Ösophaguskarzinom: Aktueller Stand der multimodalen Therapie

Zusammenfassung

Multimodale Therapiekonzepte wurden in den letzten Jahren in der Behandlung des lokal fort­geschrittenen Ösophaguskarzinoms (cT3 / 4Nx) etabliert. Dabei kommt vor allem die neoadjuvante Radiochemotherapie oder die alleinige Chemotherapie zum Einsatz. Die aktuell vorliegenden Metaanalysen zur neoadjuvanten Therapie des lokal fortgeschrittenen Ösophaguskarzinoms weisen nur einen Prognosevorteil von 5–10 % bezüglich der 5-Jahres-Überlebensrate für die Gesamtgruppe der behandelten Patienten auf. Patienten mit einem sehr guten histopathologischen Ansprechen zeigen jedoch ausgezeichnete Über­lebens­wahrscheinlichkeiten trotz eines initial fort­geschrittenen Tumorstadiums. Patienten mit ­einem schlechten histopathologischen Ansprechen haben keinen Vorteil oder eher einen Pro­gno­senachteil. Deshalb wären prädiktive Marker, die eine individualisierte multimodale Therapie beim lokal fortgeschrittenen Ösophaguskarzinom ermöglichen würden, von großer Bedeutung. 

Abstract

Multimodality treatment options have been wide­ly promoted in the therapy for locally ad­vanced oesophageal cancer (cT3 / 4Nx). Generally neo­adjuvant chemotherapy and combined radio­chemotherapy are frequently used in this setting. The recent meta-analyses evaluating randomised trials of different neoadjuvant therapy protocols prior to surgery for patients with locally advanced oesophageal cancer showed only a modest im­prove­ment in survivial of 5–10 % survival at 5 years. In contrast, the meta-analyses reveal that patients with excellent histopathological re­sponses seem to highly benefit from neoadjuvant regimens. Patients with poor histopathological responses have no benefit but rather disadvan­tegeous prognoses. Therefore, predictive markers to allow individualisation of multimodality treatment in locally advanced esophageal cancer are urgently needed. 

Schlüsselwörter

Ösophaguskarzinom - multimodale Therapie - Response-Prädiktion

Key words

oesophageal cancer - multimodality treatment - response prediction

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