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Interdisziplinäre Therapie des Ösophaguskarzinoms

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best practice onkologie Aims and scope

Zusammenfassung

Die Behandlung lokalisierter Ösophaguskarzinome wurde über Jahrzehnte kontrovers diskutiert. Die chirurgische Resektion wurde als die einzige kurative Behandlungsmodalität angesehen. In den letzten Jahren erwies sich die endoskopische Resektion bei sehr frühen Karzinomen, die nicht die Submukosa infiltrieren, als eine wirksame und sichere kurative Behandlungsoption. Die neoadjuvante Platin/5-FU-basierte Chemotherapie (CTx) wurde mittlerweile für die Behandlung lokal fortgeschrittener Adenokarzinome des Ösophagus und des ösophagogastralen Übergangs als Standard etabliert. Die neoadjuvante Radiochemotherapie (RCTx) mit Platin plus 5-FU oder Paclitaxel ist der Behandlungsstandard für resektable Plattenepithelkarzinome des Ösophagus der Kategorien cT3 und cT4a und kann auch für Adenokarzinome eingesetzt werden. Patienten mit Plattenepithelkarzinom, die mit definitiver RCTx behandelt und nicht reseziert werden, erreichen eine in etwa vergleichbare Überlebensprognose wie nach Operation. Die therapieassoziierte Letalität ist nach Operation höher, die lokale Tumorkontrolle aber signifikant besser. Trotz aller Fortschritte erreicht man über alle lokalisierten Stadien hinweg bei 30–60 % der Patienten keine langfristige Tumorkontrolle. Wirksamere Behandlungsregime werden dringend benötigt. Um bessere Ergebnisse zu erreichen, soll die kurative Therapie des Ösophaguskarzinoms an Zentren mit guter interdisziplinärer Zusammenarbeit, Qualitätssicherung und hoher Erfahrung erfolgen.

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Author information

Authors and Affiliations

  1. Universitäres Krebszentrum Leipzig (UCCL), Universitätsklinikum Leipzig, Liebigstr. 20, 04301, Leipzig, Deutschland

    F. Lordick

  2. Klinik und Poliklinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Leipzig, Deutschland

    I. Gockel

  3. Klinik und Poliklinik für Gastroenterologie und Rheumatologie, Universitätsklinikum Leipzig, Leipzig, Deutschland

    J. Mössner

  4. Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Leipzig, Leipzig, Deutschland

    T. Kuhnt

  5. Institut für Pathologie, Universitätsklinikum Leipzig, Leipzig, Deutschland

    C. Wittekind

Authors
  1. F. Lordick
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  2. I. Gockel
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  3. J. Mössner
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  4. T. Kuhnt
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  5. C. Wittekind
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Corresponding author

Correspondence to F. Lordick.

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Einhaltung der ethischen Richtlinien

Interessenkonflikt. F. Lordick gibt an, dass kein Interessenkonflikt besteht. Das vorliegende Manuskript enthält keine Studien an Menschen oder Tieren.

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Lordick, F., Gockel, I., Mössner, J. et al. Interdisziplinäre Therapie des Ösophaguskarzinoms. best practice onkologie 9, 40–50 (2014). https://doi.org/10.1007/s11654-014-0515-0

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