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Das Analkarzinom — Entwicklung und Wirksamkeit der Strahlentherapie

Anal carcinoma — Development and efficiency of radiotherapy

  • Themenschwerpunkt: „Analkarzinom“
  • Published:
Acta Chirurgica Austriaca Aims and scope Submit manuscript

Zusammenfassung

Grundlagen: Das Analkarzinom kann in 80% der Fälle konservativ behandelt werden.

Methodik: Beim Analkanalkarzinom wird die Bestrahlung des Perineums und der dorsalen Hälfte des kleinen Beckens (Minimaldosis 35 Gy in 19 Tagen) vorzugsweise assoziiert mit einer kurzen simultanen Chemotherapie (5-Fluorouracil [5-FU], Mitomycin C [MTC]) und mit einer Curie-Therapie mit Iridium 192 (10 bis 15 Gy) 2 Monate später. Die prinzipielle Bestrahlung der Leistenregionen sollte Fällen mit hohem Risiko vorbehalten sein (T3-Tumoren bzw. Infiltration der Linea anocutanea). Das von der Haut ausgehende Analrandkarzinom, ist sehr selten. Für Tumoren T1 und T2 muß die Lokalexzision mit einer externen Strahlentherapie (42 Gy in 17 Tagen) kombiniert werden. Die T3-Karzinome (über 5 cm) sollten primär strahlentherapeutisch behandelt werden, während die organerhaltende Chirurgie der Mehrzahl der strahlentherapeutischen Versager vorbehalten bleibt. Die Inguinalregionen sollten prinzipiell systematisch bestrahlt werden.

Ergebnisse: Die Statistik des Centre Léon Bérard zeigt anhand von 264 Fällen die länger als 3 Jahre beobachtet wurden, daß die lokale Heilung über 75% und die Sphinktererhaltung über 85% liegt.

Schlußfolgerungen: Der Stellenwert der Chirurgie beschränkt sich auf 3 Bereiche: 1. Am Anfang: inguinale Lymphknotenexcision, Kolostomie in Fällen von fortgeschrittenen Analstenosen; 2. Im zweiten Monat in Fällen, in denen eine Sphinktererhaltung nicht gerechtfertigt werden kann; 3. Später in Fällen von Rezidiv oder Komplikationen der Strahlentherapie.

Summary

Background: Anal canal cancer can be treated conservatively in 80% of the cases.

Methods: Irradiation of perineum and posterior half of the pelvic cavity (minimal dosage: 35 Gy in 19 days) is preferably combined with a brief simultaneous chemotherapy (5-Fluorouracil [5-FU], Mitomycin C [MTC]) and with seeds of iridium-192 (10 to 15 Gy) 2 months later. Inguinal irradiation as a rule should be reserved for high risk cases (T3 tumours or infiltration of the anocutaneous line). Cancer of the anal margin originating from the perianal skin is extremely rare. For T1- and T2 tumours local excision has to be combined with external radiotherapy (42 Gy within 17 days). Carcinomas of stage T3 (larger than 5 cm) should bei submitted to primary radiotherapy, whereas organsaving surgery can be reserved for the majority of the cases not cured by radiotherapy. As a rule irradiation of the groins is to be done systematically.

Results: On grounds of 264 cases with an observation period longer than 3 years the statistic of Centre Léon Bérard demonstrates rates of local cure and of sphincter preservation exceeding 75% and 85% respectively.

Conclusions: Surgery is recurred to in three instances: 1) initially: biopsy of inguinal lymph nodes, colostomy in cases of severe anal stenosis; 2) during the second month, when sphincter preservation appears unreasonable; 3) later in cases of failure or of complications following radiotherapy.

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Papillon, J. Das Analkarzinom — Entwicklung und Wirksamkeit der Strahlentherapie. Acta Chir Austriaca 26, 373–378 (1994). https://doi.org/10.1007/BF02620040

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