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Chancen und Grenzen der stereotaktisch fraktionierten Hochpräzisionsbestrahlung beim nichtkleinzelligen Lungenkarzinom im Stadium I/II

Opportunities and limitations of fractionated stereotactic body radiotherapy for stage I/II non-small-cell lung cancer

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Die Onkologie Aims and scope

Zusammenfassung

Hintergrund

Mit der fraktionierten stereotaktischen Hochpräzisionsbestrahlung des Körperstamms („stereotactic body radiation therapy“, SBRT) lässt sich durch nichtinvasive Applikation ablativer Strahlendosis bei Patienten mit nichtkleinzelligem Lungenkarzinom im Frühstadium (ES-NSCLC) eine hervorragende Tumorkontrolle bei guter Verträglichkeit und erhaltener Lebensqualität erzielen.

Material und Methoden

Der aktuelle Standard in den Leitlinien und Herausforderungen der SBRT für Patienten mit ES-NSCLC werden dargestellt. Auch werden Empfehlungen aus Leitlinien und Literatur erörtert.

Ergebnisse

Für inoperable Patienten gilt die SBRT als Therapiestandard, sie ist der konventionell fraktionierten RT und der Radiofrequenzablation (RFA) in Überlebensdaten überlegen. Für operable Patienten bleibt die Resektion der Standard, auch wenn Studien für die SBRT gute lokale Kontrollraten, Toxizitätsprofile und Lebensqualität zeigen. Bei Patienten mit zentralem ES-NSCLC sollten nur risikoadaptierte Fraktionierungsschemata angewendet werden, bei Patienten mit interstitieller Lungenfibrose muss das erhöhte Therapierisiko gegen die Indikation abgewogen werden. Eine weitere Herausforderung stellt die Verbesserung der systemischen Kontrolle und des Überlebens dar, die mittels einer Kombination der SBRT mit Checkpointinhibitoren angegangen wird.

Schlussfolgerungen

Die innovative Technik der extrakraniellen SBRT hat in den letzten Jahren eine exorbitante Entwicklung erfahren und stellt eine etablierte, für inoperable Patienten mit ES-NSCLC bereits empfohlene, für operable eine zu diskutierende Behandlungsalternative zur Operation und RFA dar. Herausforderungen in der Anwendung der SBRT finden sich bei zentralen Tumoren, pulmonalen Vorerkrankungen und hinsichtlich der Kombination mit Systemtherapie, die Gegenstand aktueller Studien ist.

Abstract

Background

Fractionated stereotactic body radiotherapy (SBRT) can achieve excellent tumor control with good toxicity profiles and maintained quality of life through non-invasive application of ablative radiation dose in patients with early stage non-small-cell lung cancer (ES-NSCLC).

Materials and methods

The current standard and challenges of SBRT for patients with ES-NSCLC are presented. Recommendations from guidelines and literature are also discussed.

Results

For inoperable patients, SBRT is considered the standard of care and is superior to conventionally fractionated RT and radiofrequency ablation (RFA) in survival data. For operable patients, resection remains the standard, even if studies show good local control rates, toxicity profiles, and quality of life for SBRT. Only risk-adapted fractionation schemes should be used in patients with central ES-NSCLC; in patients with interstitial lung disease (ILD), increased risk of toxicity must be weighed against the indication. Another challenge is to improve systemic control and survival, which is addressed by combining SBRT with checkpoint inhibitors.

Conclusions

The innovative technique of extracranial SBRT has undergone exorbitant developments in recent years and represents an established treatment alternative to surgery and RFA that is already recommended for inoperable patients with ES-NSCLC and is to be considered for operable patients. Challenges in the use of SBRT are treatment of centrally localized tumors, patients suffering from pulmonary diseases and the combination of SBRT with systemic therapy, which is the subject of current studies.

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Authors and Affiliations

  1. Klinik für Strahlenheilkunde – Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg und Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partnerstandort Freiburg, Freiburg, Deutschland

    Sonja Adebahr

  2. Klinik und Poliklinik für Radioonkologie und Strahlentherapie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland

    Denise Bernhardt

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  1. Sonja Adebahr
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  2. Denise Bernhardt
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Correspondence to Denise Bernhardt.

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Interessenkonflikt

S. Adebahr (SA) und D. Bernhardt (DB) geben an, dass kein Interessenkonflikt besteht. SA wird über Drittmittel des BMBF, Dekade gegen Krebs, finanziert. DB gibt an, dass Honorare geleistet wurden durch AstraZeneca, Novocure, B. Braun sowie Advisory Boards für Novocure.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Adebahr, S., Bernhardt, D. Chancen und Grenzen der stereotaktisch fraktionierten Hochpräzisionsbestrahlung beim nichtkleinzelligen Lungenkarzinom im Stadium I/II. Onkologie 28, 1051–1058 (2022). https://doi.org/10.1007/s00761-022-01258-w

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