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Peritonealkarzinose des Magenkarzinoms

Therapeutische Möglichkeiten bei Peritonealkarzinose des Magenkarzinoms

Peritoneal carcinomatosis of gastric cancer

Treatment options for peritoneal carcinomatosis of gastric cancer

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Zusammenfassung

Hintergrund

Das Magenkarzinom zählt zu den aggressivsten bösartigen Erkrankungen des Gastrointestinaltraktes mit einer hohen Metastasierungsrate. Die peritoneale Metastasierung tritt bei insgesamt bis zu 60 % aller PatientInnen auf und synchron bei bis zu 30 % bei lokal fortgeschrittenen Magenkarzinomen. Die zytoreduktive Chirurgie (CRS) und hypertherme intraperitoneale Chemotherapie (HIPEC) bei selektiven PatientInnen gelten seit mehreren Jahren als neues Behandlungsverfahren, da durch die HIPEC eine zusätzliche Applikation angeboten wird.

Fragestellung

Im Rahmen des Beitrags soll eine übersichtliche Darstellung zu den verschiedenen Therapieoptionen in Abhängigkeit der Ausdehnung der Peritonealkarzinose bei einem Magenkarzinom gegeben werden.

Methoden

Es erfolgten eine Literaturrecherche und Darstellung der aktuellen Literatur zur Behandlung des peritoneal metastasierten Magenkarzinoms. Unterschieden wurde zwischen der limitierten und ausgedehnten Peritonealkarzinose mit jeweiliger therapeutischer Strategie.

Ergebnisse

Prinzipiell behält die individualisierte Systemtherapie einen hohen Stellenwert bei der Behandlung des peritoneal metastasierten Magenkarzinoms. In ausgewählten Fällen und bei limitierter Peritonealkarzinose können bei PatientInnen eine CRS und eine HIPEC erfolgen, und hierdurch kann das Überleben verbessert werden. Bei ausgedehnter Peritonealkarzinose ist die zytoreduktive Chirurgie jedoch weiterhin kontraindiziert, in Ausnahmefällen kann eine PIPAC („pressurized intraperitoneal aerosol chemotherapy“) erfolgen.

Schlussfolgerung

CRS und HIPEC können bei selektiven PatientInnen eine Verbesserung in Bezug auf das Gesamt- und erkrankungsfreie Überleben bewirken. Bei einer ausgedehnten Peritonealkarzinose steht weiterhin die individualisierte Chemotherapie im Vordergrund.

Abstract

Background

Gastric cancer is one of the most aggressive malignant diseases of the gastrointestinal tract with a high rate of metastasis. Peritoneal metastasis occurs in up to 60% of all patients and synchronously in up to 30% in locally advanced gastric cancer. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been an established treatment option in selected patients for several years, as the HIPEC serves as an alternative administration route.

Objective

This article presents a schematic display of the various treatment options depending on the extent of peritoneal carcinomatosis in a gastric cancer.

Methods

A literature search and analysis of the current literature on the treatment of gastric cancer with peritoneal metastases were carried out. A differentiation was made between limited and extensive peritoneal carcinomatosis together with the appropriate treatment strategy.

Results

Principally, individual systemic chemotherapy is the backbone of treatment of gastric cancer with peritoneal metastases. In selected patients and in cases of limited peritoneal carcinomatosis, CRS and HIPEC can be conducted and survival is improved; however, CRS is still contraindicated in cases of extensive peritoneal carcinomatosis and in exceptional cases pressurized intraperitoneal aerosol chemotherapy (PIPAC) can be carried out.

Conclusion

In selected patients CRS and HIPEC can lead to an improvement with respect to overall and disease-free survival. In cases of extensive peritoneal carcinomatosis, individualized chemotherapy remains the major treatment option.

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Authors and Affiliations

  1. Chirurgische Klinik, Campus Charité Mitte | Campus Virchow Klinikum, Charité – Universitätsmedizin, Augustenburger Platz 1, 13353, Berlin, Deutschland

    Eva M. Dobrindt, Safak Gül-Klein, Miguel Enrique Alberto Vilchez, Felix Gronau &  Beate Rau MBA, FEBS (hon)

  2. Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Charité – Universitätsmedizin, 13353, Berlin, Deutschland

    Peter Thuss-Patience

Authors
  1. Eva M. Dobrindt
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  2. Safak Gül-Klein
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  3. Miguel Enrique Alberto Vilchez
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  4. Felix Gronau
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  5. Peter Thuss-Patience
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  6. Beate Rau MBA, FEBS (hon)
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Correspondence to Beate Rau MBA, FEBS (hon).

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Interessenkonflikt

E.M. Dobrindt, S. Gül-Klein, M.E. Alberto Vilchez, F. Gronau, P. Thuss-Patience und B. Rau geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Dobrindt, E.M., Gül-Klein, S., Alberto Vilchez, M.E. et al. Peritonealkarzinose des Magenkarzinoms. Chirurgie 93, 1133–1138 (2022). https://doi.org/10.1007/s00104-022-01699-4

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  • DOI: https://doi.org/10.1007/s00104-022-01699-4

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