Subscribe to RSS
DOI: 10.1055/s-0043-111766
Die Nachsorge des Lungenkarzinoms
Follow-Up and Surveillance after Lung Cancer TreatmentPublication History
Publication Date:
19 February 2019 (online)
![](https://www.thieme-connect.de/media/zblchir/201901/lookinside/thumbnails/10-1055-s-0043-111766_zbc3664378_cme-1.jpg)
Zusammenfassung
Ziel dieses Beitrags ist es, die aktuellen Leitlinien bzw. Empfehlungen zur Nachsorge des Lungenkarzinoms zu präsentieren und eine evidenzbasierte Herangehensweise für die Erstellung von individualisierten Nachsorgepläne aufzuzeigen.
Abstract
The aim of this article is to present the current guideline recommendations for the follow-up and surveillance of lung cancer patients and to outline an evidence-based approach to planing individualised follow-up care.
-
Die Nachsorge soll asymptomatische Rezidive bzw. Tumorprogression entdecken. Zusätzlich soll eine multiprofessionelle Betreuung in der Phase nach Ende einer Lungenkrebstherapie den körperlichen und auch psychosozialen Zustand des Patienten optimieren und erhalten.
-
Die unterschiedlichen Leitlinien empfehlen eine Nachsorge alle 3 – 6 Monate für 2 – 3 Jahre, und danach eine jährliche Nachsorge.
-
Die Dauer der Nachsorge umfasst längstens 5 Jahre, obwohl ein erhöhtes Rezidivrisiko bis zu 9 Jahre nach Therapieende gefunden wurde.
-
Patienten mit einem asymptomatischen Rezidiv haben eine bessere Prognose als symptomatische Patienten weshalb die Nachsorge eine bildgebende Diagnostik beinhalten sollte.
-
Die Art der Bildgebung und die Nachsorgeintervalle sollen an die Bedürfnisse des individuellen Patienten angepasst werden.
-
Literatur
- 1 Huber RM, Tufman A. Nachsorge beim Lungenkarzinom. In: Huber RM. Hrsg. Manual Tumoren der Lunge und des Mediastinum des Tumorzentrum München. 11. Aufl.. München: Zuckschwerdt; 2017
- 2 Hanna W, Paul N, Darling G. et al. Minimal-dose computed tomography is superior to chest x-ray for the follow-up and treatment of patients with resected lung cancer. J Thorac Cardiovasc Surg 2014; 147: 30-35
- 3 Westeel V, Barlesi P, Foucher JJ. et al. Results of the phase III IFCT-0302 trial assessing minimal versus CT-scan-based follow-up for completely resected non-small cell lung cancer (NSCLC). Ann Oncol 2017; 28 (Suppl. 05) DOI: 10.1093/annonc/mdx378.012.
- 4 Leitlinienprogramm Onkologie der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (AWMF); Deutsche Krebsgesellschaft e. V. (DKG), Deutsche Krebshilfe (DKH). S3-Leitlinie zur Prävention, Diagnostik, Therapie und Nachsorge des Lungenkarzinoms der Deutschen Gesellschaft für Pneumologie und der Deutschen Krebsgesellschaft, AWMF-Register Nr. 020/007OL, Stand: 02/2018, gültig bis 12/2022. Im Internet: https://www.awmf.org/uploads/tx_szleitlinien/020-007OL_l_S3_Lungenkarzinom_2018-03.pdf Stand: 04.02.2019
- 5 Postmus PE, Kerr KM, Oudkerk M. et al. Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2017; 28 (Suppl. 04) iv1-iv21
- 6 [Anonym] National Institute for Health and Care Excellence (2011) Lung cancer: diagnosis and management (NICE Clinical Guideline 33). Im Internet: https://www.nice.org.uk/guidance/cg121/chapter/1-Guidance%23follow-up-and-patient-perspectives Stand: 26.11.2018
- 7 Ettinger D, Wood D, Aisner D. et al. NCCN Clinical Practice Guidelines (NCCN Guidelines®). Non-Small-Cell Lung Cancer. Version Version 3.2019. Im Internet: https://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf Stand: 29.01.2019
- 8 Nguyen TK, Senan S, Bradley JD. et al. Optimal imaging surveillance after stereotactic ablative radiation therapy for early-stage non-small cell lung cancer: Findings of an International Delphi Consensus Study. Pract Radiat Oncol 2018; 8: e71-e78
- 9 Van Loon J, Grutters J, Wanders R. et al. Follow-up with 18FDG-PET-CT after radical radiotherapy with or without chemotherapy allows the detection of potentially curable progressive disease in non-small cell lung cancer patients: a prospective study. Eur J Cancer 2009; 45: 588
- 10 Maeshima A, Tochigi N, Yoshida A. et al. Histological scoring for small lung adenocarcinomas 2 cm or less in diameter: a reliable prognostic indicator. J Thorac Oncol 2010; 5: 333-339
- 11 Kadota K, Villena-Vargas J, Yoshizawa A. et al. Prognostic significance of adenocarcinoma in situ, minimally invasive adenocarcinoma, and nonmucinous lepidic predominant invasive adenocarcinoma of the lung in patients with stageI disease. Am J Surg Pathol 2014; 38: 448-460
- 12 Kobayashi N, Toyooka S, Soh J. et al. Risk factors for recurrence and unfavorable prognosis in patients with stage I non-small cell lung cancer and a tumor diameter of 20 mm or less. J Thorac Oncol 2007; 2: 808-812
