LungekræftLungekræft tager mange liv. Vi kan gøre mere for at forhindre.

 

Ved strategisk at kombinere billeddiagnostik, it og laboratorieapplikationer, kan lungekræft bekæmpes gennem:

  • Tidlig detektion ved screeningsprogrammer, der skal reducere dødelighed
  • Avanceret billeddannelse til bedre visualisering af tumorer
  • Innovativ behandlingsplanlægning for bedre overlevelse og færre bivirkninger
  • Individualiseret behandling og systematisk vurdering af respons
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Lungescreening

De fleste mennesker der får lungekræft i dag, diagnosticeres så sent, at sygdommen ikke kan helbredes. Undersøgelser viser, at lungescreeningsprogrammer for højrisikopatienter kan redde liv. Hvorfor ikke starte nu?

Risikoen for at udvikle lungekræft påvirkes af mange faktorer, såsom alder, genetik, livsstil og eksponering for miljøforhold. Da denne type kræft er så farlig, er lungemedicinske fagfolk nu opsat på, at etablere et nationalt lungescreeningsprogram inklusiv lavdosis CT og biomarkører for at reducere dødeligheden.

Fordele ved CT-screening

National Lung Screening Trial (NLST) fra USA og den såkaldte NELSON-undersøgelse fra Belgien og Holland er de største undersøgelser, der er gennemført med hensyn til brugbarheden af CT ved lungescreening. I NLST fra USA deltog mere end 50.000 patienter, der havde røget 20 cigaretter dagligt i tredive år. Undersøgelsen viste en forbedret overlevelse for gruppen, der modtog lav-dosis CT, sammenlignet med kontrolgruppen, der modtog røntgenstråler.

NELSON-undersøgelsen har fulgt over 15.000 deltagere i ti år og viser god effekt af lungescreening. Tallene fra undersøgelsen er vist på flere store internationale lungekonferencer og dokumenterer, at dødeligheden bliver reduceret med 24% hos mænd og 33% hos kvinder. Screeningsmetoden var også her lavdosis CT-undersøgelser blandt daglige rygere i risikogrupper. Mange fagfolk har kommenteret resultaterne i medierne.

Radiolog Haseem Ashraf har en doktorgrad i screening af lungekræft og sidder i screeningsudvalget for både danske og norske lungekræftgrupper. Han mener, at konklusionerne fra undersøgelserne tyder på, at screening af storrygere i Norge bør indføres.

Haseem Ashraf, lektor ved Universitetet i Oslo og seniorkonsulent ved Thoracic Radiology Department ved Akershus Universitets Hospital

Lungekræft koster flest liv

Lungekræft er den kræftsygdom, der koster flest liv både i Norge og internationalt. Når vi har en metode til at reducere dødeligheden markant, hvorfor så ikke bruge den? Nu har du to store undersøgelser fra de sidste ti år, der viser, at du kan redde mange liv ved at introducere et screeningsprogram. Fordi det er muligt at opdage kræft, før den har spredt sig, er det muligt at tilbyde en mere helbredende behandling, siger Haseem Ashraf, lektor ved Universitetet i Oslo og seniorkonsulent ved Thoracic Radiology Department ved Akershus Universitets Hospital.

Tidlig diagnose er afgørende

Undersøgelsesudvalget i den norske lungekræftgruppe har estimeret, at syv til otte procent af den norske befolkning i aldersgruppen 55-75 år falder ind under kriterierne. Nogle mennesker ønsker ikke screening, hvorfor de estimerer, at ca. 50.000 kan være relevante for årlig screening.
- Et screeningprogram for lungekræft skal være lige så naturligt som anden screening, hvis det er velbegrundet i videnskabelige studier. Når to store undersøgelser har vist positive resultater med CT-lavdosisscreening, er der al grund til at overveje, om Norge skal indføre målrettet screening for denne sygdom, siger Leder af Norsk Radiografforbund Bent Ronny Mikalsen til fagmagasinet Hold Pusten.
Han mener, at den tilgængelige kapacitet inden for billeddiagnostik og patologi bliver et centralt emne, når myndighederne beslutter om de skal gennemføre et CT-screeningsprogram for lungekræft.

