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Neoadjuvante und adjuvante Therapie des Magen- und Ösophaguskarzinoms

Neoadjuvant and adjuvant treatment in gastric and oesophageal cancer

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Zusammenfassung

Die Prognose lokal fortgeschrittener Magen- und Ösophaguskarzinome ist ungünstig. Durch multimodale Behandlungsstrategien lässt sich die Prognose im Vergleich zu alleiniger chirurgischer Therapie verbessern. Zwei in Europa durchgeführte randomisierte Studien zeigten, dass die perioperative Chemotherapie zu einem signifikanten Überlebensvorteil für Patienten mit Magenkarzinomen und Adenokarzinomen des gastroösophagealen Übergangs führt. Die Ergebnisse haben einen nachhaltigen Einfluss auf die aktuelle Therapie dieser Tumoren in den klinischen Stadien II und III. Aufgrund aktueller Metanalysen werden Patienten mit lokal fortgeschrittenen Adenokarzinomen des Ösophagus entweder mit Chemotherapie oder mit Radiochemotherapie vorbehandelt. Plattenepithelkarzinome des Ösophagus werden mittels kombinierter Radiochemotherapie behandelt. Die nachfolgende Resektion ist optional. Patienten mit lokal fortgeschrittenen Magen- und Ösophaguskarzinomen sollten immer in einem onkologischen Zentrum vorgestellt werden, wo die Befunde im interdisziplinären Tumorboard besprochen werden. Die Prognose ist nachweislich besser, wenn die Therapie an ausgewiesenen Zentren erfolgt.

Abstract

The prognosis of locally advanced gastric and oesophageal cancers is poor, but it has been shown that multimodal treatment can lead to better outcomes than surgery alone. Two randomised studies conducted in Europe have shown that perioperative chemotherapy does significantly improve the survival of patients with adenocarcinoma of the stomach and oesophagogastric junction. These results have had a profound effect on the treatment of patients presenting with stage II or stage III disease. Because of the results of recent meta-analyses, patients with locally advanced adenocarcinomas of the oesophagus receive neoadjuvant chemotherapy or chemoradiation therapy. Squamous cell cancer of the oesophagus is treated with chemoradiation. Secondary resection is optional. Patients with locally advanced gastric and oesophageal cancer should always be referred to an experienced high-volume centre where findings are discussed by a multidisciplinary tumour board. It has been demonstrated that outcomes are better when such patients are treated in designated centres.

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Lordick, F., Ott, K. Neoadjuvante und adjuvante Therapie des Magen- und Ösophaguskarzinoms. Gastroenterologe 4, 224–231 (2009). https://doi.org/10.1007/s11377-008-0272-0

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  • DOI: https://doi.org/10.1007/s11377-008-0272-0

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