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Zentralbl Chir 2017; 142(S 01): S38-S43
DOI: 10.1055/s-0043-115641
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Die Bedeutung der Chirurgie beim oligometastatischen und oligoprogressiven nicht kleinzelligen Lungenkarzinom

The Significance of Surgery for Oligometastatic and Oligoprogressive Non-small Cell Lung Cancer
Severin Schmid
Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Deutschland
,
Bernward Passlick
Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Deutschland
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Publication History

Publication Date:
28 September 2017 (online)

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Zusammenfassung

Das bessere Verständnis der Tumorbiologie sowie die neuen Therapien beim nicht kleinzelligen Lungenkarzinom haben zu einer weiteren Differenzierung der Therapie auch der metastasierten Erkrankung geführt. Der Begriff des oligometastatischen Lungenkarzinoms beschreibt vergleichsweise gutartige Verläufe mit nur wenigen, häufig auf ein Organsystem beschränkten Metastasen. Zum Erreichen eines optimalen Behandlungsergebnisses für jede charakteristische Ausprägung bzw. Tumorbiologie muss ein adäquater Therapieansatz unter Einbeziehung der verschiedenen Therapiemodalitäten gefunden werden. In diesem Rahmen gewinnt die Chirurgie auch in kurativen Konzepten zunehmend an Bedeutung. Analog zum oligometastatischen Lungenkarzinom wurde der Begriff der oligoprogressiven Erkrankung geprägt. Dieser resultierte insbesondere aus den Beobachtungen des Krankheitsverlaufs bei Lungenkarzinomen, die eine der gängigen Treibermutationen, wie die ALK-Fusion oder die EGFR-Mutation, aufweisen. In einigen Fällen findet sich hier eine auf wenige Herde begrenzte Progression der metastasierten Erkrankung bei sonst stabilem Befund. Bisherige Studien zeigen sowohl beim oligometastatischen als auch beim oligoprogressiven Lungenkarzinom bei entsprechend selektionierten Patienten ermutigende Ergebnisse, mit z. T. deutlichem Überlebensvorteil durch ein aggressives chirurgisches Vorgehen in Kombination mit der üblicherweise durchgeführten Systemtherapie. Zu klären bleibt jedoch, ob der beobachtete Überlebensvorteil lediglich aufgrund der günstigeren Tumorbiologie bei den ausgewählten Patienten oder aber aufgrund der gewählten Therapien zustande kommt. Zudem bedarf es in Zukunft exakterer Marker zur Identifikation geeigneter Patientenkollektive.

Abstract

An increased understanding of tumour biology as well as novel therapeutic options have led to a further differentiation of metastatic non-small cell lung cancer. Oligometastatic lung cancer has a relatively benign clinical course with few metastases, which are often confined to a single organ. To create the best outcomes, the ideal treatment must be used for each individual tumor biology, with consideration of the different treatment modalities. Surgery is of increasing significance in curative treatment concepts in metastatic lung cancers. In analogy to oligometastatic disease, the term “oligoprogression” has emerged in recent years. This describes a state in which metastatic lung cancers which express sensitizing mutations show progression of disease only at a limited number of anatomical sites whilst under therapy with tyrosine kinase inhibitors. Current studies have shown encouraging results for surgical therapy in combination with systemic therapy of both oligometastatic and oligoprogressive disease in well selected patients. It remains to be determined whether the observed survival benefits are based on the favourable tumour biology or the applied treatment modalities. Moreover, robust molecular markers have to be determined to identify patients who will benefit from aggressive surgical treatment, in order to avoid overtreatment.

Schlüsselwörter

oligometastatisches Lungenkarzinom - nicht kleinzelliges Lungenkarzinom - Oligometastasierung - oligoprogressives Lungenkarzinom - Oligoprogression

Key words

oligoprogressive lung cancer - oligometastatic lung cancer - non-small cell lung cancer
 

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