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Adjuvante Therapie des Kolon- und Rektumkarzinoms

Adjuvant therapy of colorectal cancer

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Zusammenfassung

Die spezifische postoperative Therapie des lokal fortgeschrittenen, nicht metastasierten Kolon- und Rektumkarzinoms verbessert die Heilungsraten – in Hinblick auf das Gesamtüberleben beim Kolon- und die Lokalrezidivfreiheit beim Rektumkarzinom – signifikant und findet seit 15 Jahren als adjuvante Therapie Anwendung. Aufgrund der hohen Inzidenz von Lokalrezidiven und Fernmetastasen wird gegenwärtig in klinischen Studien der bereits für die Palliation bewiesene signifikante Nutzen einer 5-Fluoropyrimidin-basierten Kombinationschemotherapie für die adjuvante Situation überprüft. In der adjuvanten Therapie des Kolonkarzinoms im Stadium III etablierte sich die Ergänzung von Oxaliplatin, das in Ausnahmefällen auch bei Erkrankungen im Stadium II eingesetzt wird. Die Standardbehandlung des Rektumkarzinoms beinhaltet die präoperative neoadjuvante kombinierte Radio- und Chemotherapie mit 5-Fluorouracil gefolgt von einer postoperativen Nachbehandlung im Stadium II und III bzw. die alleinige neoadjuvante Kurzzeitradiatio mit additiver adjuvanter Chemotherapie.

Abstract

Specific postoperative adjuvant chemotherapy significantly improves overall survival of patients with stage III colon cancer and lowers the rates of local disease recurrence of stage II and III rectal cancer after curative surgical treatment. Because of the high incidence of local and distant disease recurrence, great efforts are now being made in clinical studies to transfer the benefits of 5-fluoropyrimidine-based combination chemotherapy known from palliative stages, to the adjuvant situation. In the adjuvant treatment of curative resected stage III colon cancer, the addition of oxaliplatin has now been established, which can also be used in exceptional cases in stage II. Standard in the treatment of stage II and stage III rectal cancer is the pre-operative neo-adjuvant combined radiotherapy and chemotherapy based on 5-fluorouracil followed by post-operative chemotherapy or alternatively, preoperative irradiation with 25 Gy delivered in 5 fractions in 1 week followed by adjuvant chemotherapy.

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  1. Medizinische Klinik I, St.-Josef-Hospital, Klinkum der Ruhr-Universität , Gudrunstraße 56, 44791, Bochum, Deutschland

    N. Ansorge,  W. Schmidt &  P. Ritter

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  1. N. Ansorge
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  2. W. Schmidt
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  3. P. Ritter
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Ansorge, N., Schmidt, W. & Ritter, P. Adjuvante Therapie des Kolon- und Rektumkarzinoms. Gastroenterologe 3, 119–125 (2008). https://doi.org/10.1007/s11377-008-0173-2

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