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Neoadjuvante und adjuvante Therapie des Rektumkarzinoms

Neoadjuvant and adjuvant therapy of rectal cancer

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Zusammenfassung

Die Therapie des Rektumkarzinoms konnte in den vergangenen Jahren durch Fortschritte im Bereich der präoperativen Diagnostik, der Chirurgie und der Pathologie verbessert werden. In dieser Übersicht möchten wir vor allem die Entwicklungen im Bereich von Chemotherapie und Strahlentherapie darstellen, die wesentlich zur Verbesserung der Lokalrezidivrate des Rektumkarzinoms beigetragen haben. Wir diskutieren die Vor- und Nachteile einer prä- und postoperativen Radio- bzw. Radiochemotherapie und zeigen mögliche Weiterentwicklungen der multimodalen Therapie des Rektumkarzinoms auf.

Abstract

The therapy of rectal cancer could be improved in recent years by advances in the areas of preoperative diagnostics, surgery and pathology. In this review we would like to present in particular the developments in the areas of chemotherapy and radiotherapy which have substantially contributed to improvements in the local recurrence rates of rectal cancer. The advantages and disadvantages of preoperative and postoperative radiotherapy and chemoradiotherapy will be discussed and possible further developments in multimodal therapy of rectal cancer will be presented.

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Literatur

  1. MacFarlane JK, Ryall RD, Heald RJ (1993) Mesorectal excision for rectal cancer. Lancet 341: 457–460

    Article  CAS  PubMed  Google Scholar 

  2. Stamos MJ, Murrell Z (2007) Management of early rectal T1 and T2 cancers. Clin Cancer Res 13: 6885s-6889s

    Article  CAS  PubMed  Google Scholar 

  3. Schmiegel W, Reinacher-Schick A, Arnold D et al (2008) Update S3-guideline „colorectal cancer“ 2008. Z Gastroenterol 46: 799–840

    Article  CAS  PubMed  Google Scholar 

  4. Willett CG (1998) Sphincter preservation in rectal cancer. Local excision followed by postoperative radiation therapy. Semin Radiat Oncol 8: 24–29

    Article  CAS  PubMed  Google Scholar 

  5. NIH consensus conference (1990) Adjuvant therapy for patients with colon and rectal cancer. JAMA 264: 1444–1450

    Article  Google Scholar 

  6. Adjuvant radiotherapy for rectal cancer (2001) a systematic overview of 8,507 patients from 22 randomised trials. Lancet 358: 1291–1304

    Article  Google Scholar 

  7. Gastrointestinal Tumor Study Group (1985) Prolongation of the disease-free interval in surgically treated rectal carcinoma.. N Engl J Med 312: 1465–1472

    Article  Google Scholar 

  8. Fisher B, Wolmark N, Rockette H et al (1988) Postoperative adjuvant chemotherapy or radiation therapy for rectal cancer: results from NSABP protocol R-01. J Natl Cancer Inst 80: 21–29

    Article  CAS  PubMed  Google Scholar 

  9. Krook JE, Moertel CG, Gunderson LL et al (1991) Effective surgical adjuvant therapy for high-risk rectal carcinoma. N Engl J Med 324: 709–715

    Article  CAS  PubMed  Google Scholar 

  10. Bosset JF, Collette L, Calais G et al (2006) Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 355: 1114–1123

    Article  CAS  PubMed  Google Scholar 

  11. Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351: 1731–1740

    Article  CAS  PubMed  Google Scholar 

  12. Swedish Rectal Cancer Trial (1997) Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med 336: 980–987

    Article  Google Scholar 

  13. Folkesson J, Birgisson H, Pahlman L et al (2005) Swedish Rectal Cancer Trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol 23: 5644–5650

    Article  PubMed  Google Scholar 

  14. Kapiteijn E, Marijnen CA, Nagtegaal ID et al (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345: 638–646

    Article  CAS  PubMed  Google Scholar 

  15. Sebag-Montefiore D, Stephens RJ, Steele R et al (2009) Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet 373: 811–820

    Article  PubMed  Google Scholar 

  16. Pettersson D, Cedermark B, Holm T et al (2010) Interim analysis of the Stockholm III trial of preoperative radiotherapy regimens for rectal cancer. Br J Surg 97: 580–587

