Neoadjuvante Therapie des Ösophaguskarzinoms - Standortbestimmung 2005

Zusammenfassung

Seit einigen Jahren werden Anstrengungen unternommen, um die ungünstige Prognose der Patienten mit einem Ösophaguskarzinom durch multimodale Therapieverfahren zu verbessern. Unumstritten gilt die Operation beim lokal begrenzt wachsenden Karzinom als Verfahren der Wahl, sofern der Patient aus allgemeinen Gründen für eine Operation geeignet ist. Postoperative adjuvante Verfahre spielen in der Praxis keine Rolle. In der neoadjuvanten Situation scheint gesichert, dass die alleinige präoperative Radiotherapie nicht hilfreich ist, umstritten sind die Daten für eine präoperative Chemotherapie. Nach kombiniertem Einsatz der Radio-Chemotherapie kann mit einem kompletten Tumorresponse in 20-25 % der Patienten gerechnet werden, diese Patienten profitieren von der Therapie. Allerdings gibt es nach wie vor keine Indikatoren, die vor Therapiebeginn erkennen lassen, welche Patienten Responder sein werden. Jüngere Metaanalysen belegen zwar einen geringen positiven Effekt der neoadjuvanten Radio-Chemotherapie auch ohne Stratifizierung in den Tumorresponse. Daraus lässt sich aber bislang noch kein allgemeiner Konsens zur Indikation der neoadjuvanten Radio-Chemotherapie ableiten.

Abstract

Neoadjuvant therapy has been implemented to improve the prognosis of patients with oesophageal cancer. Operative therapy remains the therapy of choice for nonmetastatic disease in patients who can tolerate resection. Adjuvant therapy following resection is usually not indicated. For neoadjuvant therapy it seems to be confirmed that preoperative radiotherapy has only very little benefit and therefore, should not be recommended. Data for preoperative chemotherapy are conflicting. Following preoperative combined radio-chemotherapy a complete response of tumour can be expected in 20-25 % of treated patients with a marked advantage for these patients. However, there are still no markers available indicating tumour response before the start of perioperative radio-chemotherapy. Recently published metaanalyses confirm a small overall benefit for perioperative radio-chemotherapy. However, these data so far have not led to a broad agreement on the indication of neoadjuvant therapy in oesophageal cancer.

Schlüsselwörter

präoperative Radio-Chemotherapie - Ösophaguskarzinom - neoadjuvante Therapie

Key words

oesophageal cancer - neoadjuvant therapy - preoperative radiochemotherapy

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