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Perioperative Therapie bei Adenokarzinomen des Ösophagus und ösophagogastralen Übergangs

Perioperative treatment of adenocarcinoma of the esophagus and esophagogastric junction

  • Leitthema
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Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Die Behandlung lokal fortgeschrittener Adenokarzinome des Ösophagus und des ösophagogastralen Übergangs wurde über Jahrzehnte kontrovers diskutiert. Die chirurgische Resektion wurde als die einzige kurative Behandlungsmodalität angesehen.

Ziel und Ergebnisse

Kontrollierte klinische Studien konnten belegen, dass neoadjuvante Therapiekonzepte zur Verbesserung der R0-Resektionsrate, Senkung der systemischen Rezidivrate und zur Verbesserung der Gesamtprognose führen. Die neoadjuvante Chemotherapie wurde mittlerweile für die Behandlung der Tumorstadien cT3 und resektabel cT4 als Standard etabliert. Die Radiochemotherapie kann eine alternative Behandlungsoption hierfür sein. Trotz der Fortschritte erreicht man bei etwa 30–60 % der Patienten keine langfristige Tumorkontrolle. Wirksamere Behandlungsregime werden benötigt.

Schlussfolgerung

Um bessere Ergebnisse zu erreichen, sollte die kurative Therapie des Ösophaguskarzinoms an Zentren mit interdisziplinärer Zusammenarbeit, Qualitätssicherung und Erfahrung erfolgen. Aktuelle Forschungsschwerpunkte richten sich auf personalisierte Therapien sowie die Erforschung prädiktiver und prognostischer Parameter.

Abstract

Background

The treatment of localized esophageal adenocarcinoma and cancer of the esophagogastric junction has been controversially debated over the past few decades. Surgical resection was regarded as the only curative treatment option.

Objective and results

Controlled randomized clinical trials have shown that multimodal neoadjuvant treatment enhances the rate of curative (R0) resections and reduces the likelihood of systemic relapse. Overall, survival can be improved by neoadjuvant chemotherapy. Meanwhile, neoadjuvant chemotherapy has an established role in the treatment of locally advanced esophageal adenocarcinoma and cancer of the esophagogastric junction. Neoadjuvant chemoradiation is a further treatment option. Despite all progress, there is still a lack of long-term tumor control in 30–60 % of treated patients. Therefore, more efficacious treatment regimens are urgently needed.

Conclusion

To obtain optimal outcomes, patients with esophageal cancer should be treated in centers with interdisciplinary cooperation, quality assurance, and experience. Current research is focused on targeted drugs and the development of predictive and prognostic markers.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. M. Knödler, T. Kuhnt und F. Lordick geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Universitäres Krebszentrum Leipzig (UCCL), Universitätsklinikum Leipzig, Liebigstraße 20, 04301, Leipzig, Deutschland

    M. Knödler & F. Lordick

  2. Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Leipzig, Leipzig, Deutschland

    T. Kuhnt

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  1. M. Knödler
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  2. T. Kuhnt
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  3. F. Lordick
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Correspondence to M. Knödler.

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Knödler, M., Kuhnt, T. & Lordick, F. Perioperative Therapie bei Adenokarzinomen des Ösophagus und ösophagogastralen Übergangs. Onkologe 20, 1210–1216 (2014). https://doi.org/10.1007/s00761-014-2760-9

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  • DOI: https://doi.org/10.1007/s00761-014-2760-9

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