    Article  CAS  PubMed  Google Scholar 

  17. Capirci C, Valentini V, Cionini L et al (2008) Prognostic value of pathologic complete response after neoadjuvant therapy in locally advanced rectal cancer: long-term analysis of 566 ypCR patients. Int J Radiat Oncol Biol Phys 72: 99–107

    PubMed  Google Scholar 

  18. Sanghera P, Wong DW, McConkey CC et al (2008) Chemoradiotherapy for rectal cancer: an updated analysis of factors affecting pathological response. Clin Oncol (R Coll Radiol) 20: 176–183

    Google Scholar 

  19. De laTorre A, Garcia-Berrocal MI, Arias F et al (2008) Preoperative chemoradiotherapy for rectal cancer: randomized trial comparing oral uracil and tegafur and oral leucovorin vs. intravenous 5-fluorouracil and leucovorin. Int J Radiat Oncol Biol Phys 70: 102–110

    Google Scholar 

  20. Hofheinz R, Wenz F, Post S et al (2009) Capecitabine (Cape) versus 5-fluorouracil (5-FU)-based (neo-)adjuvant chemoradiotherapy (CRT) for locally advanced rectal cancer (LARC): Safety results of a randomized, phase III trial. ASCO Meeting Abstracts 27: 4014

    Google Scholar 

  21. Aschele C, Pinto C, Cordio S et al (2009) Preoperative fluorouracil (FU)-based chemoradiation with and without weekly oxaliplatin in locally advanced rectal cancer: Pathologic response analysis of the studio terapia adiuvante retto (STAR)-01 randomized phase III trial. ASCO Meet Abstr 27: CRA4008

    Google Scholar 

  22. Gerard JP, Azria D, Gourgou-Bourgade S et al (2010) Comparison of two neoadjuvant chemoradiotherapy regimens for locally advanced rectal cancer: results of the phase III trial ACCORD 12/0405-Prodige 2. J Clin Oncol 28: 1638–1644

    Article  CAS  PubMed  Google Scholar 

  23. Cunningham D, Humblet Y, Siena S et al (2004) Cetuximab monotherapy and cetuximab plus irinotecan in irinotecan-refractory metastatic colorectal cancer. N Engl J Med 351: 337–345

    Article  CAS  PubMed  Google Scholar 

  24. Van Cutsem E, Lang I, D’haens G et al (2008) KRAS status and efficacy in the first-line treatment of patients with metastatic colorectal cancer (mCRC) treated with FOLFIRI with or without cetuximab: The CRYSTAL experience. ASCO Meet Abstr 26: 2

    Google Scholar 

  25. Bokemeyer C, Bondarenko I, Makhson A et al (2009) Fluorouracil, leucovorin, and oxaliplatin with and without cetuximab in the first-line treatment of metastatic colorectal cancer. J Clin Oncol 27: 663–671

    Article  CAS  PubMed  Google Scholar 

  26. Weiss C, Arnold D, Dellas K et al (2010) Preoperative radiotherapy of advanced rectal cancer with Capecitabine and Oxaliplatin with or without Cetuximab: A pooled analysis of three prospective phase I-II trials. Int J Radiat Oncol Biol Phys (Epub ahead of print)

  27. Rodel C, Arnold D, Hipp M et al (2008) Phase I-II trial of cetuximab, capecitabine, oxaliplatin, and radiotherapy as preoperative treatment in rectal cancer. Int J Radiat Oncol Biol Phys 70: 1081–1086

    PubMed  Google Scholar 

  28. Horisberger K, Treschl A, Mai S et al (2009) Cetuximab in combination with capecitabine, irinotecan, and radiotherapy for patients with locally advanced rectal cancer: results of a Phase II MARGIT trial. Int J Radiat Oncol Biol Phys 74: 1487–1493

    CAS  PubMed  Google Scholar 

  29. Bertolini F, Chiara S, Bengala C et al (2009) Neoadjuvant treatment with single-agent cetuximab followed by 5-FU, cetuximab, and pelvic radiotherapy: a phase II study in locally advanced rectal cancer. Int J Radiat Oncol Biol Phys 73: 466–472

