Dr Futterer describes a small cohort of patients who underwent gamma knife surgery for an isolated cerebral metastasis, who also, in order to yield positive results, had to have a good Karnofsky index and whose thoracic tumor should receive “definitive” treatment (radiochemotherapy, trimodal approach). Such patients are not common.
We agree that such an approach is probably justified in clearly defined cases (this is also the case for isolated adrenal metastases, but such cases would be even more rare) in relatively young patients, but in a CME article with a clear word limit, studies of only 42 patients cannot always be included. The highly recommended regular tumor boards at the centers help include such aspects in the considerations of the individual case.
In an article on lung cancer that served the purpose of continuing medical education, only specific palliative measures could be included, for reasons of space. We are fully aware of the wide range of palliative measures, but this is too great in scope for such an article. The S3 lung cancer guideline has 150 pages—our article had 9 pages.
As far as the level of evidence (4) and the patient numbers for the studies of the effect of aerobic endurance training in lung cancer patients (who have undergone surgery!) are concerned, we refer readers to the literature (1).
Professor Lübbe is right, palliative medicine is indisputably essential, especially in lung cancer. But we didn’t write about pain therapy, diet/nutrition, psychological care, preserving patients’ mobility and independence, and patients’ desire for a self determined death. Our topic was the “current diagnosis and treatment” of lung cancer.
Footnotes
Conflict of interest statement
Professor Hammerschmidt has received honoraria for speaking and travel expenses from Roche, as well as honoraria for speaking from GSK. Professor Wirtz declares that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.
References
- 1.Goeckenjan G, Sitter H, Thomas M, et al. Prevention, Diagnosis, Therapy, and Follow-up of Lung Cancer Interdisciplinary Guedeline of the German Respiratory Society and the German Cancer Society (Prävention, Diagnostik, Therapie und Nachsorge des Lungenkarzinoms Interdisziplinäre S3-Leitlinie der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin und der Deutschen Krebsgesellschaft) Pneumologie. 2010;64(Suppl. 2):23–155. [Google Scholar]