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Regression von Ösophaguskarzinomen nach neoadjuvanter Radiochemotherapie

Kriterien der histopathologischen Evaluation

Regression of oesophageal carcinomas after neoadjuvant radiochemotherapy: criteria of the histopathological evaluation

  • Schwerpunkt: Tumorregression—Originalarbeit
  • Published:
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Zusammenfassung

Da lokal fortgeschrittene Ösophaguskarzinome nach alleiniger chirurgischer Resektion eine insgesamt schlechte Prognose aufweisen, wurden verschiedene neoadjuvante Therapiestrategien entwickelt. Der Behandlungserfolg ist mit dem Ausmaß der Tumorregression assoziiert. Die vorliegende Studie umfasst 67 Patienten mit Ösophaguskarzinomen (cT2–cT4, cNx, cM0), die mit einer Cisplatin- und 5-Fluorouracil-haltigen simultanen Radiochemotherapie behandelt wurden. In 43 Fällen lagen Plattenepithel-, in 24 Fällen Adenokarzinome vor. Nach Abschluss der Therapie erfolgte die chirurgische Resektion und pathologische Untersuchung der Operationspräparate. Das Ausmaß der Tumorregression wurde histologisch semiquantitativ ausgewertet, therapieinduzierte Veränderungen morphologisch evaluiert. Dabei ergab sich eine signifikant bessere Prognose für Patienten bei einer Regression der Karzinome um 90% oder mehr. Zudem korrelierten die Ausprägung der resorptiv-histiozytären Reaktion, der riesenzelligen Fremdkörperreaktion und der lymphozytären Infiltrate mit dem Regressionsgrad.

Diese Ergebnisse belegen die große Bedeutung einer exakten pathologischen und histomorphologischen Aufarbeitung für die Abschätzung des Therapieansprechens und der Überlebenswahrscheinlichkeit nach neoadjuvanter Radiochemotherapie von Ösophaguskarzinomen.

Abstract

Following surgical resection locally advanced oesophageal carcinomas exhibit a bad prognosis and therefore neoadjuvant therapeutic strategies were developed. Because success of therapy is associated with the extent of tumor regression in this context, the introduction of objective histopathological criteria seems to be very important. This study included 67 patients with oesophageal carcinomas (cT2–cT4 cNx cM0) that were treated with a cisplatin- and 5-fluorouracil-containing simultaneous radiochemotherapy. In 43 patients squamous cell, in 24 cases adenocarcinomas were diagnosed. After completion of therapy, a surgical resection and a histopathological examination of the tissue specimens were performed. The extent of tumor regression was histologically evaluated and therapy-induced alterations were graded semiquantitatively. Thereby, a significantly favorable prognosis was observed in the group of patients that showed a regression of carcinomas of 90% or more. Additionally, the extent of a resorptive-histiocytic reaction, giant cells and lymphocytic infiltrates correlated with the grade of regression.

These results underline the importance of an exact examination and histomorphological evaluation of the response for the assessment of survival probability after neoadjuvant radiochemotherapy of oesophageal carcinomas.

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Authors and Affiliations

  1. Institut für Pathologie, Universität zu Köln

    S. Lang, T. K. Zirbes, J. Thiele & H. P. Dienes

  2. Klinik für Viszeral- und Gefäßchirurgie, Universität zu Köln

    S. P. Mönig, W. Schröder, R. Metzger, A. H. Hölscher & P. M. Schneider

  3. Klinik und Poliklinik für Strahlentherapie, Universität zu Köln

    R. P. Müller

  4. Institut für Pathologie, Universität zu Köln, Joseph-Stelzmann-Straße 9, 50931, Köln

    S. E. Baldus

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  1. S. E. Baldus
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  10. A. H. Hölscher
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  11. P. M. Schneider
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Correspondence to S. E. Baldus.

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Baldus, S.E., Mönig, S.P., Schröder, W. et al. Regression von Ösophaguskarzinomen nach neoadjuvanter Radiochemotherapie. Pathologe 25, 421–427 (2004). https://doi.org/10.1007/s00292-004-0697-2

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  • DOI: https://doi.org/10.1007/s00292-004-0697-2

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