Zusammenfassung
Die chirurgische Behandlung des duktalen Pankreaskarzinoms durch alleinige operative Behandlung bleibt in der Mehrzahl der Fälle unbefriedigend. Nur eine Resektion lokal im Gesunden mit einem zirkumferentiellen Sicherheitsabstand von mindestens 1 mm eröffnet betroffenen Patienten überhaupt Heilungschancen, sofern zudem Fernmetastasen ausgeschlossen worden waren. Wahrscheinlich kommen deshalb weniger als 20 % aller Fälle derzeit für eine chirurgische Behandlung überhaupt in Betracht und höchstens 4 % können primär, ohne eine palliative Resektion zu riskieren, operiert werden. Unter mehreren Aspekten könnte eine neoadjuvante Radiochemotherapie die Prognose verbessern, wobei die Patientenselektion für dieses Verfahren und das strategische Vorgehen im interdisziplinären Kontext noch unklar ist. Die aktuelle CONKO-007-Studie könnte wesentlich zur Klärung der anstehenden Fragen beitragen.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Literatur
Barbier L, Turrini O, Gregoire E et al (2011) Pancreatic head resectable adenocarcinoma: preoperative chemoradiation improves local control but does not affect survival. HPB (Oxford) 13: 64–69
Brunner TB (2013) Neoadjuvant therapy for potentially resectable pancreatic cancer: an emerging paradigm? Curr Oncol Rep 15: 162–169
Brunner TB, Tinkl D, Grabenbauer GG et al (2006) Maintenance chemotherapy after chemoradiation improves survival of patients with locally advanced pancreatic carcinoma: a retrospective analysis of prospectively recruited patients. Strahlenther Onkol 182: 210–215
Callery MP, Chang KJ, Fishman EK et al (2009) Pretreatment assessment of resectable and borderline resectable pancreatic cancer: Expert consensus statement. Ann Surg Oncol 16: 1727–1733
Chatterjee D, Katz MH, Rashid A et al (2012) Perineural and intraneural invasion in posttherapy pancreaticoduodenectomy specimens predicts poor prognosis in patients with pancreatic ductal adenocarcinoma. Am J Surg Pathol 36: 409–417
Cheng TY, Sheth K, White RR et al (2006) Effect of neoadjuvant chemoradiation on operative mortality and morbidity for pancreaticoduodenectomy. Ann Surg Oncol 13: 66–74
Cunningham D, Atkin W, Lenz HJ et al (2010) Colorectal cancer. Lancet 375: 1030–1047
Esposito I, Kleeff J, Bergmann F et al (2008) Most pancreatic cancer resections are R1 resections. Ann Surg Oncol 15: 1651–1660
Gastrointestinal Tumor Study Group (1988) Treatment of locally unresectable carcinoma of the pancreas: comparison of combined-modality therapy (chemotherapy plus radiotherapy) to chemotherapy alone. J Natl Cancer Inst 80: 751–755
Glimelius B, Pahlman L, Cervantes A (2010) Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 21 (Suppl 5): v82–86
Heald RJ, Moran BJ, Ryall RD et al (1998) Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg 133: 894–899
Huguet F, Andre T, Hammel P et al (2007) Impact of chemoradiotherapy after disease control with chemotherapy in locally advanced pancreatic adenocarcinoma in GERCOR phase II and III studies. J Clin Oncol 25: 326–331
Katz MH, Pisters PW, Evans DB et al (2008) Borderline resectable pancreatic cancer: The importance of this emerging stage of disease. J Am Coll Surg 206: 833–846
Krishnan S, Rana V, Janjan NA et al (2007) Induction chemotherapy selects patients with locally advanced, unresectable pancreatic cancer for optimal benefit from consolidative chemoradiation therapy. Cancer 110: 47–55
Lu DS, Reber HA, Krasny RM et al (1997) Local staging of pancreatic cancer: criteria for unresectability of major vessels as revealed by pancreatic-phase, thin-section helical CT. Am J Roentgenol 168: 1439–1443
Moertel CG, Frytak S, Hahn RG et al (1981) Therapy of locally unresectable pancreatic carcinoma: a randomized comparison of high dose (6000 rads) radiation alone, moderate dose radiation (4000 rads + 5-fluorouracil), and high dose radiation + 5- fluorouracil: The Gastrointestinal Tumor Study Group. Cancer 48: 1705–1710
Mukherjee S, Hurt CN, Bridgewater J et al (2013) Gemcitabine-based or capecitabine-based chemoradiotherapy for locally advanced pancreatic cancer (SCALOP): a multicentre, randomised, phase 2 trial. Lancet Oncol 14(4): 317–326
Neoptolemos JP, Stocken DD, Friess H et al (2004) A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 350: 1200–1210
Oettle H, Post S, Neuhaus P et al (2007) Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA 297: 267–277
Quirke P, Durdey P, Dixon MF et al (1986) Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet 2: 996–999
Rodel C, Liersch T, Hermann RM et al (2007) Multicenter phase II trial of chemoradiation with oxaliplatin for rectal cancer. J Clin Oncol 25: 110–117
Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351: 1731–1740
Shinchi H, Takao S, Noma H et al (2002) Length and quality of survival after external-beam radiotherapy with concurrent continuous 5-fluorouracil infusion for locally unresectable pancreatic cancer. Int J Radiat Oncol Biol Phys 53: 146–150
Simons JP, Shah SA, Ng SC et al (2009) National complication rates after pancreatectomy: beyond mere mortality. J Gastrointest Surg 13: 1798–1805
Stefanidis D, Grove KD, Schwesinger WH et al (2006) The current role of staging laparoscopy for adenocarcinoma of the pancreas: a review. Ann Oncol 17: 189–199
Varadhachary GR, Tamm EP, Abbruzzese JL et al (2006) Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann Surg Oncol 13: 1035–1046
Witkowski ER, Smith JK, Tseng JF (2013) Outcomes following resection of pancreatic cancer. J Surg Oncol 107: 97–103
Zhang Y, Frampton AE, Cohen P et al (2012) Tumor infiltration in the medial resection margin predicts survival after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. J Gastrointest Surg 16: 1875–1882
Zhang Y, Frampton AE, Kyriakides C et al (2012) Loco-recurrence after resection for ductal adenocarcinoma of the pancreas: predictors and implications for adjuvant chemoradiotherapy. J Cancer Res Clin Oncol 138: 1063–1071
Zhu CP, Shi J, Chen YX et al (2011) Gemcitabine in the chemoradiotherapy for locally advanced pancreatic cancer: a meta-analysis. Radiother Oncol 99: 108–113
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Hohenberger, W., Brunner, T., Golcher, H. (2013). Ist Radiochemotherapie beim Pankreaskarzinom effektiv?. In: Beger, H., et al. Erkrankungen des Pankreas. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-37964-2_72
Download citation
DOI: https://doi.org/10.1007/978-3-642-37964-2_72
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-37963-5
Online ISBN: 978-3-642-37964-2
eBook Packages: Medicine (German Language)