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Multimodale palliative Behandlung des Pankreaskarzinoms

Multimodal palliative treatment of pancreatic cancer

  • Leitthema
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Das Pankreaskarzinom ist bei stetig steigender Inzidenz die vierthäufigste krebsbedingte Todesursache in der westlichen Welt. In Deutschland erkranken jährlich mehr als 4900 Männer und 5500 Frauen, was etwa 3% aller Krebsneuerkrankungen ausmacht. Aufgrund der unspezifischen Symptomatik wird das Pankreaskarzinom in etwa 80–90% der Fälle erst im fortgeschrittenen oder metastasierten Stadium diagnostiziert. Eine potenziell kurative Resektion kommt deshalb nur bei ca. 20% der Patienten infrage; die 5-Jahres-Überlebensrate nach einer kompletten Resektion liegt bei 20%. Beim fortgeschrittenen bzw. metastasierten Pankreaskarzinom gilt eine palliative systemische Chemotherapie inzwischen als Standard. Der Wert der Radio-Chemo-Therapie wird aktuell in mehreren laufenden Phase-III-Studien evaluiert. Weitere wichtige Therapiesäulen in der palliativen Situation sind die adäquate Schmerztherapie gemäß WHO-Stufenplan sowie eine frühzeitig begonnene unterstützende Ernährungstherapie.

Abstract

Exhibiting a rising incidence, pancreatic carcinoma is the fourth most common cause of death in the Western world. In Germany more than 4900 men and 5500 women suffer from pancreatic carcinoma every year, about 3% of all newly diagnosed cases of cancer. Because of the non specific symptoms, pancreatic carcinoma is detected in 80–90% of cases in an advanced or metastatic stage. In only 20% of all patients is an operation possible and after complete resection the 5-year survival rate is 20%. Palliative chemotherapy is supposed to be the standard treatment in advanced and metastatic pancreatic carcinoma. The value of radiochemotherapy is currently being evaluated in several phase III studies. In the palliative situation sufficient analgesic treatment is necessary as well as early initiation of nutritional support.

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Literatur

  1. Bergqvist D, Agnelli G, Cohen AT, Eldor A, Nilsson PE, Le Moigne-Amrani A, Dietrich-Neto F (2002) Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. N Engl J Med 346: 975–980

    Article  CAS  PubMed  Google Scholar 

  2. Berlin JD, Catalano P, Thomas JP, Kugler JW, Haller DG, Benson AB 3rd (2002) Phase III study of gemcitabine in combination with fluorouracil versus gemcitabine alone in patients with advanced pancreatic carcinoma: Eastern Cooperative Oncology Group Trial E2297. J Clin Oncol 20: 3270–3275

    Article  CAS  PubMed  Google Scholar 

  3. Bramhall SR, Rosemurgy A, Brown PD, Bowry C, Buckels JA (2001) Marimastat as first-line therapy for patients with unresectable pancreatic cancer: a randomized trial. J Clin Oncol 19: 3447–3455

    CAS  PubMed  Google Scholar 

  4. Bramhall SR, Schulz J, Nemunaitis J, Brown PD, Baillet M, Buckels JA (2002) A double-blind placebo-controlled, randomised study comparing gemcitabine and marimastat with gemcitabine and placebo as first line therapy in patients with advanced pancreatic cancer. Br J Cancer 87: 161–167

    Article  CAS  PubMed  Google Scholar 

  5. Burris HA 3rd, Moore MJ, Andersen J et al. (1997) Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol 15: 2403–2413

    CAS  PubMed  Google Scholar 

  6. Cheverton P, Friess H, Andras C et al. (2004) Phase II results of exatecan (DX-8951f) versus gemcitabine (Gem) in chemotherapy-naive patients with advanced pancreatic cancer (APC). Proc Am Soc Clin Oncol 23 [Suppl]: 15 (Abstr 4005)

    Google Scholar 

  7. Crane CH, Janjan NA, Evans DB et al. (2001) Toxicity and efficacy of concurrent gemcitabine and radiotherapy for locally advanced pancreatic cancer. Int J Pancreatol 29: 9–18

    CAS  PubMed  Google Scholar 

  8. Cullinan S, Moertel CG, Wieand HS et al. (1990) A phase III trial on the therapy of advanced pancreatic carcinoma. Evaluations of the Mallinson regimen and combined 5-fluorouracil, doxorubicin, and cisplatin. Cancer 65: 2207–2212

    CAS  PubMed  Google Scholar 

  9. Cutsem E van, Velde H van de, Karasek P et al. (2004) Phase III trial of gemcitabine plus tipifarnib compared with gemcitabine plus placebo in advanced pancreatic cancer. J Clin Oncol 22: 1430–1438

    Article  PubMed  Google Scholar 

  10. Ducreux M, Rougier P, Pignon JP et al. (2002) A randomised trial comparing 5-FU with 5-FU plus cisplatin in advanced pancreatic carcinoma. Ann Oncol 13: 1185–1191

