Zusammenfassung
In der modernen Onkologie kommt es immer mehr zu einer Verflechtung von Chirurgie, Chemotherapie und Strahlentherapie auf dem Boden multimodaler Strategien. Der Grund dafür ist, daß trotz kompletter Tumorresektion (R0) die Langzeitergebnisse für Patienten mit lokal fortgeschrittenen Tumoren des Gastrointestinaltraktes bis heute unbefriedigend sind. Im Rahmen der multimodalen Therapie wird die Chemotherapie, die Strahlentherapie und die Radio-/Chemotherapie eingesetzt. Dies ist möglich vor, während und nach einer Resektion. Im folgenden werden die klinischen und theoretischen Grundlagen dieser kombinierten Therapieprinzipien dargestellt.
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Weiterführende Literatur
Fink U, Stein HJ, Siewert, JR (1998) Multimodale Therapie bei Tumoren des oberen Gastrointestinal-trakts. Chirurg 69: 349–359
Fink U, Stein HJ, Schuhmacher C, Wilke HJ (1995) Neoadjuvant therapy for gastric cancer: Update. World J Surg 19: 509–516
Fisher B, Gunduz N, Saffer EA (1983) Influence on the interval between primary tumor removal and chemotherapy on kinetics and growth of metastases. Cancer res 43: 1488–1492
Gunduz N, Fisher B, Saffer EA (1979) Effect on surgical removal on the growth and kinetics of residual tumor. Cancer res 39: 1361–1365
Hamada M, Fujiwara T, Hizuta A, Gochi A, Naomoto Y, Takakura N, Takahashi K, Roth JA, Tanaka N, Orita K (1996) The p53 gene is a potent determinant of chemosensivity and radiosensivity in gastric and colorectal cancers. J Cancer Res Clin Oncol 122: 360–365
Hermans J, Bonenkamp JJ, Boon MC, Bunt AM, Ohyama S, Sasako M, van de Velde CJ (1993) Adjuvant therapy after curative resection for gastric cancer: meta analysis of randomized trials. J Clin Oncol 11:1441–1447
Johnston PG, Lenz HJ, Leichman CG, Dannenberg KD, Allegra CJ, Dannenberg PV, Leichman L (1995) Thymidilate Synthase Gene and protein expression correlate and are associated with response to 5-fluouracil in human colorectal and gastric tumors. Cancer Res 55: 1407–1412
McNamara DA, Harmey JH, Walsh TN, Redmond HP, Bouchier-Hayes DJ (1998) Significance of angiogenesis in cancer therapy British J Surg 85: 1044–1055
Murphy SM, Goldschmidt RA, Rao LN (1989) The influence of surgical trauma on experimental metastasis. Cancer 64: 2035–2044
Siewert JR, Sendler A, Dittler HJ, Fink U, Höfler H (1995) Staging of gastrointestinal cancer as a precondition for multimodal treatment. World J Surg 19: 168–177
Allen-Mersch TG, Earlam S, Fordy C, Abrams K, Houghton T (1994) Quality of life and survival with continous hepatic-artery floxurdine infusion for colorectal liver metastases. Lancet 344: 1255–1260
Asahara T, Kikkawa M, Okajiama M, Ojima Y, Toyota K, Nakahara H, Katayama K, Itamoto T, Marubayashi S, One E, Yahata H, Dohi K, Azuma K, Ito K (1998) Studies of postoperative transarterial infusion chemotherapy for liver metastasis of colorectal carcinoma after hepatectomy. Hepato-Gastroenterology 45: 805–11
Berger H, Baethge I, Rudolphi A, Boos KS, Stäbler A, Reiser M, Seidel D (1998) Transcatheter chemoem-bolisation of hepatocellular carcinoma: a study of the pharmacokinetics of epirubicin with lipiodol or starch microspheres as embolizing agent. Reg Cancer Treatment 9: 181–185
Bronowicki JP, Vetter D, Dumas F, Boudjema K, Bader R, Weiss AM, Wenger JJ, Boisel P, Bigard MA, Doffoel M (1994) Transcatheter oily chemoembolization for hepatocellular carcinoma. Cancer 74:16–24
Gansauge F, Link KH, Rillinger N, Kunz R, Berger HG (1996) Adjuvante regionale Chemotherapie beim resezierten fortgeschrittenen Pankreaskarzinom. Chirurg 67: 362–365
Goldberg SN, Solbiati L, Hahn R F, Cosman E, Conrad JE, Fogle R, Gazelle GS (1998) Large-volume tissue ablation with radio-frequency by using a clustered, internally cooled electrode technique: Laboratory and clinical experience in liver metastases. Radiology 209: 371–379
Group d’étude et de traitment du carcinom hépatocellulaire (1995) A comparison of lipiodol chemoembolization and conservative traetment for unresectable hepatocellular carcinoma. N Engl J Med 332: 1256–1261
Livraghi T, Giorgio A, Marin G, Solmi A, de Sio I, Bolondi L, Pompili M, Brunello F, Lazzaroni S, Torzilli G, Zucchi A (1995) Hepatocellular carcinoma and cirrhosis in 746 patients: Long term results of percutaneous ethanol injection. Radioloy 197: 101–108
Meta-Analysis Group in Cancer (1996) Reappraisal of hepatic arterial infusion in the treatment of non-resectable liver metastases from colorectal cancer. J Natl Cancer Inst 88,5: 252–258
Muchmore JH, Preslau JE, George WJ (1996) Regional chemotherapy for inoperable pancreatic carcinoma. Cancer 78: 664–673
