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Der Onkologe

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Rolle der Radiotherapie beim Pankreaskarzinom

  • Nicole L. GoerigEmail author
  • Rainer Fietkau
Leitthema
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Zusammenfassung

Hintergrund

Das Pankreaskarzinom ist ein Tumor mit einer jährlichen weltweiten Inzidenz von ca. 340.000 Neuerkrankungen. Die Prognose ist mit Fünfjahresüberleben von 2–6 % extrem ungünstig. Bei Diagnosestellung ist die Resektion als die einzig kurative Option bei nur etwa 30 % der Patienten primär möglich. Sowohl zur Herstellung von Operabilität bei zunächst nicht resektablem Befund und zur Verbesserung des Operationsergebnisses als auch zur Erhöhung der Lebenserwartung definitiv inoperabler Patienten auch in fortgeschrittenen Stadien kann die Radio(chemo)therapie angewandt werden.

Ziel

Diese Arbeit gibt eine aktuelle Übersicht über die Rolle der Radiotherapie bei der Behandlung des Pankreaskarzinoms.

Material und Methoden

Es wurde eine Literaturanalyse von grundlegenden Arbeiten, Original- und Übersichtsarbeiten und aktuellen Studien durchgeführt.

Ergebnisse

Daten aus prospektiven und retrospektiven Studien zeigen, dass die neoadjuvante Radiochemotherapie die Zahl der operablen Patienten erhöhen und ihr Überleben verbessern kann. Vergleichbare Hinweise gibt es in der adjuvanten Radiochemotherapie von operierten Patienten mit zusätzlichen Risikofaktoren (R1, N +). Bei definitiver Inoperabilität und in der Rezidivtherapie kann die Radiochemotherapie ebenfalls einen positiven Beitrag zur lokalen Tumorkontrolle und Verbesserung der Therapiefreiheit leisten, evtl. auch zur Prognose. In der palliativen Situation kann die Bestrahlung zur lokalen Schmerzbehandlung eingesetzt werden.

Diskussion

Die Rolle der Radiotherapie im Rahmen multimodaler Therapiekonzepte wird derzeit kritisch diskutiert. Eine Reihe von retrospektiven und prospektiven Studien geben jedoch deutliche Hinweise für einen zusätzlichen Nutzen der Radiotherapie zur Operation und Chemotherapie. Dies muss in prospektiven Studien, bei denen moderne gewebeschonende Bestrahlungstechniken wie Stereotaxie und intensitätsmodulierte Radiotherapie zum Einsatz kommen, jedoch noch weiter abgeklärt werden.

Schlüsselwörter

Rezidivtherapie Radiochemotherapie Inoperabilität Neoadjuvant Adjuvant 

Role of radiotherapy in pancreatic cancer

Abstract

Background

Pancreatic cancer is a tumor with a worldwide incidence of approximately 340,000 newly diagnosed patients per year. With a 5-year overall survival of 2–6% the prognosis is very poor. At the time of diagnosis, resection is the only curative option primarily possible for approximately 30% of the patients. Chemoradiotherapy is a treatment option for achieving resectability of primarily unresectable tumors, improving the results of surgery and also for increasing survival of definitively inoperable patients with advanced states of the disease.

Objective

This article gives a current overview on the role of radiotherapy for treatment of pancreatic cancer.

Material and methods

Literature analysis of fundamental studies, original and review articles and of current trials.

Results

Data from prospective and retrospective analyses show that neoadjuvant chemoradiotherapy of pancreatic cancer increases the number of resectable patients and improves the overall survival. There are comparable data for adjuvant chemoradiotherapy of resected patients with additional risk factors (R1, N +). In cases where resection is definitively impossible, chemoradiotherapy also contributes to local tumor control and improving therapy-free intervals, potentially even to the prognosis. In the palliative setting, irradiation can be used for local pain management.

Discussion

The role of radiotherapy as part of multimodal treatment concepts for pancreatic cancer is currently under discussion; however, there are a number of retrospective and prospective studies clearly suggesting the benefits of radiotherapy in addition to surgery and chemotherapy. Prospective studies are necessary for further verification using modern techniques for radiotherapy, such as stereotactic and intensity-modulated radiotherapy. The use of older studies, with inadequate irradiation techniques and obsolete doses from today’s point of view, for evaluating the effects of radiotherapy is not acceptable.

Keywords

Relapse therapy Chemoradiotherapy Inoperability Neoadjuvant Adjuvant 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

N.L. Goerig und R. Fietkau geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Klinik für Strahlentherapie, Universitätsklinikum ErlangenFriedrich-Alexander-Universität Erlangen-NürnbergErlangenDeutschland

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