    Article  CAS  PubMed  Google Scholar 

  11. El-Rayes BF, Zalupski MM, Shields AF et al. (2003) Phase II study of gemcitabine, cisplatin, and infusional fluorouracil in advanced pancreatic cancer. J Clin Oncol 21:2920–2925

    Article  CAS  PubMed  Google Scholar 

  12. Furuse J, Kinoshita T, Kawashima M et al. (2003) Intraoperative and conformal external-beam radiation therapy with protracted 5-fluorouracil infusion in patients with locally advanced pancreatic carcinoma. Cancer 97: 1346–1352

    Article  CAS  PubMed  Google Scholar 

  13. Geenen RC van, Keyzer-Dekker CM, Tienhoven G van, Obertop H, Gouma DJ (2002) Pain management of patients with unresectable peripancreatic carcinoma. World J Surg 26: 715–720

    Article  PubMed  Google Scholar 

  14. Gould MK, Dembitzer AD, Doyle RL, Hastie TJ, Garber AM (1999) Low-molecular-weight heparins compared with unfractionated heparin for treatment of acute deep venous thrombosis. A meta-analysis of randomized, controlled trials. Ann Intern Med 130: 800–809

    CAS  PubMed  Google Scholar 

  15. Heinemann V, Quietzsch D, Gieseler F et al. (2003) A phase III trial comparing gemcitabine plus cisplatin versus gemcitabine alone in advanced pancreatic carcinoma. Proc Am Soc Clin Oncol 22: 250 (Abstr 1003)

    Google Scholar 

  16. Icli F, Akbulut H, Utkan G et al. (2003) Low molecular weight heparin (LMWH) increases the efficacy of cisplatinum plus gemcitabine combination in advanced pancreatic cancer. Proc Am Soc Clin Oncol 22: 286 (Abstr 1149)

    Google Scholar 

  17. Kornek GV, Schratter-Sehn A, Marczell A et al. (2000) Treatment of unresectable, locally advanced pancreatic adenocarcinoma with combined radiochemotherapy with 5-fluorouracil, leucovorin and cisplatin. Br J Cancer 82: 98–103

    Article  CAS  PubMed  Google Scholar 

  18. Li CP, Chao Y, Chi KH et al. (2003) Concurrent chemoradiotherapy treatment of locally advanced pancreatic cancer: gemcitabine versus 5-fluorouracil, a randomized controlled study. Int J Radiat Oncol Biol Phys 57: 98–104

    Article  CAS  PubMed  Google Scholar 

  19. Lionetto R, Pugliese V, Bruzzi P, Rosso R (1995) No standard treatment is available for advanced pancreatic cancer. Eur J Cancer 31A: 882–887

    Article  CAS  PubMed  Google Scholar 

  20. Louvet C, Labianca R, Hammel P et al. (2004) GemOx (gemcitabine + oxaliplatin) versus Gem (gemcitabine) in non resectable pancreatic adenocarcinoma: final results of the GERCOR/GISCAD Intergroup Phase III. Proc Am Soc Clin Oncol 23 [Suppl]: 15 (Abstr 4008)

    Google Scholar 

  21. Merli G, Spiro TE, Olsson CG et al. (2001) Subcutaneous enoxaparin once or twice daily compared with intravenous unfractionated heparin for treatment of venous thromboembolic disease. Ann Intern Med 134: 191–202

    CAS  PubMed  Google Scholar 

  22. Moertel CG, Frytak S, Hahn RG et al. (1981) Therapy of locally unresectable pancreatic carcinoma: a randomized comparison of high dose (6000 rads) radiation alone, moderate dose radiation (4000 rads + 5-fluorouracil), and high dose radiation + 5-fluorouracil: the Gastrointestinal Tumor Study Group. Cancer 48: 1705–1710

    CAS  PubMed  Google Scholar 

  23. Mohiuddin M, Regine WF, Stevens J, Rosato F, Barbot D, Biermann W, Cantor R (1995) Combined intraoperative radiation and perioperative chemotherapy for unresectable cancers of the pancreas. J Clin Oncol 13: 2764–2768

    CAS  PubMed  Google Scholar 

  24. Moore MJ, Hamm J, Eisenberg P et al. (2000) A comparison between gemcitabine (GEM) and the matrix metalloproteinase (MMP) inhibitor BAY12–9566 (9566) in patients with advanced pancreatic cancer (APC). Proc Am Soc Clin Oncol 19 [Suppl]: 240a (Abstr 930)

    Google Scholar 

  25. O’Reilly EM, Abou-Alfa GK, Letourneau R et al. (2004) A randomized phase III trial of DX-8951f (exatecan mesylate; DX) and gemcitabine (GEM) vs. gemcitabine alone in advanced pancreatic cancer (APC). Proc Am Soc Clin Oncol 23 [Suppl]: 15 (Abstr 4006)

