Zusammenfassung
Das kolorektale Karzinom ist trotz abnehmender Inzidenz bei Männern die dritthäufigste und bei Frauen die zweithäufigste Krebserkrankung. Seit 1998 existiert die Leitlinie „Kolorektales Karzinom“, die erste onkologische S3-Leitlinie in Deutschland. In der letzten Aktualisierung wurden die Abschnitte „Endoskopie: Durchführung und Polypenmanagement“, „adjuvante und neoadjuvante Therapie“ und „Therapeutisches Vorgehen bei Metastasierung und in der palliativen Situation“ überarbeitet. Beim Polypenmanagement wurden die Nachsorgeintervalle für Low-Risk-Adenome verlängert und bei serratierten Adenomen dem der traditionellen Adenome angepasst. Bei T1-Karzinomen wurde Budding als möglicher Bestandteil in die Risikostratifizierung aufgenommen. Bei unter 70-jährigen Patienten im Stadium III bleibt eine oxaliplatinhaltige Therapie Standard in der adjuvanten Chemotherapie. Eine kürzlich veröffentlichte Studie zeigt, dass in der Low-Risk-Situation (N1 und T2/3) eine Therapieverkürzung auf 3 Monate ähnliche Ergebnisse erreicht wie eine Therapie über 6 Monate bei deutlich geringerer Nebenwirkungsrate. Für die metastasierte Situation wurde ein Algorithmus erstellt, der u. a. Ausmaß der Metastasierung, Allgemeinzustand des Patienten und Tumorlokalisation berücksichtigt. Der molekularbiologischen Untersuchung kommt eine entscheidende Bedeutung zu.
Abstract
Although the incidence of colorectal cancer (CRC) in Germany has decreased in recent years, it still remains the third most common cancer in men and the second most common cancer in women. In 1998, an evidence-based guideline for the management of CRC was established in Germany—the very first oncologic S3 guideline. During the last update, the sections “endoscopy and polyp management”, “adjuvant and neoadjuvant treatment”, and “therapy in the metastasized patient or palliative situation” were updated. The polyp surveillance interval for low-risk adenomas was increased, the interval for serrated adenomas was recommended to be the same as for traditional adenomas. For T1 cancers, the factor “budding” was introduced as an optional factor for risk stratification. For stage III patients younger than 70 years, oxaliplatin-based adjuvant chemotherapy remains standard. A study published recently shows that in the low-risk situation (N1 and T2/3), decreasing treatment duration to 3 months has similar efficacy as treatment for 6 months, with a significantly lower rate of side effects. For patients with metastases, an algorithm has been introduced that considers the extent of disease, the patient’s general condition, and tumor location. Molecular examinations nowadays play an important role in treatment decisions.
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Pox, C. Update der S3-Leitlinie zum kolorektalen Karzinom. best practice onkologie 13, 254–262 (2018). https://doi.org/10.1007/s11654-018-0093-7
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DOI: https://doi.org/10.1007/s11654-018-0093-7
Schlüsselwörter
- Kolorektales Karzinom
- Leitlinie
- Therapiealgorithmus metastasiertes KRK
- Adjuvante Chemotherapie
- Darmpolypen
- Endoskopie