Bedre differentiering

Zaigham Saghir er speciallæge i lungemedicin, Ph.D. og klinisk lektor ved lungemedicinsk afdeling, medicinsk afdeling på Herlev- Gentofte Hospital og Københavns Universitet. Han påpeger vigtigheden af udvælgelsen af hvem, der skal tilbydes screening:

- "Der er ingen tvivl om, at screening fungerer, men vi kan godt blive bedre til at vælge dem, der skal screenes. Vi bør finde dem med den højeste risiko og undgå at overdiagnosticere. Vi ser allerede gode resultater, så det er bare at komme i gang med højrisikopatienter og blive bedre til at differentiere kontinuerligt," siger Zaigham Saghir til Diagnostisk Tidsskrift.

Undersøgelser udført i Danmark viser de samme resultater som NELSON og NLST.

Zaigham Saghir, speciallæge i lungemedicin, Ph.D. og klinisk lektor ved lungemedicinsk sektion, medicinsk afdeling ved Herlev og Gentofte Hospital og Københavns Universitet.

- "Vi så, at screening over fem år ikke gav signifikante resultater, men da vi fulgte op efter yderligere fem år, kunne vi se effekten hos mennesker med den højeste risiko. Det vil være spændende at se, hvad opfølgning efter mere end 10 år efter den sidste screening viser," siger Zaigham.

Den danske lungekræftgruppe (DLCG) mener, at lungescreening bør være nøje tilrettelagt og organiseret for at give resultater.

”Screening, som ikke er systematisk og organiseret, har stor risiko for at ende med spild af ressourcer. DLCG arbejder derfor med at definere, hvordan screening for lungekræft med lavdosis CT bedst kan implementeres i Danmark," skriver DLCG i en nylig artikel i Dansk Journal of Medicine.

Situationen i Sverige

Det lungemedicinske fagerhverv i Sverige har også forpligtet sig til at fremskynde et nationalt lungescreeningsprogram for patienter med høj risiko. Hver dag dør 10 mennesker i Sverige af lungekræft.

I en kronik i Dagens Medicin skriver Roger Henriksson, Hirsh Koyi, Eva Brandén og Tommy Björk følgende:

"Vi foreslår, at Sundhedsstyrelsen, baseret på de nye fund og den nye teknologi, der er tilgængelig, kan forberede betingelserne for at indføre organiseret lungekræftscreening i hele Sverige kombineret med effektive forebyggende foranstaltninger til at nå målet om totalt rygestop."

”Omkostningerne ved at screene og den efterfølgende nødvendige behandling er lavere end omkostningerne ved behandling af en patient, med avanceret, alvorlig lungekræft, som meget sjældent kan behandles. Især når screeningen kombineres med rygestop, bliver den sundhedsøkonomiske fordel for samfundet stor,” skriver de i deres artikel i Dagens Medicin.

Med CT-platformen SOMATOM go. har Siemens Healthineers den nødvendige teknologi til at gøre lungekræftscreening med lavdosis CT effektiv og behagelig for patienten.

- Dette er en ny og nem måde at bruge CT på. Undersøgelsen udføres på få sekunder, og stråledosis er næsten den samme som ved traditionel røntgen. CT-undersøgelsen giver tredimensionelle billeder og dermed et langt bedre overblik end med et røntgenbillede. Mistanke om patologiske ændringer kan påvises meget tidligt, siger produktspecialist for CT, Kjell Fladstad i Siemens Healthineers Norge.

Fladstad understreger, at lavdosis-CT er særligt velegnet til screening af højrisikopatienter i en tidlig fase. Hvis der er mistanke om lungekræft, skal diagnostisk CT-scanning anvendes i overensstemmelse med de gældende kræftpakker.

Muligt med mobil scanning

Siemens Healthineers i England har afsluttet et lungescreeningsprojekt for højrisikopatienter med en mobil CT-scanner i Manchester, og det kan være muligt at bruge denne model i de nordiske lande. Projektet er et samarbejde mellem flere organisationer.
- Med de rette partnere og finansiering på plads er vores mål at bidrage til implementeringen af lungescreeningsprogrammer i de nordiske lande. Vi mener, det er på tide at introducere lungekræftscreening af højrisikogrupper, siger Lars Karlsson, chef for billeddiagnostik i Siemens Healthineers.

