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Strahlentherapie beim Analkanal- und Rektumkarzinom

Das squamöse Analkarzinom aus strahlentherapeutischer Sicht

Radiotherapy of anal and rectal cancer

Squamous cell anal carcinoma from a radiologic perspective

  • Leitthema
  • Published:
coloproctology Aims and scope

Zusammenfassung

Analkarzinome werden mit einer primären kurativen Radiochemotherapie behandelt. Standard ist die parallele Chemotherapie mit 5‑Fluorouracil (5-FU) und Mitomycin. Die Radiotherapie umfasst das inguinale und pelvine Lymphabflussgebiet und den Primärtumor. Die Akutreaktionen sind wegen der Behandlung der inguinalen Lymphknotenregion vergleichsweise stark mit einer guten Erholung im weiteren Verlauf. In der Nachsorge sollte in den ersten 6 Monaten nur bei einem progredienten Residuum eine histologische Sicherung erfolgen. Im Rezidivfall bleibt nur noch die chirurgische Therapieoption. Das Rektumkarzinom wird im Stadium II und III mit einer neoadjuvanten Radiochemotherapie behandelt. Standard ist die parallele Chemotherapie mit 5‑FU. Häufig wird Capecitabin als 5‑FU-Äquivalent eingesetzt. Die Hinzunahme von Oxaliplatin bringt keine Vorteile. Wahrscheinlich gleiche onkologische Ergebnisse erzielt die Kurzzeitradiotherapie mit 5‑mal 5 Gy. In beiden Fällen sollte jedoch immer 6 bis 8 Wochen bis zur Operation abgewartet werden. Im Rezidivfall ist eine erneute Bestrahlung möglich. Die Toxizität ist i. d. R. moderat. Intraoperative Radiotherapie und eine Bestrahlung mit Partikeln können im Rezidivfall ebenfalls erwogen werden.

Abstract

Anal canal cancer is treated with definitive chemoradiation. Standard treatment includes simultaneous chemotherapy with 5‑fluorouracil (5-FU) and mitomycin. Radiotherapy encompass the inguinal and pelvic lymph nodes as well as the primary tumor. Acute toxicity is comparatively severe due to the more spacious radiotherapy volume than in standard pelvic irradiation, but recovery is usually good. During the first 6 months after treatment, biopsy should only be performed when there is evidence of progression of residual tumor. If relapse occurs, surgery is the only curative treatment option in almost all cases. UICC stage II or III rectal cancer is treated with neoadjuvant radiochemotherapy. Standard treatment includes concomitant chemotherapy with 5‑FU. Capecitabine is a frequently used oral equivalent to 5‑FU. The addition of oxaliplatin does not improve outcome. It is very likely that standard radiotherapy has the same effect as short-course radiotherapy with 5 × 5 Gy. In both cases, surgery must be performed 6 to 8 weeks after radiotherapy. In case of local relapse, second pelvic radiotherapy is feasible with moderate toxicity. Intraoperative radiotherapy and particle radiotherapy are further options in selected cases of tumor recurrence.

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  1. Abteilung für Radioonkologie und Strahlentherapie, Charité, Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Deutschland

    A. Madlung

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Für diesen Beitrag wurden vom Autor keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Madlung, A. Strahlentherapie beim Analkanal- und Rektumkarzinom. coloproctology 41, 255–261 (2019). https://doi.org/10.1007/s00053-019-0378-5

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