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Neoadjuvante Therapie im oberen Gastrointestinaltrakt

Aktuelle Konzepte beim Barrett-Karzinom

Neoadjuvant therapy in the upper gastro-intestinal tract

Modern strategies for Barrett’s cancer

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Zusammenfassung

Während die primäre Resektion mit systematischer Lymphadenektomie nach wie vor den Goldstandard in der Behandlung des lokoregionalen Adenokarzinoms im distalen Ösophagus darstellt, kommen bei Patienten mit lokal fortgeschrittenen Tumoren und Tumoren mit ausgedehnter lymphatischer Metastasierung neoadjuvante Therapiekonzepte zunehmend zum Einsatz. Anhand der Datenlage ist beim Adenokarzinom des distalen Ösophagus (Barrett-Karzinom) die neoadjuvante Chemotherapie ähnlich effektiv wie die neoadjuvante kombinierte Radiochemotherapie, geht jedoch im Gegensatz zur präoperativen Radiochemotherapie nicht mit einer Erhöhung der perioperativen Morbidität und Mortalität einher. Das objektive Ansprechen auf die Vorbehandlung stellt den wesentlichen Prognosefaktor bei diesen multimodalen Therapiekonzepten dar. Anhand der mittels FDG-PET gemessenen Veränderungen im Glukosemetabolismus des Primärtumors scheint beim Adenokarzinom des distalen Ösophagus eine Evaluierung und sogar Prädiktion des Ansprechens auf die Vorbehandlung bereits kurz nach Einleitung einer neoadjuvanten Chemotherapie möglich. Dies eröffnet Möglichkeiten für den individualisierten und selektiven Einsatz neoadjuvanter Therapiestrategien.

Abstract

While primary surgical resection with systematic lymphadenectomy remains the treatment of choice for locoregional Barrett’s cancer, neoadjuvant chemotherapy is an increasingly accepted treatment modality for patients with locally advanced tumors and patients with extensive lymphatic spread. In contrast to neoadjuvant radiochemotherapy preoperative chemotherapy alone does not seem to increase peri-operative complications and mortality. Responders to pre-operative treatment clearly have a survival advantage as compared to those who do not respond. The use of positron emission tomography to measure changes in glucose metabolism of the primary tumor can predict response early after initiation of neoadjuvant chemotherapy and thus help to select patients who will or will not benefit from this approach. The best treatment strategy for non-responders to neoadjuvant therapy remains to be defined.

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Authors and Affiliations

  1. Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Klinikum Nürnberg Nord, 90419, Nürnberg, Deutschland

    H.J. Stein

  2. Chirurgische Klinik und Poliklinik der Technischen Universität München, München, Deutschland

    M. Feith

  3. Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    J.R. Siewert

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  1. H.J. Stein
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  2. M. Feith
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  3. J.R. Siewert
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Correspondence to H.J. Stein.

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Stein, H., Feith, M. & Siewert, J. Neoadjuvante Therapie im oberen Gastrointestinaltrakt. Chirurg 80, 1019–1022 (2009). https://doi.org/10.1007/s00104-009-1734-8

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  • DOI: https://doi.org/10.1007/s00104-009-1734-8

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