    Google Scholar 

  26. Oster MW, Gray R, Panasci L, Perry MC (1986) Chemotherapy for advanced pancreatic cancer. A comparison of 5-fluorouracil, adriamycin, and mitomycin (FAM) with 5-fluorouracil, streptozotocin, and mitomycin (FSM). Cancer 57: 29–33

    CAS  PubMed  Google Scholar 

  27. Pelzer U, Hempel C, Stieler J et al. (2002) Oxaliplatin (OXA) in combination with high dose 5-FU/Folic acid (FA) as salvage therapy in patients with Gemzar-refractory advanced pancreatic cancer. Proc Am Soc Clin Oncol 21 [Suppl]: 172 (Abstr 684)

    Google Scholar 

  28. Pilepich MV, Miller HH (1980) Preoperative irradiation in carcinoma of the pancreas. Cancer 46: 1945–1949

    CAS  PubMed  Google Scholar 

  29. Poen JC, Collins HL, Niederhuber JE et al. (1998) Chemo-radiotherapy for localized pancreatic cancer: increased dose intensity and reduced acute toxicity with concomitant radiotherapy and protracted venous infusion 5-fluorouracil. Int J Radiat Oncol Biol Phys 40: 93–99

    Article  CAS  PubMed  Google Scholar 

  30. Prott FJ, Schonekaes K, Preusser P et al. (1997) Combined modality treatment with accelerated radiotherapy and chemotherapy in patients with locally advanced inoperable carcinoma of the pancreas: results of a feasibility study. Br J Cancer 75: 597–601

    CAS  PubMed  Google Scholar 

  31. Rich T, Harris J, Abrams R et al. (2004) Phase II study of external irradiation and weekly paclitaxel for nonmetastatic, unresectable pancreatic cancer: RTOG-98-12. Am J Clin Oncol 27: 51–56

    Article  CAS  PubMed  Google Scholar 

  32. Richards D, Kindler H, Oettle H (2004) A randomized phase III study comparing gemcitabine + pemetrexed versus gemcitabine in patients with locally advanced and metastatic pancreas cancer. Proc Am Soc Clin Oncol 23 [Suppl]: 15 (Abstr 4007)

    Google Scholar 

  33. Rickles FR, Edwards RL (1983) Activation of blood coagulation in cancer: Trousseau’s syndrome revisited. Blood 62: 14–31

    CAS  PubMed  Google Scholar 

  34. Rocha Lima C, Rotche R, Jeffery M et al. (2003) A randomized phase III study comparing efficacy and safety of gemcitabine (GEM) and irinotecan (I), to GEM alone in patients (pts) with locally advanced or metastatic pancreatic cancer who have not received prior systemic therapy. Proc Am Soc Clin Oncol 22 [Suppl]: 251 (Abstr 1005)

    Google Scholar 

  35. Shen VS, Pollak EW (1980) Fatal pulmonary embolism in cancer patients: is heparin prophylaxis justified? South Med J 73: 841–843

    CAS  PubMed  Google Scholar 

  36. Shinchi H, Takao S, Noma H, Matsuo Y, Mataki Y, Mori S, Aikou T (2002) Length and quality of survival after external-beam radiotherapy with concurrent continuous 5-fluorouracil infusion for locally unresectable pancreatic cancer. Int J Radiat Oncol Biol Phys 53: 146–150

    Article  CAS  PubMed  Google Scholar 

  37. Sorensen HT, Mellemkjaer L, Olsen JH, Baron JA (2000) Prognosis of cancers associated with venous thromboembolism. N Engl J Med 343: 1846–1850

    Article  CAS  PubMed  Google Scholar 

  38. Wilkowski R, Thoma M, Heinemann V, Rau HG, Wagner A, Stoffregen C, Duhmke E (2003) Radiochemotherapy with gemcitabine and cisplatin in pancreatic cancer—feasible and effective. Strahlenther Onkol 179: 78–86

    Article  PubMed  Google Scholar 

  39. Willich N (1995) Intraoperative Strahlentherapie beim Pankreaskarzinom: palliative und kurative Therapieansätze. Chir Gastroenterol 11: 124

    Google Scholar 

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Authors and Affiliations

  1. Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Charité, Campus Virchow-Klinikum, Berlin

    H. Oettle & A. Hilbig

  2. Klinik für Strahlentherapie Charité, Campus Mitte, Berlin

    L. Moser & V. Budach

  3. Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 , Berlin

    H. Oettle

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  1. H. Oettle
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Correspondence to H. Oettle.

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Oettle, H., Moser, L., Hilbig, A. et al. Multimodale palliative Behandlung des Pankreaskarzinoms. Onkologe 10, 1310–1319 (2004). https://doi.org/10.1007/s00761-004-0799-8

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  • DOI: https://doi.org/10.1007/s00761-004-0799-8

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