Multimodale Therapie des SCLC in den Stadien I–III. Rolle der Chirurgie

Winter, H. und Schneider, C. (2017): Multimodale Therapie des SCLC in den Stadien I–III. Rolle der Chirurgie. In: Onkologe, Bd. 23, Nr. 5: S. 366-372

Abstract

Small cell lung cancer (SCLC) is characterized by rapid tumor growth, early metastatic spread and a dismal prognosis. As two prospective randomized trials carried out 45 years ago failed to show an advantage of surgery over chemoradiotherapy, surgery was abandoned as an integral therapeutic option for the treatment of SCLC;however, in recent years a favorable course of the disease was observed in a highly selected group of patients with an early tumor stage of SCLC (IA/B) following complete surgical resection of the tumor in combination with an adjuvant platinum-based chemotherapy. Based on a selective literature search, the role of surgery within the framework of a multimodal treatment strategy for SCLC was analyzed. The intent was to define the impact of different parameters, such as patient characteristics, tumor stage, the time and context of other therapeutic variables in which surgery would result in a favorable outcome. A selective literature search was performed in PubMed based on the following key words: surgery, small cell lung cancer (SCLC) and multimodal therapy strategies for the treatment of SCLC. Papers published earlier than 1960 were excluded from the study. The exact staging of patients with SCLC is difficult and frequently imprecise. Specifically, the radiological assessment of the mediastinal lymph node compartment is often falsely negative. This emphasizes the importance of systematic histological clarification of mediastinal lymph nodes prior to initiation of a therapeutic strategy. Patients with histologically proven negative lymph nodes (N0) and early tumor stage (T1-2) of SCLC will possibly profit from a complete tumor resection as long as distant organ metastases can be excluded and the patients are functionally operable. Even in cases of mediastinal lymph node metastases (N2) an operative resection of tumors can improve survival as long as a platinum-based adjuvant induction chemoradiotherapy is successful in downstaging of the mediastinal lymph node involvement. Survival of patients who received surgery was better following lobectomy as compared to limited sublobar resection or pneumonectomy. Postoperatively, a platinum-based adjuvant chemotherapy should be administered to the patient within a multimodal therapy. If positive mediastinal lymph node metastases are histologically proven during the surgical resection, a platinum-based adjuvant chemotherapy and mediastinal irradiation should be carried out.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 0947-8965
• Sprache: Deutsch