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Neoadjuvante Chemotherapie oder primäre Chirurgie bei kolorektalen Lebermetastasen

Pro neoadjuvante Chemotherapie

Neoadjuvant chemotherapy or primary surgery for colorectal liver metastases

Pro adjuvant chemotherapy

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Zusammenfassung

Die medikamentöse Behandlung kolorektaler Lebermetastasen hat sich in den zurückliegenden zwei Jahrzehnten erheblich weiterentwickelt. Kombinationsregime zeigten eine höhere Effizienz und verbesserten das Überleben. Eine perioperative Therapie mit FOLFOX führte bei resektablen Metastasen zu einer Verbesserung des progressionsfreien Überlebens in einer prospektiv randomisierten, kontrollierten Studie. Die Sicherheit der perioperativen Chemotherapie war zufriedenstellend; nur wenige Patienten zeigten eine Progression. Generell sollte eine präoperative Therapie nicht länger als 3 bis 4 Monate dauern, um eine chemotherapieassoziierte Leberschädigung zu vermeiden. Bei Patienten mit grenzwertig resektablen kolorektalen Metastasen kann ein Ansprechen auf eine Chemotherapie die sekundäre Resektabilität herbeiführen. In dieser Situation sind Kombinationen aus zytotoxischen Medikamenten und monoklonalen Antikörpern angezeigt. Bevacizumab und, bei Vorliegen eines unmutierten RAS-Status, die gegen den „epidermal growth factor receptor“ (EGFR) gerichteten Antikörper Cetuximab oder Panitumumab können zum Erreichen einer höheren Ansprechrate und eines verbesserten Überlebens mit einer Chemotherapie kombiniert werden. Entscheidend ist, die Behandlung kolorektaler Lebermetatastasen in ihren Möglichkeiten und Zielsetzungen im multidisziplinären Kontext zu evaluieren.

Abstract

Medicinal treatment of colorectal cancer liver metastases has undergone significant developments in the past two decades. Cytotoxic treatment regimens have demonstrated greater efficacy and contributed to a significant improvement in survival. Perioperative therapy with FOLFOX has demonstrated progression-free survival benefits in resectable colorectal liver metastases in a prospective randomized controlled trial. The safety of perioperative chemotherapy was found to be acceptable and only a few patients showed initial progression. In general, preoperative chemotherapy should not extend beyond 3–4 months to avoid chemotherapy-associated liver damage. For patients with borderline resectable metastases, a response to chemotherapy can establish secondary resectability. Combinations of cytotoxic drugs are adequate in this situation. The addition of bevacizumab or anti-epidermal growth factor receptor (EGFR) antibodies for tumors without RAS mutations are reasonable choices for a better response and improved survival outcome. It is crucial that all treatment decisions for systemic colorectal liver metastases include correct definitions of treatment goals and endpoints and are derived based on appropriate multidisciplinary considerations.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. F. Lordick, M. Knödler, U. Hacker und M. Bartels geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Universitäres Krebszentrum (UCCL), Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland

    F. Lordick, M. Knödler & U. Hacker

  2. Klinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Leipzig, Deutschland

    M. Bartels

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  1. F. Lordick
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  2. M. Knödler
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  4. M. Bartels
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Correspondence to F. Lordick.

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Lordick, F., Knödler, M., Hacker, U. et al. Neoadjuvante Chemotherapie oder primäre Chirurgie bei kolorektalen Lebermetastasen. Chirurg 85, 11–16 (2014). https://doi.org/10.1007/s00104-013-2564-2

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  • DOI: https://doi.org/10.1007/s00104-013-2564-2

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