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Neoadjuvante und perioperative Therapie des Magenkarzinoms

Neoadjuvant and perioperative therapy for gastric carcinomas

  • Leitthema
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

In den letzten 20 Jahren sind in der Therapie von Adenokarzinomen des Magens und gastroösophagealen Übergangs deutliche Fortschritte gemacht worden. Dies gilt sowohl für die palliative Chemotherapie als auch für perioperative Therapien mit kurativem Behandlungsansatz. In randomisierten Studien konnte gezeigt werden, dass eine prä- und postoperative Chemotherapie im Vergleich zu alleiniger Chirurgie das krankheitsfreie Überleben und das Gesamtüberleben nach 5 Jahren signifikant um ca. 10–14% verbessert und zu keiner Erhöhung der postoperativen Morbidität und Letalität führt. Aufgrund dieser Ergebnisse wird jetzt die perioperative Chemotherapie bei Patienten mit einem lokal begrenzten und endosonographisch (EUS) als uT2–uT4 definierten Tumor als Therapie der Wahl angesehen. Die Rolle der präoperativen Chemostrahlentherapie ist noch nicht definitiv geklärt. Bisherige Studienergebnisse weisen daraufhin, dass diese Therapiemodalität sehr wirksam zu sein scheint. Dies gilt insbesondere für Adenokarzinome des gastroösophagealen Übergangs und des distalen Ösophagus. Eine postoperative (adjuvante) Chemotherapie kann derzeit nach R0-Resektion nicht empfohlen werden. In westlichen Studien wurde bisher kein relevanter Benefit für diese Therapiestrategie nachgewiesen. Die postoperative Chemostrahlentherapie ist nicht generell zu empfehlen. Sie stellt aber eine sinnvolle Behandlungsoption für Patienten dar, die nicht adäquat onkologisch operiert worden sind.

Abstract

During the past two decades, relevant steps were taken in the treatment of adenocarcinomas of the stomach and gastroesophageal junction. This was shown for palliative (chemotherapy) therapies and for perioperative treatment strategies applied with curative intent. The administration of preoperative and postoperative chemotherapy has clearly demonstrated a statistically significant and clinically relevant difference in disease-free and overall survival of approximately 10–14% compared with surgery alone, without increasing postoperative morbidity and mortality. Based on these results, perioperative chemotherapy should be regarded as the treatment of choice for patients with locoregional tumors that are defined as uT2–uT4 by endoscopic ultrasound. The potential role of preoperative chemoradiation remains to be determined. Available study results strongly indicate that this treatment strategy is effective. This appears to be especially true for adenocarcinomas of the gastroesophageal junction and distal esophagus. To date, postoperative (adjuvant) chemotherapy after R0 resection cannot be recommended. With this treatment strategy, a relevant survival benefit could not be shown in Western trials, and postoperative chemoradiation cannot be generally recommended. However, it is a meaningful approach for patients whose operations did not fulfill oncological surgical criteria.

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Authors and Affiliations

  1. Medizinische Klinik IV/Onkologie, Kliniken Essen-Mitte, Huyssens-Stiftung, Henricistraße 92, 45136, Essen, Deutschland

    H. Wilke & M. Stahl

  2. Klinik und Poliklinik für Strahlentherapie – Radioonkologie, Universitätsklinik Münster, Münster, Deutschland

    N. Willich

  3. Klinik für Allgemein- und Visceralchirurgie, Städtisches Klinikum, Solingen, Deutschland

    H.-J. Meyer

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  1. H. Wilke
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  2. N. Willich
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  3. H.-J. Meyer
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  4. M. Stahl
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Correspondence to H. Wilke.

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Wilke, H., Willich, N., Meyer, HJ. et al. Neoadjuvante und perioperative Therapie des Magenkarzinoms. Onkologe 14, 370–380 (2008). https://doi.org/10.1007/s00761-008-1337-x

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