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Palliative und supportive Therapie des Ösophaguskarzinoms

Palliative and supportive therapy of esophageal cancer

  • Leitthema
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Die Prognose des Ösophaguskarzinoms im fortgeschrittenen Stadium ist ungünstig, und die Palliativtherapie dieser Patienten erfordert ein breites Spektrum unterschiedlicher Maßnahmen zur Linderung der Beschwerden. Dennoch eröffnet das zunehmende Verständnis der Tumorbiologie des Plattenepithel- und Adenokarzinoms der Speiseröhre die Chance auf verbesserte Therapiemöglichkeiten.

Ergebnisse

Lokale Therapieverfahren für Stenose und Blutung können in der endoskopischen Therapie, einer lokalen Radiotherapie oder äußerst selten in einer palliativen Resektion bestehen. Systemtherapien werden zumeist als Zwei- oder Dreifachtherapien verabreicht – mit dem Ziel der Prognoseverbesserung sowie eventueller Verbesserung von Symptomen.

Diskussion

Die Wahl der Therapie richtet sich nach den Beschwerden, der Tumorsituation, dem Allgemeinzustand und den Wünschen des Patienten.

Schlussfolgerung

Neben allgemeinen Palliativ- und Supportivmaßnahmen profitieren Patienten mit primär inoperablem bzw. metastasiertem Ösophaguskarzinom von einem individuell erstellten, multimodalen Therapiekonzept.

Abstract

Background

The prognosis for patients with advanced esophageal cancer is poor and palliative therapy for these patients necessitates a broad spectrum of different measures to relieve symptoms. However, the increasing knowledge of tumor biology of adenocarcinoma and squamous cell cancer of the esophagus may facilitate improved treatment options.

Results

Local treatment modalities include endoscopic stenting and hemostasis, radiotherapy and very rarely palliative resection. Systemic chemotherapy usually combines two or three cytotoxic drugs with the aim to improve prognosis and possibly to alleviate symptoms. In patients with unresectable or metastatic esophageal cancer, multimodal treatment (i.e. radiotherapy, chemotherapy, combined radiochemotherapy, palliative and supportive care) should be individualized and conducted within all subspecialties (tumor board conferences).

Discussion

The choice of the procedure is based on the symptoms, the tumor situation, the patients’ general status and patient preferences.

Conclusion

If possible an individual, interdisciplinary treatment concept should be designed for each patient and modified according to the course of the disease.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. S. Lorenzen weist auf folgende Beziehungen hin: Sie arbeitet sporadisch als Beraterin für Eli Lilly, Roche und Sanofi-Aventis. Sie erhielt Vortragshonorare von Roche und Eli Lilly. Der Beitrag enthält keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. III. Medizinische Klinik, Abteilung für Hämatologie und Onkologie, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, München, Deutschland

    S. Lorenzen

  2. II. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, München, Deutschland

    J.T. Siveke

  3. Interdisziplinäres Zentrum Palliativmedizin, Klinik und Poliklinik für Strahlentherapie , Universitätsklinikum Würzburg, Würzburg, Deutschland

    B. van Oorschot

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  1. S. Lorenzen
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  2. J.T. Siveke
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  3. B. van Oorschot
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Correspondence to S. Lorenzen.

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Lorenzen, S., Siveke, J. & van Oorschot, B. Palliative und supportive Therapie des Ösophaguskarzinoms. Onkologe 20, 1217–1221 (2014). https://doi.org/10.1007/s00761-014-2761-8

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  • DOI: https://doi.org/10.1007/s00761-014-2761-8

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