Lars Karlsson, chef for billeddiagnostik i Siemens Healthineers.

Early detection & diagnosis

Treating late-stage lung cancer is extremely challenging. However, lung cancer treatment can be significantly more effective if the disease is detected earlier in stage I or II, before the onset of symptoms when the disease is still localized. This emphasizes the benefit to establish screening programs for earlier detection. Precise lung cancer staging of lymph node involvement and distant metastases determines the prognosis and is the foundation of adequate therapy selection.


Lung cancer screening -  Image reading and reporting with syngo.via
  • 3D reading and advanced visualization
  • designed for both routine and challenging cases
  • dedicated modality-specific applications
  • structured reporting (Lung-RADS™)
  • server-client concept

Lung cancer screening - Computed Tomography
Interventional CT procedure to biopsy a lung cancer lesion

What is the impact of CT screening on the lung-cancer mortality rate?
The authors of NELSON Study point out that "Lung-cancer mortality was significantly lower among those who underwent volume CT screening"2

  • Latest recommendation of the American Association of Physicists in Medicine3 qualifies the Siemens Healthineers CT scanners4 for low-dose Lung Cancer Screening (LCS).
  • Unique radiation dose-saving technologies also available for LCS protocols.
  • Tin filter technology optimizes X-ray spectral shaping for improved dose efficiency and early detection.
  • Lung CAD, a second reader tool, provides highly sensitive and specific detection of lung nodules. It is available with syngo.via as inline tool and with CT View&GO5.
  • Adaptive 3D Intervention Suite is designed to perform CT-guided interventions for further evaluation of suspicious findings and to fulfill country specific guidelines for lung nodules with a diameter ≥ 8 mm or a volume ≥ 300 mm6

Learn more about our CT portfolio


X-ray products  - Lung cancer screening
Effect of advanced image post-processing on Siemens Healthineers radiography images
  • all relevant Siemens Healthineers' X-ray systems can be configured with dedicated hard- and software for lung imaging
  • ClearRead Bone Suppression™ to suppress bone structures for a clearer, unobstructed view of soft tissue
  • ClearRead +Detect™ is an advanced computer-aided detection (CAD) technology that identifies areas on a chest X-ray that may be early-stage lung cancer

Positron Emission Tomography – Computed Tomography (PET/CT)  - Lung cancer screening
  • finest volumetric resolution7
  • fast, amplitude-based gating technology (HD•Chest) virtually freezes respiratory motion and helps improve lesion detectability in the thoracic and abdominal areas
  • FlowMotion™ continuous bed motion for routine imaging of motion-sensitive organs with the highest possible resolution

Magnetic Resonance Imaging (MRI) and Molecular MR (MR/PET)  - Lung cancer screening
Biograph mMR dataset of a lung cancer patient visualized in syngo.mMR General reader
  • robust MR techniques for lung imaging
  • unmatched soft-tissue contrast for infiltration assessment, surgery planning, and whole-body staging
  • multi-parametric MRI can provide information on cellular density, perfusion, and vascularity
  • DotGO workflow engines8, for standardized protocols and more predictable scan slots
  • Biograph mMR™ combines MRI’s anatomical and functional information with the high sensitivity of PET in one single simultaneous, integrated MRI and PET system

Therapy

Today, the majority of lung cancer cases is detected when the disease is already in an advanced stage – and so treatment of lung cancer primarily consists of either radio(chemo)therapy potentially followed by surgery or systemic chemotherapy.
But therapy planning for lung cancer patients and the appropriate therapy selection also depends on the patient’s condition, histological and molecular characteristics of the tumor, and staging information.

The success of therapeutic approaches is based on meaningful image information that helps to guide targeted therapy. For most tumors that are detected early and are still localized, the treatment of choice in lung cancer is primary surgery.


