Pankreaskarzinom

Zusammenfassung

Das Adenokarzinom des Pankreas ist trotz erheblicher Fortschritte im Bereich der Epidemiologie, Molekulargenetik und ­Diagnostik unverändert durch eine extrem schlechte Prognose gekennzeichnet. Die vorliegende Arbeit versucht, durch eine kritische Analyse der umfangreichen Datenlage Empfehlungen zum diagnostischen und therapeutischen Vorgehen zu entwickeln.

Ein kosteneffizienter diagnostischer Algorithmus bei klinischem Verdacht auf ein Pankreaskarzinom besteht im initialen Einsatz des abdominellen Ultraschalls, der bei Fehlen von Fernmetastasen oder uneindeutigem Befund von einem MRT in „One-stop-Technik” gefolgt wird. Potenziell resektable Patienten sind einer explorativen Laparotomie zuzuführen.

In frühen Tumorstadien ist eine Resektion unter ­kurativer Zielsetzung möglich und aufgrund der verbesserten Operationstechnik in erfahrenen Zentren gerechtfertigt. Möglicherweise führt eine adjuvante Chemotherapie zu einer Prognoseverbesserung.

Bei irresektablem lokal fortgeschrittenen Tumor können eine kombinierte Radiochemotherapie oder Chemotherapie indiziert sein. Bei Vorliegen von Fernmetastasen kann eine systemische Chemotherapie mit Gemcitabine das Überleben geringfügig ­verbessern und bei ausgewählten Patienten zu einem klinischen Benefit führen. Den therapeutischen Grundpfeiler in jedem Stadium stellt eine an Symptomen orientierte supportive Behandlung dar.

Die aktuelle Datenlage macht deutlich, dass der Entwicklung innovativer therapeutischer und diagnostischer Strategien herausragende Bedeutung zukommt.

Abstract

Despite considerable progress in the areas of epidemiology and molecular genetics, pancreatic cancer is still characerized by a dismal prognosis. The current overwiev attempts a critical analysis of the published data resulting in recommendations for diagnostic and therapeutic algorithms.

The diagnostic work-up of suspected pancreatic cancer patients includes an initial abdominal ultrasound which in case of ambiguous results or the absence of distant metastases is followed by „one-stop-MRI” and explorative laparotomy.

Locally confined tumour disease should proceed to resective surgery which however results in cure only in a minority of resected patients even in specialized centers. Adjuvant chemotherapy might be of some benefit in terms of survival. Locally advanced but irresectable disease can be considered for combined radiochemotherapy. Systemic chemotherapy with Gemcitabine ­results in marginal benefit of overall survival and may offer clinical benefit to a subgroup of patients. Best supportive care still remains the mainstay of irresectable disease.

This summary highlights the urgent need for the development of innovative diagnostic and therapeutic strategies.

Schlüsselwörter

Übersicht - Pankreaskarzinom - Diagnostik - adjuvant - Chemotherapie - Lebensqualität - Palliation

Key words

Review - pancreatic cancer - diagnosis - adjuvant therapy - chemotherapy - quality of life - palliation

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