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Erschienen in:

01.08.2008 | Leitthema

Systemische Therapie des kleinzelligen Lungenkarzinoms

Induktions-, Erhaltungs- und Rezidivtherapie

verfasst von: Prof. Dr. N. Niederle, K.-M. Deppermann, M. Wolf

Erschienen in: Die Onkologie | Ausgabe 8/2008

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Zusammenfassung

Das kleinzellige Lungenkarzinom ist durch schnelles Tumorwachstum und frühzeitige Metastasierung gekennzeichnet. Die mittlere Überlebenszeit ohne Therapie beträgt 3 bis 5 Monate. Wegen der Disseminationsneigung und dem guten Ansprechen auf zytoreduktive Maßnahmen gilt bei der überwiegenden Zahl der Patienten heute eine intensive 4- bis 6-malige Kombinationschemotherapie mit 2 bis 3 Substanzen (Cisplatin + Etoposid oder Adriamycin + Cyclophosphamid + Vincristin) als indiziert. Die Ergebnisse sind abhängig vom Allgemeinzustand des Patienten sowie besonders vom Krankheitsstadium. In dem potentiell kurablen lokoregionalen Stadium“limited disease” sind die Raten für komplette Remissionen (40–60%), die medianen Überlebenszeiten (14–18 Monate) und die Langzeitüberlebensraten deutlich günstiger als im fortgeschrittenen Stadium“extensive disease” (15–30%; 8–12 Monate). Langzeitüberleben oder gar Heilung sind allerdings selten, die 3-Jahres-Überlebensraten liegen bei 5–10%. Der Stellenwert einer Erhaltungstherapie ist weiterhin nicht belegt. Im Gegensatz dazu ist der Vorteil einer erneuten Therapie für Patienten mit initialem Tumoransprechen und Rezidiv nach über 6 Wochen nach letzter Erstlinientherapie bewiesen. Die Auswahl des Therapieregimes muss sich nach Art und Ergebnis der Erstlinientherapie, der Dauer des behandlungsfreien Intervalls sowie dem Allgemeinzustand richten. Topotecan ist zurzeit das am besten untersuchte Medikament, ähnliche Behandlungsergebnisse können aber auch mit anderen Substanzen erzielt werden. Bei einem Rückfall, der mehr als 3 Monate nach Ende der Induktionstherapie auftritt, ist auch eine erneute Behandlung mit der Primärkombination möglich.
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Metadaten
Titel
Systemische Therapie des kleinzelligen Lungenkarzinoms
Induktions-, Erhaltungs- und Rezidivtherapie
verfasst von
Prof. Dr. N. Niederle
K.-M. Deppermann
M. Wolf
Publikationsdatum
01.08.2008
Verlag
Springer-Verlag
Erschienen in
Die Onkologie / Ausgabe 8/2008
Print ISSN: 2731-7226
Elektronische ISSN: 2731-7234
DOI
https://doi.org/10.1007/s00761-008-1428-8

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