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Therapie des Pankreasadenokarzinoms

Therapy of pancreatic adenocarcinoma

  • Übersicht
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Zusammenfassung

□ Hintergrund

Trotz erheblicher Fortschritte im Bereich der Epidemiologie, Molekulargenetik und Diagnostik ist das Adenokarzinom des Pankreas unverändert durch eine extrem schlechte Prognose gekennzeichnet. In der Häufigkeit tumorbedingter Todesfälle liegt es an fünfter Stelle Die vorliegende Arbeit gibt einen kritischen Überblick über die umfangreiche Datenlage und analysiert Therapieempfehlungen, die auf gesicherten Erkenntnissen beruhen.

□ Chirurgische Therapie

Bei einer Minderheit von Patienten wird ein lokal begrenztes Krankheitsstadium diagnostiziert. Hier ist eine chirurgische Resektion unter kurativer Zielsetzung möglich und aufgrund der verbesserten Operationstechnik in erfahrenen Zentren gerechtfertigt.

□ Radio-und Chemotherapie

Möglicherweise führt eine adjuvante Radiochemotherapie zu einer Überlebensverbesserung. Eine kombinierte Radiochemotherapie kann ferner bei irresektabler, lokal fortgeschrittener Erkrankung indiziert sein. Der systemischen Chemotherapie kommt in fortgeschrittenem Krankheitsstadium eine rein palliative Rolle zu. Kein Behandlungsprotokoll hat bislang reproduzierbar eine eindeutige Lebensverlängerung demonstrieren können. Möglicherweise profitiert jedoch ein Teil der Patienten klinisch von einer Chemotherapie. Grundpfeiler in jedem Stadium stellt eine an Symptomen orientierte supportive Behandlung dar.

□ Sclußfolgerung

Angesichts der aktuellen Datenlage ist die Entwicklung innovativer therapeutischer Strategien von herausragender Bedeutung.

Abstract

□ Background

Despite significant advances in the areas of epidemiology, risk factors, molecular genetics and diagnosis pancreatic carcinoma is characterized by a dismal prognosis and ranks 5th among malignancy-associated deaths. This article attempts to critically review the current literature and analyze therapeutic recommendations based on published evidence. Therapeutic options are based on the stage of the disease.

□ Surgical Treatment

Surgical resection with curative intention is feasible only in a minority of patients presenting with locally confined tumor disease.

□ Radio- and Chemotherapy

Adjuvant combined radiochemotherapy might potentially improve survival and can also be considered in unresectable, locally advanced disease. The role of chemotherapy in advanced disease is exclusively palliative. Up to now, no chemotherapeutic regimen has demonstrated convincing impact on survival. Newer substances, such as gemcitabine, appear to be of some value in respect to quality of life. Best supportive care oriented at clinical symptoms remains a cornerstone in the therapeutic concept of patients with pancreatic carcinoma.

□ Conclusion

Development of innovative therapeutic strategies is therefore mandatory.

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  1. Medizinische Klinik mit Schwerpunkt Hepatologie und Gastroenterologie Universitätsklinikum Charité, Medizinische Fakultät der Humboldt-Universität zu Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, D-13353, Berlin, Deutschland

    Stefan Rosewicz

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  1. Michael Böhmig
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Böhmig, M., Wiedenmann, B. & Rosewicz, S. Therapie des Pankreasadenokarzinoms. Med Klin 94, 614–625 (1999). https://doi.org/10.1007/BF03045002

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