reviews current treatment options.

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