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Neoadjuvante Radiochemotherapie und Responseprädiktion

Neoadjuvant radiochemotherapy and response prediction

  • Leitthema
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Der Onkologe Aims and scope

Zusammenfassung

Bisher wurden 10 randomiserte Studien zur neoadjuvanten Radiochemotherapie bei Patienten mit als resektabel eingestuftem Ösophaguskarzinom durchgeführt. Eine Auswertung der randomisierten Studien ergibt, dass ein Nutzen der neoadjuvanten Therapie auf die Langzeitergebnisse bei Patientenkollektiven mit schlechter Prognose nach alleiniger Chirurgie vorhanden ist. Nach adäquatem Staging gilt dies hauptsächlich für T3/T4-Tumoren, bei denen die R0-Resektabilität beeinträchtigt ist, oder für Tumoren mit vorhandenen Lymphknotenmetastasen, die als negativer Prognosefaktor betrachtet werden können. Hier ist nach den vorhandenen randomisierten Studien der Einsatz der neoadjuvanten Radiochemotherapie beim Ösophaguskarzinom zu rechtfertigen. Zur neoadjuvanten Strahlenchemotherapie beim Ösophaguskarzinom wurden ferner mehr als 50 Phase-II-Studien durchgeführt. Daraus ergeben sich weitere wichtige Informationen zur Bewertung dieser Therapieform.

Die Etablierung von molekularen Responseprädiktoren wird bereits seit Jahren als ein viel versprechender Ansatz zur Effektivitätssteigerung der multimodalen Therapie des Ösophaguskarzinoms betrachtet. Zusammenfassend lässt sich festhalten, dass die molekulare Responseprädiktion beim multimodal therapierten Ösophaguskarzinom noch weit von einer Einbindung in die tägliche klinische Praxis entfernt ist. Bislang am besten untersucht ist der prädiktive Wert von p53, wobei die bisherige Datenlage widersprüchlich erscheint.

Abstract

Up to now, ten randomized studies have been performed to evaluate radiochemotherapy of patients with esophageal carcinoma categorized as resectable. Analysis of the randomized studies revealed that neoadjuvant therapy exerts a useful effect on long-term results in patient groups with poor prognosis following surgery alone. Based on adequate staging, this holds true especially for T3-T4 tumors with poor RO resectability or tumors with existing lymph node metastases that can be considered negative prognostic factors. According to the available randomized studies, application of neoadjuvant radiochemotherapy can be justified in these cases of esophageal carcinoma. In addition, more than 50 phase II trials on neoadjuvant radiochemotherapy for esophageal carcinoma have been conducted. These have provided further important information for assessing this treatment form.

For many years now, establishment of molecular predictors of response have been regarded as a promising approach to increasing effectivity of multimodal therapy of esophageal carcinoma. In summary, it can be concluded that molecular prediction of response in esophageal carcinoma treated by a multimodal approach is far from becoming integrated into routine clinical practice. The prognostic value of p53 has been the most extensively investigated to date although results up to now appear to be conflicting.

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Authors and Affiliations

  1. Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Essen

    M. Stuschke

  2. Institut für Pathologie, Klinikum rechts der Isar, Technische Universität München

    M. Sarbia

  3. Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Essen, Hufelandstraße 55, 45122, Essen

    M. Stuschke

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  1. M. Stuschke
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  2. M. Sarbia
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Correspondence to M. Stuschke.

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Stuschke, M., Sarbia, M. Neoadjuvante Radiochemotherapie und Responseprädiktion. Onkologe 10, 1179–1190 (2004). https://doi.org/10.1007/s00761-004-0784-2

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  • DOI: https://doi.org/10.1007/s00761-004-0784-2

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