Interdisziplinäre Diagnostik und Therapie von malignen Mesotheliomen

Zusammenfassung

Das asbestbedingte maligne Mesotheliom (MM) gehört in Deutschland mit ca. 1000 Neuerkrankungen pro Jahr zu den häufigen berufsbedingten Krebserkrankungen. Die Diagnose eines MM ist, sofern die entsprechenden diagnostischen Kriterien erfüllt sind, sowohl aus histologischem als auch aus zytologischem Probenmaterial mit hoher Spezifität möglich. Allerdings werden viele MM zyto-/histologisch erst in fortgeschrittenen Stadien entdeckt. Klinisch/radiologische Aspekte ergänzen die Diagnostik und ermöglichen eine interdisziplinäre Beurteilung des Tumorstadiums und individuelle Entscheidungen über die bestmöglichen Therapieoptionen für jeden einzelnen Patienten. Diagnostisch hat die videoassistierte Thorakoskopie (VATS) den höchsten Stellenwert. Die Therapieplanung orientiert sich am vorliegenden MM-Subtyp, der Tumorausbreitung und Stadium sowie dem klinischen Zustand des Patienten. Die Prognose des MM ist im Allgemeinen sehr ungünstig. Dementsprechend zielt die Standardtherapie auf eine makroskopische radikale Tumorresektion im Sinne einer Zytoreduktion im Rahmen eines geeigneten multimodalen Therapiekonzepts (Chemotherapie, Strahlentherapie, Psychoonkologie). Ziel palliativer Maßnahmen sollte v.a. die Symptomkontrolle sein. Insgesamt ist die interdisziplinäre Diagnostik und Therapie des MM entscheidend für die bestmögliche Versorgung der MM-Kranken.

Abstract

The asbestos-related malignant mesothelioma (MM) is one of the common occupational cancers in Germany with approximately 1000 new cases per year. Provided that the appropriate diagnostic criteria are fulfilled, MM can be diagnosed with high specificity from both histological and cytological specimens. However, many MM are detected cyto-/histologically only at advanced stages. Clinical/radiological aspects complement each other and enable interdisciplinary assessment of tumor stage and individualized decisions on the best possible therapeutic options. Diagnostically, video-assisted thoracoscopy (VATS) has the highest priority. Therapy planning is based on the MM subtype, tumor spread and stage, and the patientʼs clinical condition. MM has generally a very unfavorable prognosis. Accordingly, the standard therapy aims at a macroscopic radical tumor resection in terms of cytoreduction within the framework of a suitable multimodal therapy concept (chemotherapy, radiotherapy, psychooncology). The aim of palliative measures should be primarily symptom control. Overall, interdisciplinary diagnosis and therapy of MM is crucial for the best possible care of MM patients.

Schlüsselwörter

malignes Mesotheliom - Zyto-/Histologie - interdisziplinäre Diagnostik und Therapie

Keywords

malignant mesothelioma - cyto-/histology - interdisciplinary diagnosis and therapy

Publication History

Received: 16 August 2023

Accepted after revision: 30 October 2023

Article published online:
04 January 2024

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