Interventional imaging with angiography and CT - Primary surgery in lung cancer
  • minimally invasive interventions are expected to save healthy tissue, to minimize the risk of complications, and reduce the duration of the intervention as well as the hospitalization
  • site-specific integration of superior imaging devices into the operating room (OR)

Artis zeego, Siemens Healthineers' unique multi-axis robotic angiography system

  • delivers unrivaled positioning flexibility
  • hygiene class A room category in operation
  • syngo DynaCT Large Volume to acquire volumes of almost twice the diameter or height of conventional C-arm CTs for visualization of lung and all surrounding thoracic structures
  • syngo Needle Guidance for 3D path planning and precise navigation of devices from skin entry point to the target

MIYABI Angio-CT for the most challenging requirements in lung imaging

  • customized solution
  • combination of an Artis angiography system and a state-of-the-art CT
  • sliding gantry configuration in one- or two-room solutions

Two ablation needles positioned in target area.
Two ablation needles positioned in target area.
Courtesy of University Hospital QiLu Hospital of Shandong University, Jinan, China

Minimally invasive image guidance enables cost-effective procedures9 for the diagnosis and treatment of suspicious lesions.
The SOMATOM Force and Drive and the SOMATOM Edge Plus, Definition Edge and Confidence feature the Adaptive 3D Intervention Suite providing:

  • A wired or wireless i-control directly at the tableside that allows you to interact with the software and control all relevant scan parameters during CT-guided procedures designed for increased process efficiency.
  • Full navigation in the three-dimensional space of the patient together with real-time fluoroscopic image guidance that shall help with fast and accurate instrument positioning in the most complex anatomies.
  • Auto Needle Detection that detects the needle tip automatically to provide an accurate overview of the current needle and target position to explore needle paths you did not even think of before.

Learn more about CT-guided interventions


Radiation oncology - Primary surgery in lung cancer
Virtual simulation in lung radiotherapy with the SOMATOM Definition AS Open – RT Pro edition
  • Siemens Healthineers' large-bore CT scanners for comprehensive motion management in RT planning
  • Siemens Healthineers' SPECT and SPECT/CT systems for tissue perfusion imaging helps to avoid radiation to well-perfused lung tissue
  • syngo.via RT Image Suite for 4D multimodality image analysis allowing RT planning according to patients’ specific breathing patterns
  • Partnership with Varian Medical Systems 

Siemens Healthineers' large-bore PET/CT systems

  • industry’s finest volumetric resolution7 and high lesion contrast
  • flexible respiratory motion management

Monitoring & follow-up

Therapy monitoring and follow-up of lung cancer are key to individualized patient treatment. Monitoring the tumor’s response allows a timely adaptation to the selected therapy. This is important when several therapeutic options are available, as is the case with lung cancer.

After completion of the therapy, a systematic follow-up for the early detection of lung cancer relapse should always be part of the patient’s workup and is described in the corresponding guidelines.


Computed Tomography & syngo.via - Lung cancer therapy monitoring
CT follow-up examination consisting of baseline and two follow-up scans: evaluation and reporting are supported by syngo.via-based oncology applications
  • through functional examinations like tissue perfusion or iodine quantification SOMATOM CT systems enable an earlier assessment of tumor’s response in the lung or disease progression
  • syngo.via-based reading applications permit a standardized and efficient image analysis
  • longitudinal studies of the same patient are automatically registered, the trending of lesion size change is automatically visualized
  • structured reporting allows efficient communication across departments and disciplines

Positron Emission Tomography - Lung cancer therapy monitoring
SUV trending in a multi-timepoint PET/CT examination for response monitoring: the effects of the therapy are graphically visualized automatically
  • early predictor of response
  • advanced system calibration of Biograph PET/CT systems helps ensure consistent quantitative accuracy across multiple time points
  • Small, 4 mm LSO crystals provide high sensitivity in detecting local and distant recurrences of lung carcinoma
  • syngo.via with EQ•PET helps reduce technology-induced variations and inter-reader variability by normalizing PET SUV values between different scanners and reconstruction methods
  • Continuous bed motion, made possible by FlowMotion™ technology supports precise disease characterization in therapy monitoring of lung cancer

 


  • comprehensive menu of oncology tests, e.g. general and specific tests to assess side-effects in the patient or tumor markers such as carcinoembryonic antigen (CEA)

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