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Strahlentherapie des Rektumkarzinoms

Radiotherapy of rectal cancer

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Zusammenfassung

Klinisches Problem

Trotz verbesserter Früherkennungsmöglichkeiten wird die Diagnose des Rektumkarzinoms meist in einem lokal weit fortgeschrittenem Stadium gestellt.

Therapeutische Standardverfahren/Empfehlung für die Praxis

Das lokal fortgeschrittene Rektumkarzinom bedarf einer präoperativen Radiochemotherapie zur Verbesserung der Sphinktererhaltsrate, der lokalen Kontrolle und des Gesamtüberlebens. Es ist belegt, dass selbst bei optimaler Chirurgie die lokale Kontrolle durch eine Strahlentherapie verbessert werden kann.

Innovationen, Zukunftsaussichten

Die neoadjuvante Therapie mit einem Langzeit- oder Kurzzeitschema wird kontrovers diskutiert. Der Einsatz neuerer Substanzen zur Verbesserung der systemischen Kontrolle wird derzeit untersucht. Durch moderne Strahlentherapietechniken stehen die Erhöhung der Effektivität der Radiochemotherapie und die Verminderung der therapieassoziierten Toxizität im Vordergrund.

Abstract

Clinical issue

Despite improved screening options, most patients with rectal cancer are diagnosed at a locally advanced disease stage.

Standard treatment/practical recommendations

The treatment strategy includes preoperative radiochemotherapy as a cornerstone in order to improve sphincter preservation and local control. It is evident that radiotherapy can achieve improved local control even if optimal surgery (total mesorectal excision TME) is performed.

Treatment innovations, future prospects

Whether the neoadjuvant therapy should be applied as a long-term or short-term schedule is controversially discussed. The benefit of newer agents to improve systemic control is still under investigation. Modern radiotherapy techniques increase the effectiveness of radiochemotherapy and may reduce therapy-associated toxicity.

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Abb. 1

Abbreviations

5-FU:

5-Fluorouracil

Chx:

Chemotherapie

CRM:

Zirkumferenzieller Resektionsrand

DFS:

Krankheitsfreies Überleben

Gy:

Gray

LC:

Lokale Kontrolle

LR:

Lokalrezidivrate

LV:

Leukovorin

pCR:

Pathologische Vollremission

RCT:

Radiochemotherapie

RT:

Radiotherapie

TME:

Totale mesorektale Exzision

Literatur

  1. Aschele C, Cionini L, Lonardi S et al (2011) Primary tumor response to preoperative chemoradiation with or without oxaliplatin in locally advanced rectal cancer: pathologic results of the STAR-01 randomized phase III trial. J Clin Oncol 29(20):2773–2780. doi:10.1200/JCO.2010.34.4911

    Article  PubMed  CAS  Google Scholar 

  2. Birgisson H, Pahlman L, Gunnarsson U et al (2005) Occurrence of second cancers in patients treated with radiotherapy for rectal cancer. J Clin Oncol 23(25):6126–6131. doi:10.1200/JCO.2005.02.543

    Article  PubMed  Google Scholar 

  3. Bosset JF, Collette L, Calais G et al (2006) Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 355(11):1114–1123. doi:10.1056/NEJMoa060829

    Article  PubMed  CAS  Google Scholar 

  4. Braendengen M, Tveit KM, Bruheim K et al (2011) Late patient-reported toxicity after preoperative radiotherapy or chemoradiotherapy in nonresectable rectal cancer: results from a randomized phase III study. Int J Radiat Oncol Biol Phys 81(4):1017–1024. doi:10.1016/j.ijrobp.2010.07.007

    Article  PubMed  Google Scholar 

  5. Bujko K, Nowacki MP, Nasierowska-Guttmejer A et al (2006) Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. Br J Surg 93(10):1215–1223. doi:10.1002/bjs.5506

    Article  PubMed  CAS  Google Scholar 

  6. Folkesson J, Birgisson H, Pahlman L et al (2005) Swedish rectal cancer trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol 23(24):5644–5650. doi:10.1200/JCO.2005.08.144

    Article  PubMed  Google Scholar 

  7. Gerard JP, Azria D, Gourgou-Bourgade S et al (2010) Comparison of two neoadjuvant chemoradiotherapy regimens for locally advanced rectal cancer: results of the phase III trial ACCORD 12/0405-Prodige 2. J Clin Oncol 28(10):1638–1644. doi:10.1200/JCO.2009.25.8376