- 13 Watanabe K, Tsuboi M, Sakamaki K. et al. Postoperative follow-up strategy based on recurrence dynamics for non-small-cell lung cancer. Eur J Cardiothorac Surg 2016; 49: 1624-1631
- 14 Dood R, Zhou Y, Armbruster S. et al. Defining survivorship and surveillance with evidence. 2018 ASCO Annual Meeting, Abstract Nr. 6528. J Clin Oncol 2018; 36 (Suppl.) 6528
- 15 Johnson BE. Second Lung Cancers in patients after treatment for an initial lung cancer. J Natl Cancer Inst 1998; 90 (18) 1335-1345
- 16 Surapaneni R, Singh P, Rajagopalan K. et al. Stage I Lung Cancer Survivorship: Risk of Second Malignancies and Need for Individualized Care Plan. J Thorac Oncol 2012; 7: 1252-1256
- 17 Srikantharajah D, Ghuman A, Nagendran M. et al. Is computed tomography follow-up of patients after lobectomy for non-small cell lung cancer of benefit in terms of survival?. Interact Cardiovasc Thorac Surg 2012; 15: 893-898
- 18 Calman L, Beaver K, Hind D. et al. Survival benefits from follow-up of patients with lung cancer: a systematic review and meta-analysis. J Thorac Oncol 2011; 6: 1993-2004
- 19 Pisters KM, Le Chevalier T. Adjuvant chemotherapy in completely resected non-small-cell lung cancer. J Clin Oncol 2005; 23: 3270-3278
- 20 Toyokawa G, Seto T, Takenoyama M. et al. Insights into brain metastasis in patients with ALK+ lung cancer: is the brain truly a sanctuary?. Cancer Metastasis Rev 2015; 34: 797-805
- 21 Sawada S, Suehisa H, Ueno T. et al. Monitoring and management of lung cancer patients following curative-intent treatment: clinical utility of 2-deoxy-2-[fluorine-18]fluoro-d-glucose positron emission tomography/computed tomography. Lung Cancer (Auckl) 2016; 7: 45-51
- 22 Mansueti JR, Maillie S. A Review of non-small cell lung cancer post-treatment follow-up imaging procedures with pet/ct scans versus CT scans and the effect on patient survival. Int J Radiat Oncol 2017; 98: 231
- 23 Reddy J, Tang C, Shih T. et al. Influence of Surveillance PET/CT on Detection of Early Recurrence After Definitive Radiation in Stage III Non-small-cell Lung Cancer. Clin Lung Cancer 2017; 18: 141-148
- 24 Ulaner GA, Lyall A. Identifying and distinguishing treatment effects and complications from malignancy at FDG PET/CT. Radiographics 2013; 33: 1817-1834
- 25 Zhu H, Bi Y, Han A. et al. Risk factors for brain metastases in completely resected small cell lung cancer: a retrospective study to identify patients most likely to benefit from prophylactic cranial irradiation. Radiat Oncol 2014; 9: 216
- 26 Hendriks LEL, Brouns AJWM, Amini M. et al. Development of symptomatic brain metastases after chemoradiotherapy for stage III non-small cell lung cancer: Does the type of chemotherapy regimen matter?. Lung Cancer 2016; 101: 68-75
- 27 Zeng H, Xie P, Meng X. et al. Risk factors for brain metastases after prophylactic cranial irradiation in small cell lung cancer. Sci Rep 2017; 7: 42743
- 28 Mamon HJ, Yeap BY, Jänne PA. et al. High risk of brain metastases in surgically staged IIIA non-small-cell lung cancer patients treated with surgery, chemotherapy, and radiation. J Clin Oncol 2005; 23: 1530-1537
- 29 Chen AM, Jahan TM, Jablons DM. et al. Risk of cerebral metastases and neurological death after pathological complete response to neoadjuvant therapy for locally advanced nonsmall‐cell lung cancer. Cancer 2007; 109: 1668-1675 doi:10.1002/cncr.22565
- 30 Omuro AMP, Kris MG, Miller VA. et al. High incidence of disease recurrence in the brain and leptomeninges in patients with nonsmall cell lung carcinoma after response to Gefitinib. Cancer 2005; 103: 2344-2348
- 31 Williams K, Jackson SE, Beeken RJ. et al. The impact of a cancer diagnosis on health and well-being: a prospective, population-based study. Psychooncology 2016; 25: 626-632
- 32 Owen J, Goldstein M, Lee J. et al. Use of health-related and cancer-specific support groups among adult cancer survivors. Cancer 2007; 109: 2580-2589
- 33 Lou F, Huang J, Sima C. et al. Patterns of recurrence and second primary lung cancer in early-stage lung cancer survivors followed with routine computed tomography surveillance. J Thorac Cardiovasc Surg 2013; 145: 75-82
- 34 Martini N, Beins MS, Burt MD. et al. Incidence of local recurrence and second primary tumors in resected stage I lung cancer. J Thorac Cardiovasc Surg 1995; 109: 120-129
- 35 Novello S, Barlesi F, Califano R. et al. Metastatic non-small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2016; 27 (Suppl. 05) v1-v27