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Indikationen zur neoadjuvanten Therapie beim Rektumkarzinom

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Zusammenfassung

Prä- wie postoperative adjuvante Therapien haben beim lokal fortgeschrittenen, prognostisch resektablen Rektumkarzinom (R0-Resektion) die Ergebnisse verbessert. Grundsätzlich gilt in diesen Stadien des Rektumkarzinoms (T3/4 N0 M0; jedes T-Stadium N+M0) immer noch der interdisziplinäre Konsens der Deutschen Krebsgesellschaft, der sich für die postoperative adjuvante Radiochemotherapie ausspricht. Nach zahlreichen klinischen Studien mit guten Resultaten wird international mittlerweile die präoperative adjuvante Therapie bevorzugt. Sie scheint bei vergleichsweise höherer Compliance der Patienten auch besser toleriert zu werden. Die alleinige hypofraktionierte präoperative Radiotherapie über 3–4 Felder, der in kürzester Zeit die Operation folgt, stellt beim primär resektablen T3-Tumor eine Therapieoption dar. Ein zusätzlicher Nutzen kann von einer konventionell fraktionierten simultanen Radiochemotherapie (Einzeldosis im Bereich von 2 Gy, Gesamtdosis über 40 Gy, Chemotherapie basiert auf 5-FU), der die Operation erst nach mehreren Wochen folgt, erwartet werden. Dringend zu empfehlen ist eine präoperative Therapie bei T4-Tumoren, bei denen der Chirurg von einer R1- oder R2-Resektion ausgehen muss. Die Wahrung der Kontinenz kann bei Einhaltung der erforderlichen chirurgischen Radikalität (Ziel: R0-Resektion!) in Einzelfällen ein weiteres Ziel der multimodalen Therapie sein.

Abstract

Pre- and postoperative adjuvant treatments for locally advanced, operable (R0 resection) rectum carcinoma have led to improved results. In principle, according to the interdisciplinary consensus of the German Cancer Society, the recommended treatment for rectum carcinoma (T3/4; N0; M0; any T stage; N+; M0) is still postoperative adjuvant radiochemotherapy. In the meantime, however, based on the good results obtained from various clinical trials preoperative adjuvant treatment is favored internationally. Not only does this treatment scheme show a comparably better compliance of the patients but it also seems to be better tolerated. One treatment option for resectable T3 tumors immediately followed by surgery is the sole hypofractionated preoperative 3–4 field external beam radiotherapy. An additional benefit can be expected from protracted preoperative radiochemotherapy (single dose 2 Gy, total dose >40 Gy, chemotherapy based on 5-FU) followed by operation several weeks later. For T4 tumors with expected R1 or R2 resection, preoperative treatment is urgently recommended. A further aim in compliance with the surgical approach (R0 resection!) and multimodal treatment may be for individual cases the preservation of continence.

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  1. Klinik und Poliklinik für Strahlentherapie und Radiologische Onkologie, Klinikum rechts der Isar der Technischen Universität München

    F. Zimmermann &  M. Molls

  2. Klinik und Poliklinik für Strahlentherapie und Radiologische Onkologie, Klinikum rechts der Isar der Technischen Universität, Ismaninger Straße 22, 81675 , München

    M. Molls

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Zimmermann, F., Molls, M. Indikationen zur neoadjuvanten Therapie beim Rektumkarzinom. Chirurg 74, 887–896 (2003). https://doi.org/10.1007/s00104-003-0739-y

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