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Das pT4-Rektumkarzinom

The pT4 rectal cancer

  • Main Topics: pT4-Cancer Of The Gastrointestinal Tract — The Importance Of Multimodal Therapeutical Concepts
  • Published:
Acta Chirurgica Austriaca Aims and scope Submit manuscript

Zusammenfassung

Grundlagen: Beim in die Umgebung infiltrierenden Rektumkarzinom (uT4) sind nicht nur die Resektabilität eingeschränkt, sondern auch die Überlebensdaten inklusive der lokalen Rezidivrate schlecht. Aufgrund der Datenlage wurden neue Therapiekonzepte entwickelt, wobei gerade präoperative Konzepte hinsichtlich Resektabilität und Lokalrezidivrate überzeugend gute Resultate zeigten.

Methodik: Verschiedene Therapieregime in der Behandlung des lokal weit fortgeschrittenen Rektumkarzinoms mit Infiltration in Nachbarorgane (uT4) werden dargestellt und diskutiert. Die therapieinduzierten Nebenwirkungen werden in Abhängigkeit der Therapiestrategien kritisch aufgezeigt.

Ergebnisse: Prinzipiell ist die Nebenwirkungsrate im präoperativen gegenüber dem postoperativen Behandlungskonzept niedriger und ist daher vorzuziehen. Beim uT4-Rektumkarzinom erreicht man durch eine präoperative Therapie ohne wesentliche Erhöhung der postoperativen Morbidität nicht nur die Verbesserung der Resektabilität, sondern damit konsequenterweise auch eine Verbesserung der Überlebensraten.

Schlußfolgerungen: Eine präoperative kombinierte Behandlung mit einer Radio-Chemotherapie beim uT4-Rektumkarzinom erzielt eine Tumorrückbildung, eine verbesserte lokale Kontrolle und eine Überlebensverlängerung und ist damit empfehlenswert.

Summary

Background: The rate of resectability and local recurrence in locally advanced rectal cancer infiltrating neighbouring organs (uT4) has led to reevaluation of treatment concepts. Preoperative combined radio-chemotherapy demonstrated favourable results in both: resectability and local recurrence.

Methods: Different therapeutical strategies in the treatment of locally advanced primary rectal cancer infiltrating neighbouring organs (uT4) are demonstrated and discussed. Therapeutic induced toxicity depending on treatment regimen is critically elucidated.

Results: Therapeutic induced toxicity in the preoperative setting is lower than in the postoperative treatment concept. Toxicity depends on the kind of chemotherapy and the application form (bolus, continuous). Preoperative treatment regimens increase the resectability of T4-tumors and in consequence improve the survival data without increasing postoperative complications.

Conclusions: Preoperative combined treatment of locally advanced uT4 rectal cancer revealed encouraging downstaging, local control, and survival rates.

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Authors and Affiliations

  1. Klinik für Chirurgie und Chirurgische Onkologie, Universitätsklinikum Charité, Robert-Rössle-Klinik, Lindenberger Weg 80, D-13122, Berlin, Deutschland

    Beate Rau, M. Hünerbein, W. Tilly, H. Riess, P. Wust & P. M. Schlag

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  1. Beate Rau
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  2. M. Hünerbein
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  3. W. Tilly
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  4. H. Riess
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  5. P. Wust
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  6. P. M. Schlag
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Correspondence to Beate Rau.

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Rau, B., Hünerbein, M., Tilly, W. et al. Das pT4-Rektumkarzinom. Acta Chir Austriaca 31, 13–16 (1999). https://doi.org/10.1007/BF02619870

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  • DOI: https://doi.org/10.1007/BF02619870

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