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Adjuvante Therapie bei soliden Tumoren des unteren Gastrointestinaltraktes

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Forschung in der Chirurgie

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Zusammenfassung

Mit adjuvanter Therapie bei Kolon- und Rektumkarzinomen lassen sich die Rezidivraten senken und die Überlebensraten verbessern. Nach den Empfehlungen der Chirurgischen Arbeitsgemeinschaft für Onkologie (CAO) sowie der Arbeitsgemeinschaft Internistischer Onkologie (AIO) und Arbeitsgemeinschaft Radio-Onkologie (ARO) sollen Kolonkarzinompatienten im UICC-Stadium III und im Stadium II (Subkategorie T4N0M0) eine postoperative adjuvante Therapie erhalten, da in diesen Stadien die Rezidivraten hoch sind und die alleinigen chirurgischen Ergebnisse durch die postoperative adjuvante Therapie verbessert werden können. Als Standard wird derzeit die Behandlung mit 5-FU + Levamisol empfohlen. Als neuere Alternative kann die Kombination mit 5-FU + Folinsäure, möglichst im Rahmen von Studien, gewählt werden. Kolonkarzinompatienten im Stadium UICC II, T3N0M0, sollten außerhalb von Studien keine adjuvante Behandlung erfahren. Entsprechend der relativ hohen Lokalrezidiv- und Fernmetastasierungsraten sollten dagegen Rektumkarzinome im Stadium UICC II und III eine postoperative Radiochemotherapie mit 45–54,4 Gy und 5-FU erhalten. Patienten mit einer Kontraindikation zur Strahlentherapie können allein chemotherapeutisch adjuvant behandelt werden. Als Alternative zur Multimodalbehandlung mit Radio- und/oder Chemotherapie kommt die Infusionsbehandlung mit dem monoklonalen Antikörper 17–1A im Rahmen von Studien in Frage. Die Studienergebnisse zur intraportalen Infusion sind noch widersprüchlich, so daß diese Behandlung nicht zum Standard zhlen kann. Trotz der nachgewiesenen Effektivität multimodaler adjuvanter Therapieformen sind in Zukunft weitere kontrollierte Studien erforderlich, um die Behandlungsergebnisse zu verbessern und die Patienten zur Vermeidung einer Übertherapie besser zu selektionieren. Zu den wesentlichen Studienkonzepten zählen die präoperative Radio- bzw. Radiochemotherapie bei Rektumkarzinomen, die intraoperative Strahlentherapie, die Hyperthermie oder immuntherapeutische Konzepte entweder alleine oder in Kombination mit Chemotherapie appliziert.

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  1. K. H. Link
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  2. L. Staib
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  3. H. G. Beger
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  1. Chirurgische Klinik I, Klinikum der Universität Ulm, Steinhövelstr. 9, D-89075, Ulm, Germany

    H. G. Berger  & A. Schwarz  & 

  2. Sektion Chirurgische Forschung Chirurgie I, der Universität Ulm, Parkstraße 11, D-89073, Ulm, Germany

    U. B. Brückner

  3. Steinhölzle 16, D-89198, Westerstetten, Germany

    W. Hartel

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Link, K.H., Staib, L., Beger, H.G. (1997). Adjuvante Therapie bei soliden Tumoren des unteren Gastrointestinaltraktes. In: Berger, H.G., Schwarz, A., Brückner, U.B., Hartel, W. (eds) Forschung in der Chirurgie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-60765-3_14

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