Gastroenterologie up2date 2009; 5(4): 261-279
DOI: 10.1055/s-0029-1215328
Leber/Galle/Pankreas

© Georg Thieme Verlag KG Stuttgart · New York

Adjuvante und palliative Therapie des Pankreaskarzinoms – Update

Volker  Kächele, Thomas  Seufferlein
Further Information

Publication History

Publication Date:
09 December 2009 (online)

Kernaussagen

Kurative, adjuvante und additive Therapie

  • Eine kurative Therapie bei Patienten mit Pankreaskarzinom ist nur nach radikaler Resektion (meist pyloruserhaltende Whipple-Operation) möglich, wobei ein Langzeitüberleben nur bei ca. 1 – 3 % der Patienten erreicht werden kann.

  • Nach potenziell kurativer Resektion sind der Resektionsstatus, das Grading, die Tumorgröße und der Nodalstatus entscheidende Prognoseparameter.

  • Eine adjuvante, aber auch eine additive Chemotherapie mit Gemcitabin ist sinnvoll.

Neoadjuvante Therapie

  • Eine neoadjuvante Radiochemotherapie mit modernen Bestrahlungsregimen ist noch nicht etabliert. Möglicherweise kann bei einem Teil der Patienten durch eine präoperative Radiochemotherapie die Prognose verbessert werden, wenn durch diese Therapie eine Operabilität zu erreichen ist.

  • Eine Induktionschemotherapie hilft eventuell dabei, Patienten zu identifizieren, die von einer neoadjuvanten Radiochemotherapie profitieren.

Palliative Therapie

  • Jede Therapie eines lokal fortgeschrittenen oder metastasierten Pankreaskarzinoms erfolgt in palliativer Absicht.

  • Trotz einzelner Studien, in denen eine geringe Überlegenheit einer Kombinationstherapie gezeigt werden konnte, bleibt Gemcitabin derzeit die palliative Standardchemotherapie. Das mittlere Überleben von Patienten mit metastasiertem Pankreaskarzinom beträgt bei Durchführung einer palliativen Chemotherapie etwas mehr als 6 Monate.

  • Durch Addition von „Biologicals” wie dem EGFR-Inhibitor Erlotinib kann nur bei Auftreten einer signifikanten Hautreaktion eine klinisch relevante Verbesserung des Überlebens erreicht werden.

  • Zweitlinientherapien nach Progress unter einer Erstlinientherapie sind wahrscheinlich wirksam, hier bieten sich Kombinationen aus Fluoropyrimidinen und Oxaliplatin an. Konzepte zur Zweitlinientherapie beim Pankreaskarzinom sollten weiter in Studien geprüft werden.

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Prof. Dr. Thomas Seufferlein

Klinik für Innere Medizin I
Martin-Luther-Universität Halle-Wittenberg

Ernst-Grube-Straße 40
06097 Halle

Email: thomas.seufferlein@medizin.uni-halle.de