Therapie des Ösophaguskarzinom

Das Ösophaguskarzinom weist trotz multimodaler Therapieansätze weiterhin nur geringe 5-Jahres-Überlebensraten von 15–25% auf. Angelehnt an die im Dezember 2023 publizierte 4. Version der S3-Leitlinie sowie die „ESMO Clinical Practice Guidelines“ stellen wir in diesem Artikel Diagnostik, Staging und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus dar.

Kernaussagen

• Die Diagnostik erfolgt durch Ösophagogastroduodenoskopie mit Biopsien.

• Für das Staging sind Endosonografie und Computertomografie notwendig.

• Bei Frühkarzinomen (T1a; ggf. T1b bei Adenokarzinomen) kann eine endoskopische Resektion versucht werden.

• Bei lokal fortgeschrittenen Karzinomen (T3–4 oder N+) ist eine multimodale Therapie indiziert. Die Immuncheckpoint-Inhibitor-Therapie nimmt hier einen immer größeren Stellenwert ein.

• Die chirurgische Resektion erfolgt abhängig von der Lokalisation des Tumors. Die Ösophagektomie sollte minimalinvasiv oder in Kombination mit offenen Verfahren (Hybrid-Technik) ausgeführt werden.

• Eine chirurgische Resektion ist bei präoperativ bekannter Oligometastasierung zurzeit nur im Rahmen von Studien indiziert (RENAISSANCE-Trial).

Schlüsselwörter

oberer Gastrointestinaltrakt - Onkologie - Chemotherapie - Radiotherapie - maligne Erkrankung

Publication History

Article published online:
24 September 2024

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