Vogl T, Mack MG, Roggau A, Straub R, Eichler KC, Müller PK, Knappe V, Felix R (1998) Internally cooled power laser for MR-guided interstitial laser-induced thermotherapy of liver lesions: initial clinical results. Radiology 209: 381–385
Calvo FA, Santos M, Brady LW (Eds) (1992) Intraoperative Radiotherapy, Clinical Experiences and Results, Springer, Berlin
Feldmann HJ, Zimmermann FB, Stepan R, Nekarda H, Kneschaurek P, Molls M (1998) Locally advanced rectal cancer: intraoperative radiotherapy using the flab method combined with pre- and postoperative radiochemotherapy. In: Kogelnik HD, Sedlmayer F (Eds) Progress in Radio-Oncology VI Mon-duzzi Editore S.p.A., Bologna/Italy, S 417–422
Grosu L, Stärk S, Feldmann HJ, Kneschaurek P, Leonardi M, Lumenta Ch, Molls M (1998) Stereotaktische Konvergenzbestrahlung am Linearbeschleuniger: Bildgebung, Technik und klinische Indikationen. Röntgenpraxis 51:9–15
Huber FT, Stepan R, Zimmermann F, Fink U, Molls M, Siewert JR (1996) Locally advanced rectal cancer: resection and intraoperative radiotherapy using the flab method combined with preoperative or postoperative radiochemotherapy. Dis Col Rect 39: 774–779
Kneschaurek P, Wehrmann R, Hugo Ch, Stepan R, Lukas P, Molls M (1995) Die Flab-Methode zur intraoperativen Bestrahlung. Strahlenther Onkol 171: 61–70
Molls M, Vaupel P (Eds) (1998) Blood Perfusion and Microenvironment of Human Tumors. Implications for Clinical Radiooncology. Springer, Berlin
Molls M (1998) Prinzipien der Kombination von Radiotherapie und Chemotherapie. In: Scherer E, Sack H (Hrsg.) Strahlentherapie, Radiologische Onkologie. 4. Aufl. Springer S 189–205
Pahlman L, Glimelius B (Swedish Cancer Trial) (1997) Improved survival with preoperative radiotherapy in resectable rectal cancer. N Eng J Med 336: 980–987
Scherer E, Sack H (Hrsg) (1996) Strahlentherapie, Radiologische Onkologie, Springer, Berlin
Streffer C, Müller WU (1984) Radiation risk from combined exposures to ionizing radiations and chemicals. Adv Radiat Biol 11: 173–210
Tannock F (1992) Potential for therapeutic gain from combined-modality treatment. In: Meyer JL, Vaeth JM (Eds) Radiotherapy/Chemotherapy Interactions in Cancer Treatment. Front Radiat Ther Oncol 26, Karger, Basel p 1–15
Withers HR, McBride WH (1997) Biologic Basis of Radiation Therapy. In: Perez CA, Brady LW (Eds) Principles and Practice of Radiation Oncology. Lippincott-Raven, Philadelphia 79: 118
Zimmermann FB, Molls M (1998) Three-dimensional treatment planning: principles and practice. Onkologie 21: 474–484
Baumgartner I, Pieczk A, Manor 0, Blair R, Kearney M, Walsh K, Isner JM (1998) Constitutive expression of phVEGF 165 after intramuscular gene transfer promotes collateral vessel development in patients with critical limb ischemia. Circulation 97: 1114–1123
Cristiano RJ, Xu B, Nguyen D, Schumacher G, Kataoka M, Spitz FR, Roth JA (1998) Viral and nonviral delivery vectors for cancer gene therapy. Cancer Detect Prev 22: 445–454
Dranoff G (1998) Cancer gene therapy: Connecting basic science with clinical inquiry. J Clin Oncol 16: 2548–2556
Hantzopoulos P, Gänsbacher B (1996) Gentherapie: Stand und Ausblick. Chirurg 67: 980–983
Hodi F, Dranoff G (1998) Genetically modified tumor cell vaccines. Surg Oncol Clin N Am 7: 471–485
Lashford L (1997) Possibilities of gene therapies for cancer. Ann Med 29: 1–4
Losordo DW, Vale PR, Symes JF, Dunnington ChH, Esakof DD, Maysky M, Ashare AB, Lathi K, Isner JM (1998) Gene therapy for myocardial angiogenesis. Initial clinical results with direct myocardial injection of phVEGF165 as sole therapy for myocardial ischemia. Circulation 98: 2800–2804
Medin J, Karlsson S (1997) Viral vectors for gene therapy of haematopoetic cells. Immunotechnology 3: 19
Naldini L (1998) Lentiviruses as gene transfer agents for delivery to non-dividing cells. Curr Opin Biotechnol 9: 480–485
Robbins PD, Ghivizzani SC (1998) Viral vectors for gene therapy. Pharmacol Ther 80: 35–47
Rosenfild M, Curiel D (1996) Gene therapy strategies for novel cancer therapeutics. Curr Opin Oncol 8: 72–77
Roth JA, Cristiano RJ (1997) Gene therapy for cancer: What have we done and where are we going? J Natl Cancer Inst 89: 21–39
Springer ML, Chen AS, Kraft PE, Bednarski M, Blau HM (1998) VEGF gene delivery to muscle; Potential role for vasculogenesis in adults. Molecular Cell 2: 549–558
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Fink, U. et al. (2000). Prinzipien der chirurgischen Onkologie. In: Roder, J.D., Stein, H.J., Fink, U. (eds) Therapie gastrointestinaler Tumoren. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-59659-9_9
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