Stereotaktische Strahlentherapie bei Lungenkrebs im Stadium I – gibt es eine Evidenz?

 

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Zusammenfassung

Die körperstereotaktische Bestrahlung (SBRT) ist eine noch junge Form der Präzisionsradiotherapie, die es erlaubt, lokal begrenzte Tumoren hochdosiert und gleichzeitig schonend zu bestrahlen. Die schnelle technische Weiterentwicklung und gleichzeitig prospektiv-klinische Evaluation erfolgte intensiv beim nicht kleinzelligen Lungenkarzinom (NSCLC) im frühen Stadium. Heute ist SBRT bereits eine evidenzbasierte und die leitliniengerechte Therapie beim NSCLC im Stadium I, wenn aufgrund begleitender Komorbiditäten eine Lobektomie kontraindiziert ist. Auch älteren und komorbiden Patienten kann mittels SBRT eine kurative Therapieoption angeboten werden; nur bei äußerst begrenzter Lebenserwartung sollte darauf verzichtet werden. Obwohl immer mehr Daten auf eine Äquivalenz von Lobektomie und SBRT hinweisen, wird die SBRT bei operablen Patienten ohne Risikofaktoren meist nur dann eingesetzt, wenn der Patient eine Lobektomie ablehnt. Darüber hinaus werden aktuell zahlreiche Anwendungen der SBRT beim lokal fortgeschrittenen NSCLC und insbesondere in der Situation der Oligometastasierung und Oligoprogression klinisch und wissenschaftlich evaluiert, mit vielversprechenden Ergebnissen.

Abstract

Stereotactic body radiotherapy (SBRT) was first described in the mid 90s as a technique using high precision radiotherapy to deliver escalated, ablative irradiation doses and which simultaneously minimised incidental irradiation of healthy tissue. Technological and clinical development of this technique has been pioneered in the field of early stage non-small cell lung cancer, where improved local tumor control led to prolonged overall survival. Today, SBRT is the evidence-based and guideline-recommended treatment of choice for early stage NSCLC in patients who are medically inoperable. SBRT has been demonstrated to be a safe and effective curative treatment option, even for very elderly patients and patients with severe comorbidities. Only patients with very short survival expectancy should not be offered SBRT. Increasing evidence suggests that the outcome is similar or equivalent for surgical lobectomy and SBRT in operable patients; however, SBRT is currently only recommended for patients refusing surgical resection. Many clinical trials are currently evaluating the value of SBRT in clinical settings other than early stage NSCLC, e.g. oligometastases and oligoprogression.

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