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Plattenepithelkarzinom des Ösophagus

Präoperative kombinierte Radiochemotherapie aus chirurgisch-onkologischer Sicht

Esophageal squamous cell carcinoma

Pre-operative combined radiochemotherapy from a surgical oncological viewpoint

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Zusammenfassung

Plattenepithelkarzinome des Ösophagus (ESCC) stellen u.a. aufgrund der vielfachen Komorbiditäten eine interdisziplinäre Herausforderung seitens Diagnostik, multimodaler und/oder chirurgischer Therapieverfahren wie auch im postoperativen Management dar. Goldstandard eines kurativen Therapieansatzes ist die radikale Chirurgie, welche standardisiert und mit vertretbarer Morbidität und Mortalität machbar ist. ESCC werden meist in lokal fortgeschrittenen Tumorstadien diagnostiziert, weswegen neoadjuvante Therapieverfahren zur Anwendung kommen. Patienten, die auf eine neoadjuvante Therapie ansprechen (Responder), weisen ein signifikant besseres Überleben auf. Die Bewertung aktuell vorhandener neoadjuvanter Studien muss kritisch erfolgen, weil sie die Response als Endpunkt nicht beinhalten. In diesem Kontext ist die bisher zur Anwendung kommende klinische Responseevaluation der WHO infrage zu stellen. Goldstandard in der Bewertung der Response ist die Histopathologie nach prozentualem Anteil residualer Tumorzellen. Die Positronenemissionstomographie als Responsekriterium ist prädiktiv für die histopathologische Response und das Überleben. ESCC-Patienten, die als Nonresponder zu klassifizieren sind, scheinen nicht von einer chirurgischen Resektion zu profitieren. Zukünftig könnten Ergebnisse einer Responseevaluation wie auch prätherapeutischer molekularbiologischer Untersuchungen Einzug in die prä- und/oder peritherapeutische onkologische Entscheidungsfindung bei Patienten mit ESCC halten.

Abstract

Esophageal squamous cell carcinomas (ESCCs) are an interdisciplinary challenge in terms of diagnosis, multimodal and/or surgical treatment procedures and also postoperative management as they are often associated with multiple comorbidities. The gold standard for a curative treatment approach is radical surgery, which is standardized and can be carried out with acceptable morbidity and mortality rates. ESCCs are usually diagnosed at locally advanced tumor stages and neoadjuvant treatment procedures are therefore used. Patients who respond to neoadjuvant therapy (responders) have a significantly better survival rate. The neoadjuvant studies that are currently available need to be critically assessed as they do not include response as an end point. In this context the WHO clinical response evaluation that has been used up to now is questionable. The histopathological findings with percentage proportions of residual tumor cells represent the gold standard for evaluating the response. Positron-emission tomography as a response criterion is predictive for the histopathological response and survival. ESCC patients who are classified as non-responders do not appear to benefit from surgical resection. In the future the results of a response evaluation and of pretreatment molecular biological tests could have a place in the process of pretherapeutic and peritherapeutic oncological decision-making in patients with ESCCs.

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  1. Chirurgische Onkologie, Allgemeine, Vizeral- und Transplantationschirurgie, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland

    B.L.D.M. Brücher F.A.C.S., F.R.C.S.

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Brücher, B. Plattenepithelkarzinom des Ösophagus. Chirurg 80, 1011–1018 (2009). https://doi.org/10.1007/s00104-009-1733-9

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