Der Onkologe

, Volume 12, Issue 6, pp 571–582 | Cite as

Neoadjuvante Chemotherapie von kolorektalen Lebermetastasen

CME Weiterbildung • Zertifizierte Fortbildung
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Zusammenfassung

Lebermetastasen können prinzipiell in kurativer Intention reseziert werden. Ist eine Resektion initial nicht möglich, kann sie bei einem Teil der Patienten nach einer neoadjuvanten Chemotherapie erfolgen. Das 5-Jahres-Überleben nach dieser Behandlung beträgt 33%. Da eine Tumorverkleinerung Bedingung für eine mögliche Resektion ist und die Resektionshäufigkeit mit der Ansprechrate korreliert, sollte ein Chemotherapieregime mit einer möglichst hohen Ansprechrate gewählt werden. Damit unterscheidet sich diese Behandlung von der palliativen Therapie des metastasierten kolorektalen Karzinoms. Sie erfordert eine intensive interdisziplinäre Zusammenarbeit. Hohe Ansprechraten werden durch die Kombination eines Antikörpers mit Irinotecan oder Oxaliplatin plus 5-FU-Infusion erreicht. Experimentell werden intensivere Kombinationsprotokolle untersucht. Mit Standardchemotherapien wie FOLFOX oder FOLFIRI wurden im Rahmen randomisierter Studien sekundäre Resektionsraten von 10% aller Patienten mit einem kolorektalen Karzinom erzielt; in den Studien zur neoadjuvanten Therapie lag dieser Wert bei etwa 30%.

Schlüsselwörter

Lebermetastasen Resektion Chemotherapieregime FOLFOX FOLFIRI 

Neoadjuvant chemotherapy for colorectal liver metastases

Abstract

Liver metastases can be resected with curative intention. If a resection of the metastases is not initially possible, it may be performed in some patients following neoadjuvant chemotherapy, resulting in a 5-year survival rate of 33%. Because tumor shrinkage is required for resection, and due to the correlation between resection rate and tumor response rate, a first line therapy with high response rates should be offered to patients. With this aim, the therapy is different from palliative therapy for metastatic colorectal cancer. It requires good interdisciplinary cooperation. High response rates may be achieved with a combination of antibodies and irinotecan or oxaliplatin containing infusional 5-FU combinations. Experimental approaches with more intensive regimens are under investigation. With standard chemotherapies such as FOLFOX or FOLFIRI, studies have shown that 10% of patients with metastatic colorectal cancer are secondarily resected; in studies with a neoadjuvant focus, a resection rate of 30% was observed.

Keywords

Liver metastases Resection Chemotherapy regime FOLFOX FOLFIRI 
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Notes

Interessenkonflikt

Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

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Copyright information

© Springer Medizin Verlag 2006

Authors and Affiliations

  1. 1.Medizinische Klinik IUniversitätsklinikum „Carl Gustav Carus“Dresden

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