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Kombination Radio(chemo)therapie beim Lungenkarzinom – Nebenwirkungsmanagement

Combined chemoradiotherapy in lung cancer—Management of side effects

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best practice onkologie Aims and scope

Zusammenfassung

Die simultane Radiochemotherapie (RCT) ist der Behandlungsstandard bei lokal fortgeschrittenen nichtkleinzelligen Bronchialkarzinomen (NSCLC) im Stadium III und in limitierten Stadien des kleinzelligen Bronchialkarzinoms bei Inoperabilität. Die Nebenwirkungen sind abhängig von den eingesetzten Substanzen, den strahlentherapeutischen Parametern und den Patientencharakteristika. Im Beitrag wird der Umgang mit häufigen und relevanten Nebenwirkungen einer RCT des Bronchialkarzinoms zusammengefasst und diskutiert. Die Chemotherapie enthält meist ein stark emetogenes Platinderivat. Daher ist die Prophylaxe von chemotherapieassoziierter Übelkeit und Erbrechen mit 5‑HT3- („Serotonin 5-hydroxytryptamin 3“) und NK-1(Neurokinin-1)-Rezeptorantagonisten sowie Dexamethason ein essenzieller Baustein des peritherapeutischen Managements. Die ebenfalls primär chemotherapiebedingte Hämatotoxizität wird je nach Schweregrad und betroffener Blutzellreihe mit Wachstumsfaktoren und Bluttransfusionen therapiert. Im Gegensatz dazu können die radiogen verursachten Veränderungen besonders im Bereich Speiseröhre und Lunge meist nicht kausal, sondern nur symptomatisch therapiert werden. Die Prophylaxe und Behandlung des weiten Spektrums an Nebenwirkungen einer Radiochemotherapie beim Bronchialkarzinom sollte unter sorgfältiger Abwägung des Schweregrades, des Behandlungserfolges und der damit assoziierten Risiken erfolgen.

Abstract

Simultaneous chemoradiotherapy (CRT) is the standard treatment for locally advanced non-small cell lung cancer (NSCLC) in stage III and for limited stages of small cell lung cancer (SCLC) and nonoperability. The side effects depend on the cytotoxic agents employed, the radiotherapeutic parameters and the patient characteristics. This article summarizes and discusses the management strategies for frequent and relevant side effects of CRT of lung cancer. The chemotherapy mostly includes a highly emetogenic platinum derivative. Therefore, prophylaxis of chemotherapy-associated nausea and vomiting with serotonin 5‑hydroxytryptamine‑3 (5-HT3) and neurokinin 1 (NK1) receptor antagonists and dexamethasone is an essential element of peritherapeutic management. The management of likewise primary chemotherapy-induced hematologic side effects depends on the severity and the affected blood cell lineage and involves growth factors and blood transfusions. In contrast, radiotherapy-induced alterations, especially of the lungs and esophagus can mostly not be causally treated but are treated symptomatically. The prophylaxis and treatment of the broad spectrum of side effects of CRT of lung cancer should be based on a thorough evaluation of the severity of symptoms, the treatment efficacy and associated risks.

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Authors and Affiliations

  1. Klinik für Radioonkologie und Strahlentherapie, Klinikum rechts der Isar der Technischen Universität München (TUM), Ismaninger Str. 22, 81675, München, Deutschland

    Kim Melanie Kraus & Stephanie Elisabeth Combs

  2. Institut für Strahlenmedizin (IRM), Helmholtz Zentrum München (HMGU), Deutsches Forschungszentrum für Gesundheit und Umwelt, 85764, Neuherberg, Deutschland

    Kim Melanie Kraus & Stephanie Elisabeth Combs

  3. Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partnerstelle München, 80336, München, Deutschland

    Kim Melanie Kraus & Stephanie Elisabeth Combs

  4. Klinik und Poliklinik für Innere Medizin III, Klinikum rechts der Isar der Technischen Universität München (TUM), Ismaninger Straße 22, 81675, München, Deutschland

    Ruth Eichner & Stephanie Elisabeth Combs

  5. TranslaTUM – Zentralinstitut für translationate Krebsforschung der Technischen Universität München, Einsteinstraße 25, 81675, München, Deutschland

    Ruth Eichner

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Kraus, K.M., Eichner, R. & Combs, S.E. Kombination Radio(chemo)therapie beim Lungenkarzinom – Nebenwirkungsmanagement. best practice onkologie 18, 496–507 (2023). https://doi.org/10.1007/s11654-023-00529-1

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