    CAS  PubMed  Google Scholar 

  30. Debucquoy A, Haustermans K, Daemen A et al (2009) Molecular response to cetuximab and efficacy of preoperative cetuximab-based chemoradiation in rectal cancer. J Clin Oncol 27: 2751–2757

    Article  CAS  PubMed  Google Scholar 

  31. Willett CG, Boucher Y, Tomaso E di et al (2004) Direct evidence that the VEGF-specific antibody bevacizumab has antivascular effects in human rectal cancer. Nat Med 10: 145–147

    Article  CAS  PubMed  Google Scholar 

  32. Willett CG, Duda DG, Tomaso E di et al (2009) Efficacy, safety, and biomarkers of neoadjuvant bevacizumab, radiation therapy, and fluorouracil in rectal cancer: a multidisciplinary phase II study. J Clin Oncol 27: 3020–3026

    Article  CAS  PubMed  Google Scholar 

  33. Marijnen CA, Rutten H, Wilt H de et al (2008) Preoperative chemoradiotherapy regimen with capecitabine and bevacizumab in locally advanced rectal cancer: A feasibility study of the Dutch Colorectal Cancer Group (DCCG). ASCO Meet Abstr 26: 15040

    Google Scholar 

  34. DiPetrillo TA, Pricolo V, Sikov WM et al (2008) Neoadjuvant bevacizumab, oxaliplatin, 5-fluorouracil, and radiation in clinical stage II-III rectal cancer. ASCO Meet Abstr 26: 15041

    Google Scholar 

  35. Crane CH, Eng C, Feig BW et al (2010) Phase II trial of neoadjuvant bevacizumab, capecitabine, and radiotherapy for locally advanced rectal cancer. Int J Radiat Oncol Biol Phys 76: 824–830

    CAS  PubMed  Google Scholar 

  36. Gerard JP, Conroy T, Bonnetain F et al (2006) Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3–4 rectal cancers: results of FFCD 9203. J Clin Oncol 24: 4620–4625

    Article  PubMed  Google Scholar 

  37. Collette L, Bosset JF, Dulk M den et al (2007) Patients with curative resection of cT3–4 rectal cancer after preoperative radiotherapy or radiochemotherapy: does anybody benefit from adjuvant fluorouracil-based chemotherapy? A trial of the European Organisation for Research and Treatment of Cancer Radiation Oncology Group. J Clin Oncol 25: 4379–4386

    Article  CAS  PubMed  Google Scholar 

  38. Bujko K, Glynne-Jones R, Bujko M (2010) Does adjuvant fluoropyrimidine-based chemotherapy provide a benefit for patients with resected rectal cancer who have already received neoadjuvant radiochemotherapy? A systematic review of randomised trials. Ann Oncol (Epub ahead of print)

  39. Fernandez-Martos C, Pericay C, Aparicio J et al (2010) Phase II, randomized study of concomitant chemoradiotherapy followed by surgery and adjuvant capecitabine plus oxaliplatin (CAPOX) compared with induction CAPOX followed by concomitant chemoradiotherapy and surgery in magnetic resonance imaging-defined, locally advanced rectal cancer: Grupo cancer de recto 3 study. J Clin Oncol 28: 859–865

    Article  CAS  PubMed  Google Scholar 

  40. Guillem JG, Diaz-Gonzalez JA, Minsky BD et al (2008) cT3N0 rectal cancer: potential overtreatment with preoperative chemoradiotherapy is warranted. J Clin Oncol 26: 368–373

    Article  PubMed  Google Scholar 

  41. Siewert JR (2010) Chirurgie. 8., komplett überarb. Aufl. Springer, Berlin Heidelberg New York

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  1. Klinik für Innere Medizin I, Universitätsklinikum Halle (Saale) der Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland

    M. Porzner &  T. Seufferlein

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  1. M. Porzner
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  2. T. Seufferlein
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Correspondence to T. Seufferlein.

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Porzner, M., Seufferlein, T. Neoadjuvante und adjuvante Therapie des Rektumkarzinoms. Gastroenterologe 5, 404–411 (2010). https://doi.org/10.1007/s11377-010-0421-0

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  • DOI: https://doi.org/10.1007/s11377-010-0421-0

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