Rektumkarzinom: neoadjuvante Strategien und total neoadjuvante Therapie

Ralf-Dieter Hofheinz

doi:10.1055/a-2241-0761

Zentralblatt für Chirurgie - Zeitschrift für Allgemeine, Viszeral-, Thorax- und Gefäßchirurgie, Table of Contents

Zentralbl Chir 2024; 149(01): 56-66
DOI: 10.1055/a-2241-0761

Übersicht

Rektumkarzinom: neoadjuvante Strategien und total neoadjuvante Therapie

Locally Advanced Rectal Cancer: New Neoadjuvant Strategies and Total Neoadjuvant Therapy

Ralf-Dieter Hofheinz

¹Mannheim Cancer Center, Universität Heidelberg, Universitätsmedizin Mannheim, Mannheim, Deutschland

› Author Affiliations

Abstract

Zusammenfassung

Die Behandlungsstrategien beim lokal fortgeschrittenen Rektumkarzinom sind stark im Wandel. Die in den Leitlinien für lokal fortgeschrittene Tumoren uniform empfohlene Therapie mit neoadjuvanter Radio(chemo)therapie (RChT), gefolgt von Chirurgie und ggf. adjuvanter Therapie ist mittlerweile zugunsten folgender Konzepte verlassen: 1. verlängerte neoadjuvante Therapie („mehr Chemotherapie vor der Operation“ als totale neoadjuvante Therapie, TNT, bezeichnet); 2. Organerhalt bei Patienten mit einem kompletten klinischen Ansprechen nach einer neoadjuvanten RChT; 3. Verzicht auf Strahlentherapie bei niedrigem Lokalrezidivrisiko; 4. definitive Immuntherapie mit Checkpoint-Inhibitoren bei Patient*innen mit einem mikrosatelliteninstabilen (MSI) Primärtumor. Im vorliegenden Beitrag sollen ausgehend vom leitlinienbasierten Status quo diese 4 neuen Strategien und aktuelle Studienkonzepte diskutiert werden.

Abstract

Treatment strategies for locally advanced rectal cancer are changing significantly. The treatment recommended in German guidelines for locally advanced tumors of neoadjuvant radio(chemo)therapy (RChT), followed by surgery and, if necessary, adjuvant therapy, are increasingly be abandoned in favor of the following concepts: (i) prolonged neoadjuvant therapy (i.e. “more chemotherapy before resection”, referred to as total neoadjuvant therapy, TNT); (ii) organ preservation in patients with a complete clinical response after neoadjuvant radiochemotherapy. (iii) omission of radiotherapy in tumors with a low risk of local recurrence; (iv) definitive treatment with immunotherapy (checkpoint inhibitors) for patients with a primary harboring microsatellite instability (MSI). Herein, current strategies and study concepts are to be discussed based on the guideline-based status quo.

Schlüsselwörter

Rektumkarzinom - neoadjuvante Therapie - Immuntherapie

Keywords

rectal cancer - neoadjuvant treatment - immunotherapy

Full Text

References

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