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Palliativtherapie des fortgeschrittenen Lungenkarzinoms

Bronchoskopische Interventionen

Palliative therapy of advanced lung cancer

Bronchioscopic interventions

  • Leitthema
  • Published:
Der Pneumologe Aims and scope

Zusammenfassung

Das Lungenkarzinom ist weiterhin die führende Krebstodesursache weltweit. Da die Mehrzahl der Patienten nach wie vor erst in fortgeschrittenen Stadien diagnostiziert wird, kommen kurative Therapieansätze nur bei der Minderheit der Patienten zum Tragen. Die Prognose ist unverändert schlecht und das Vorgehen häufig nur palliativ. Deshalb wird auch der interventionell tätige Pneumologe mit diesem Problem konfrontiert. Bei zentralen Tumoren kann das fortschreitende Wachstum zu bedrohlichen Symptomen und Situationen führen, die ein sofortiges Handeln erforderlich machen. In den letzten Jahren haben sich die technischen Verfahren verbessert. Zur raschen Abtragung stehen mechanische Methoden neben Koagulationsverfahren zur Verfügung. Der Laser hat an Popularität eingebüßt. Die Elektrokoagulation und der Argonplasmabeamer führen zu vergleichbaren Ergebnissen. Besondere Beachtung findet derzeit die Kryotherapie in Form der Kryorekanalisation. Nach Beseitigung der endoluminalen Anteile und/oder Dilatation kommt ggf. ein Stent zur Sicherung des Lumens in Betracht. Zum Repertoire gehören auch die Brachytherapie, die photodynamische Therapie und verschiedene Verfahren der Blutstillung. Mit diesem Beitrag wird ein Überblick über den derzeitigen Stand der Methoden und die Differenzialtherapie gegeben.

Abstract

Lung cancer is even today the leading cause of cancer mortality worldwide. The majority of patients are still diagnosed with advanced cancer so that curative therapy is feasible only in a minority of patients. The prognosis is up to now poor and palliative therapy unfortunately common. The bronchoscopist is confronted with an increasing number of patients suffering from centrally located cancer with life-threatening symptoms and immediate action is required. In recent years the techniques have been improved. For tumor destruction mechanical removal and different coagulation methods are available. The laser is losing popularity. Electrocoagulation and argon plasma beamer lead to comparable results. Recently cryorecanalization as a form of cryotherapy has become widely used. After removal of the intraluminal component and/or dilatation a stent can be used for securing airway patency. The repertoire also includes brachytherapy, photodynamic therapy and different methods to achieve hemostasis. An overview of the different methods of bronchoscopic tumor palliation and the differential therapy is given.

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Authors and Affiliations

  1. Pneumologie, Schwerpunkt Thorakale Endoskopie, Lungenklinik Hemer, Theo-Funccius-Str. 1, 58675, Hemer, Deutschland

    F. Stanzel

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  1. F. Stanzel
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Correspondence to F. Stanzel.

Zusatzmaterial online

Video: Tumorabtragung mit dem Laser im Zwischenbronchus rechts (QuickTime 6,5 MB)

Video: Diffus blutende Läsion im linken Hauptbronchus (QuickTime 11 MB)

Video: Behandlungsmöglichkeit mit dem Argonplasmabeamer (QuickTime 5,3 MB)

Video: Elektrokoagulation (QuickTime 14 MB)

Video: Ideal liegender Dumon-Stent in der oberen Trachea (QuickTime 5 MB)

Video: Passage durch einen Y-Metall-Stent, der mit einem weiteren Metall-Stent überlappt (QuickTime 6,3 MB)

10405_2011_500_MO7_ESM.mov

Video: Fassen der polypösen Formation mit der Schlinge und Abtragung, allerdings mit zusätzlicher Elektrokoagulation (QuickTime 27 MB)

Video: Kryokoagulation von Granulationsgewebe am Rand eines gecoverten Metall-Stents (QuickTime 6 MB)

10405_2011_500_MO9_ESM.mov

Video: Gecoverter, dünnwandiger Metall-Stent im Haupt- und Zwischenbronchus rechts bei Tumorinfiltration und -obstruktion (QuickTime 5 MB)

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Stanzel, F. Palliativtherapie des fortgeschrittenen Lungenkarzinoms. Pneumologe 9, 35–42 (2012). https://doi.org/10.1007/s10405-011-0500-z

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  • DOI: https://doi.org/10.1007/s10405-011-0500-z

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