    Article  PubMed  CAS  Google Scholar 

  8. Gerard JP, Conroy T, Bonnetain F et al (2006) Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3–T4 rectal cancers: results of FFCD 9203. J Clin Oncol 24(28):4620–4625. doi:10.1200/JCO.2006.06.7629

    Article  PubMed  Google Scholar 

  9. Maas M, Beets-Tan RG, Lambregts DM et al (2011) Wait-and-see policy for clinical complete responders after chemoradiation for rectal cancer. J Clin Oncol 29(35):4633–4640. doi:10.1200/JCO.2011.37.7176

    Article  PubMed  Google Scholar 

  10. Marijnen CA, van de Velde CJ, Putter H et al (2005) Impact of short-term preoperative radiotherapy on health-related quality of life and sexual functioning in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol 23(9):1847–1858. doi:23/9/1847 [pii]/JCO.2005.05.256

    Article  PubMed  Google Scholar 

  11. O’Connell MJ, Martenson JA, Wieand HS et al (1994) Improving adjuvant therapy for rectal cancer by combining protracted-infusion fluorouracil with radiation therapy after curative surgery. N Engl J Med 331(8):502–507. doi:10.1056/NEJM199408253310803

    Article  Google Scholar 

  12. Park JH, Yoon SM, Yu CS et al (2011) Randomized phase 3 trial comparing preoperative and postoperative chemoradiotherapy with capecitabine for locally advanced rectal cancer. Cancer 117(16):3703–3712. doi:10.1002/cncr.25943

    Article  PubMed  CAS  Google Scholar 

  13. Peeters KC, Marijnen CA, Nagtegaal ID et al (2007) The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg 246(5):693–701. doi:10.1097/01.sla.0000257358.56863.ce

    Article  PubMed  Google Scholar 

  14. Peeters KC, van de Velde CJ, Leer JW et al (2005) Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients – a Dutch colorectal cancer group study. J Clin Oncol 23(25):6199–6206. doi:10.1200/JCO.2005.14.779

    Article  PubMed  CAS  Google Scholar 

  15. Rodel C, Arnold D, Becker H et al (2010) Induction chemotherapy before chemoradiotherapy and surgery for locally advanced rectal cancer: is it time for a randomized phase III trial? Strahlenther Onkol 186(12):658–664. doi:10.1007/s00066-010-2194-2

    Article  PubMed  Google Scholar 

  16. Roh MS, Colangelo LH, O’Connell MJ et al (2009) Preoperative multimodality therapy improves disease-free survival in patients with carcinoma of the rectum: NSABP R-03. J Clin Oncol 27(31):5124–5130. doi:10.1200/JCO.2009.22.0467

    Article  PubMed  Google Scholar 

  17. Rosenberg R, Maak M, Schuster T et al (2010) Does a rectal cancer of the upper third behave more like a colon or a rectal cancer? Dis Colon Rectum 53(5):761–770. doi:10.1007/DCR.0b013e3181cdb25a

    Article  PubMed  Google Scholar 

  18. Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351(17):1731–1740. doi:351/17/1731 [pii]/NEJMoa040694

    Article  PubMed  CAS  Google Scholar 

  19. Sebag-Montefiore D, Stephens RJ, Steele R et al (2009) Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet 373(9666):811–820. doi:10.1016/S0140–6736(09)60484-0

    Article  PubMed  Google Scholar 

  20. Tiefenthal M, Nilsson PJ, Johansson R et al (2011) The effects of short-course preoperative irradiation on local recurrence rate and survival in rectal cancer: a population-based nationwide study. Dis Colon Rectum 54(6):672–680. doi:10.1007/DCR.0b013e318210c067

    Article  PubMed  Google Scholar 

  21. Van Gijn W, Marijnen CA, Nagtegaal ID et al (2011) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol 12(6):575–582. doi:10.1016/S1470-2045(11)70097–3

    Article  Google Scholar 

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Authors and Affiliations

  1. Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland

    M. Wolf , F. Zehentmayr & C. Belka

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  1. M. Wolf
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  2. F. Zehentmayr
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  3. C. Belka
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Correspondence to M. Wolf .

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Wolf , M., Zehentmayr, F. & Belka, C. Strahlentherapie des Rektumkarzinoms. Radiologe 52, 545–549 (2012). https://doi.org/10.1007/s00117-011-2286-8

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