Kombination Radio(chemo)therapie beim Lungenkarzinom – Nebenwirkungsmanagement

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.