Adjuvante Therapie des Pankreaskarzinoms

Zusammenfassung

Die Prognose des Pankreaskarzinoms ist in allen Stadien schlecht. Die einzige Heilungschance besteht in der vollständigen Resektion des Tumors. Allerdings sind nur maximal 10-25 % der Patienten überhaupt operabel, und selbst nach kurativ intendierter Operation beträgt die mediane Überlebenszeit nur etwa 18 Monate. Neben Lokalrezidiven kommt es nach der Operation auch meist frühzeitig zu systemischer Metastasierung. Zur Wirksamkeit einer adjuvanten, postoperativen Therapie liegen widersprüchliche Ergebnisse vor. In einigen Studien wurde mit einer kombinierten Strahlen- und Chemotherapie eine Verlängerung der Überlebenszeit erreicht, in anderen nicht. Die perkutane Bestrahlung kann durch eine intraoperative Radiotherapie ergänzt werden, wobei dies jedoch allenfalls die lokale Tumorkontrolle verbessert. Auch für die Wirksamkeit der alleinigen adjuvanten systemischen Chemotherapie gibt es bislang keine überzeugenden Beweise. Leider trugen auch die Ergebnisse der randomisierten Studie ESPAC-1 wegen des problematischen Designs nicht zu einer Klärung dieser Sachlage bei. Aufschlüsse erhofft man sich jetzt von neueren Studien, in denen auch der palliative Therapiestandard Gemcitabin in der adjuvanten Situation geprüft wird.

Abstract

The prognosis of pancreatic cancer is poor at any stage. The complete resection of the tumour offers the only chance of cure, but 10-25 % of the patients at most present with operable disease, and median survival following surgery with curative intention is 18 months. Local recurrence is often accompanied or rapidly followed by distant metastasis. Studies of postoperative (adjuvant) treatment have yielded contradictory results. Combined radiochemotherapy resulted in improved survival in a few studies while others failed to demonstrate any survival benefit. Intraoperative radiation therapy given in addition to percutaneous irradiation may improve local tumour control at best. At present only few data support the benefit of adjuvant systemic chemotherapy alone. Unfortunately, the recently completed ESPAC-1 study was not very helpful in settling this issue due to its problematic design. Therefore, the results of ongoing studies of adjuvant chemotherapy are eagerly awaited. These studies have also included arms with gemcitabine, the current standard for palliative treatment of pancreatic cancer, and will hopefully allow firm conclusions as to the role of postoperative chemotherapy.

Pankreaskarzinom - adjuvante Therapie - Pankreatektomie - Chemotherapie - Strahlentherapie

Pancreatic carcinoma - pancreatic cancer - adjuvant therapy - pancreatectomy - chemotherapy - radiotherapy

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