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Analkarzinom

Therapieoptionen beim lokalisierten und disseminierten Rezidiv

Anal cancer

Therapy options for localized and disseminated recurrence

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Zusammenfassung

Metastasierte bzw. lokal rezidivierte und nicht mehr R0-resektable Analkarzinome stellen eine therapeutische Herausforderung dar, weil infolge der geringen Inzidenz des Tumors und der Seltenheit von Metastasen nach adäquater Radiochemotherapie nach wie vor nur sehr wenige Daten zur medikamentösen Therapie vorliegen. Aus der älteren Literatur lässt sich ableiten, dass Cisplatin/5-Fluorouracil-haltige Protokolle eine sinnvolle Primärtherapie bei eingetretener Metastasierung darstellen und daher empfohlen werden können. Das mediane Überleben liegt mit diesen Therapien in etwa bei 12–15 Monaten. Mehrere Fallberichte zeigen darüber hinaus, dass aus der Gruppe der molekulargezielten Therapien insbesondere der EGFR-Antikörper Cetuximab vielversprechende Ergebnisse gezeigt hat. Vor einer Therapieeinleitung sollte jedoch nach Ansicht der Autoren eine KRAS-Analyse erwogen werden. Der Versuch einer primären oder sekundären Metastasenresektion erscheint bei möglicher R0-Resektion gerechtfertigt.

Abstract

Metastasized, local recurrent and non-resectable R0 anal carcinomas represent a therapeutic challenge because due to the low incidence of the tumor and the rarity of metastases following adequate radiochemotherapy, only very little data on medication therapy is available. From the older literature it can be derived that protocols with cisplatin/5-fluorourcil represent a reasonable primary therapy when metastases are present and can therefore be recommended. Using this therapy the mean survival is approximately 12-15 months. Furthermore, several case reports have documented that the group of molecular targeted therapies, especially with the epidermal growth factor receptor (EGFR) antibody cetuximab, has shown promising results. However, in the opinion of the authors a KRAS analysis should be initiated before induction of therapy. Attempts at primary or secondary resection of metastases by a possible R0 resection seem to be justified.

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  1. TagesTherapieZentrum am Interdisziplinären Tumorzentrum Mannheim, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1–3, Haus 9, 68167, Mannheim, Deutschland

    N. Schulte &  R.-D. Hofheinz

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  1. N. Schulte
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  2. R.-D. Hofheinz
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Correspondence to R.-D. Hofheinz.

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Schulte, N., Hofheinz, RD. Analkarzinom. Onkologe 18, 699–704 (2012). https://doi.org/10.1007/s00761-012-2261-7

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