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Lungenmetastasen

Pulmonary metastases

  • Leitthema
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Der Onkologe Aims and scope

Zusammenfassung

Von allen Patienten, die im Verlauf einer malignen Erkrankung Lungenmetastasen entwickeln, erfüllt etwa ein Drittel die Voraussetzungen für die chirurgische Therapie. Voraussetzungen sind neben der lokalen Resektabilität die extrathorakale Tumorfreiheit und die funktionelle Reserve im Hinblick auf den zu erwartenden Parenchymverlust. Im thoraxchirurgischen Krankengut sind diese Bedingungen am häufigsten bei Patienten mit Metastasen des kolorektalen Karzinoms und des Nierenzellkarzinoms gegeben. Davon unabhängig ist in Einzellfällen die Operation unter palliativem Aspekt oder aus diagnostischen Gründen indiziert. Die Chemotherapie hat ihre Berechtigung, sofern ein Ansprechen der Metastasen zu erwarten ist. Dies gilt vorrangig für Absiedelungen nichtseminomatöser Keimzelltumoren, des Mammakarzinoms und des Osteosarkoms. In diesen Fällen hat die Chirurgie lediglich die Aufgabe, nach Chemotherapie noch verbliebene Herde zu eliminieren. Die Strahlentherapie im Sinne einer Ganzlungenbestrahlung spielt in der Behandlung disseminierter Metastasen wegen einer ausgeprägten Dosis-Volumen-Beziehung hinsichtlich strahleninduzierter Veränderungen keine größere Rolle. Ein kurativer Effekt ist dagegen bei stereotaktischer Einzeitbestrahlung solitärer Herde zu erzielen. Dieses Verfahren kommt zum Einsatz, wenn Kontraindikationen zur Operation bestehen. Grundsätzlich sollen alle Therapieentscheidungen nur im interdisziplinären Gespräch getroffen werden.

Abstract

Approximately one-third of all patients who develop pulmonary metastases in the course of malignant disease fulfils the criteria for surgical treatment. In addition to local resectability, prerequisites include lack of extrathoracic tumors and presence of functional reserves in view of the expected parenchymal loss. Among patients undergoing thoracic surgery, these criteria are most often fulfilled by those with metastases of colorectal and renal cell cancer. Irrespective of these preconditions, surgery is indicated in individual cases from a palliative perspective or for diagnostic reasons. Chemotherapy is justified when a response of the metastases is to be expected. This pertains preferably to metastases of nonseminomatous germ cell tumors, breast cancer, and osteosarcoma. In these cases, surgery serves the sole function of eliminating residual foci after chemotherapy. Radiotherapy in the sense of total lung irradiation does not play a major role in treatment of disseminated metastases due to a pronounced dose-volume relationship regarding radiation-induced alterations. In contrast, a curative effect is achieved with stereotactic radiosurgery of solitary foci. This procedure is employed when surgical intervention is contraindicated. On principle, therapeutic decisions should only be made by the interdisciplinary team.

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Authors and Affiliations

  1. Chirurgische Abt., Thoraxklinik am Universitätsklinikum Heidelberg

    H. Dienemann

  2. Abt. Klinische Radiologie, Universitätsklinikum Heidelberg

    H. Hof & J. Debus

  3. Abt. Innere Medizin—Onkologie, Thoraxklinik am Universitätsklinikum Heidelberg

    P. Drings

  4. Chirurgische Abt., Thoraxklinik am Universitätsklinikum Heidelberg, Amalienstraße 5, 69126 , Heidelberg

    H. Dienemann

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  1. H. Dienemann
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Correspondence to H. Dienemann.

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Dienemann, H., Hof, H., Debus, J. et al. Lungenmetastasen. Onkologe 10, 458–473 (2004). https://doi.org/10.1007/s00761-004-0709-0

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