RSS-Feed abonnieren
DOI: 10.1055/s-0030-1262460
© Georg Thieme Verlag KG Stuttgart · New York
Diagnostik und Therapie des Magenkarzinoms
Diagnosis and treatment of gastric cancerPublikationsverlauf
eingereicht: 30.5.2010
akzeptiert: 1.7.2010
Publikationsdatum:
18. August 2010 (online)

Zusammenfassung
Magenkarzinome und Karzinome des ösophago-gastralen Übergangs sind die vierthäufigste Tumorerkankung weltweit und stehen an zweiter Stelle der tumorbedingten Todesursachen. Fehlende Früherkennungsprogramme in der westlichen Welt führen dazu, dass viele Patienten in fortgeschrittenen Erkrankungsstadien diagnostiziert werden. Zum sorgfältigen Staging sollte dann ein hochauflösendes Computertomogramm von Thorax, Abdomens und Beckens sowie eine videodokumentierte Endoskopie und Endosonographie zählen. Beim Mukosakarzinom kann bei Vorliegen spezifischer Kriterien eine endoskopische Mukosaresektion die chirurgische Resektion ersetzen. In den lokal fortgeschrittenen Tumorstadien II und III ist eine perioperative Chemotherapie jetzt als Standard etabliert und sollte durchgeführt werden. In der metastasierten Situation sind die Behandlungsziele palliativ. Eine Chemotherapie kann zur Verlängerung des Überlebens, zur besseren Symptomkontrolle und zu einer verbesserten Lebensqualität beitragen. Kombinationen auf der Basis eines Platinsalzes und Fluorpyrimidins sind etabliert. Etwa jedes 5. Magenkarzinom weist eine Überexpressions des Wachstumsfaktorrezeptor-Proteins Her2 auf. Der gegen Her2 gerichtete monoklonale Antikörper Trastuzumab führt bei Her2-überexprimierender Erkrankung in Kombination mit Cisplatin und 5-Fluorouracil oder Cisplatin zu einer Verlängerung des Gesamtüberlebens.
Abstract
From a global perspective, gastric cancer including cancer of the esophago-gastric junction is the fourth most common malignant tumor and the second-most common cause of cancer-related death. Due to the lack of screening programs in Western countries, most gastric cancers are diagnosed in advanced stages. A sophisticated staging should include high-resolution computed tomography of the thorax, abdomen and pelvis and video-documented endoscopy and endoscopic ultrasound. In mucosal gastric cancer, endoscopic resection can replace surgical resection if specific criteria are present. In the stages II and III perioperative chemotherapy has been established as a standard of care and should be applied. In the metastatic setting, treatment goals are palliative. Chemotherapy can prolong survival, improve symptoms and can help to maintain a better quality of life. Combination chemotherapy including a platinum compound and a fluoropyrimidine regarded as standard. About 20 % of gastric cancers exhibit overexpression of the growth factor receptor family member Her2. Trastuzumab is a monoclonal antibody directed against Her2 and has shown to prolong survival when combined with cisplatin and 5-fluorouracil or capecitabine.
Schlüsselwörter
Magenkarzinom - Diagnose - Therapie - Chirurgie - Chemotherapie
Keywords
gastric cancer - diagnosis - treatment - surgery - chemotherapy
Literatur
- 1
Ajani J A, Moiseyenko V M, Tjulandin S. et al .
Quality of life with docetaxel
plus cisplatin and fluorouracil compared with cisplatin and fluorouracil
from a phase III trial for advanced gastric or gastroesophageal
adenocarcinoma: the V-325 Study Group.
J Clin Oncol.
2007;
25
3210-3216
MissingFormLabel
- 2
Al-Batran S E, Hartmann J T, Probst S. et al .
Phase III trial in metastatic gastroesophageal
adenocarcinoma with fluorouracil, leucovorin plus either oxaliplatin
or cisplatin: a study of the Arbeitsgemeinschaft Internistische
Onkologie.
J Clin Oncol.
2008;
26
1435-1442
MissingFormLabel
- 3
Bang Y J, Van Cutsem E, Feyereislova A. et al .
Trastuzumab in combination with chemotherapy
for the treatment of HER2-positive advanced gastric or gastro-esophageal
junction cancer.
N Engl J Med.
2010;
MissingFormLabel
- 4
Bennett C, Wang Y, Pan T.
Endoscopic
mucosal resection for early gastric cancer.
Cochrane Database
Syt Rev.
2009;
4 CD004276
MissingFormLabel
- 5
Boige V, Pignon J P, Saint-Aubert B. et al .
Final results of a randomized trial comparing
preoperative 5-fluorouracil (F)/cisplatin (P) to surgery
alone in adenocarcinoma of stomach and lower esophagus (ASLE): FNLCC ACCORD07-FFCD
9703 trial.
J Clin Oncol.
2007;
25
4510
MissingFormLabel
- 6
Cascinu S, Labianca R, Barone C. et
al .
Adjuvant treatment of high-risk, radically resected
gastric cancer patients with 5-fluorouracil, leucovorin, cisplatin,
and epidoxorubicin in a randomized controlled trial.
J
Natl Cancer Inst.
2007;
99
601-607
MissingFormLabel
- 7
Cunningham D, Allum W H, Stenning S P. et al .
Perioperative chemotherapy
versus surgery alone for resectable gastroesophageal cancer.
N
Engl J Med.
2006;
355
11-20
MissingFormLabel
- 8
Cunningham D, Starling N, Rao S et
al.
Capecitabine and oxaliplatin for advanced esophagogastric
cancer.
N Engl J Med.
2008;
358
36-46
MissingFormLabel
- 9
D’Angelica M, Gonen M, Brennan M F. et al .
Patterns of initial recurrence in completely
resected gastric adenocarcinoma.
Ann Surg.
2004;
240
808-816
MissingFormLabel
- 10
Dank M, Zaluski J, Barone C. et
al .
Randomized phase III study comparing irinotecan
combined with 5-fluorouracil and folinic acid to cisplatin combined
with 5-fluorouracil in chemotherapy naive patients with advanced
adenocarcinoma of the stomach or esophagogastric junction.
Ann
Oncol.
2008;
19
1450-1457
MissingFormLabel
- 11 Federaal Kenniscentrum
voor de Gezondheidszorg Centre fédéral d’expertise
des soins de santé .Wetenschappelijke ondersteuning
van het College voor Oncologie: een nationale praktijkrichtlijn
voor de aanpak van slokdarm- en maagkanker. Brüssel; 21. März 2008
MissingFormLabel
- 12
Feussner H, Omote K, Fink U. et
al .
Pretherapeutic laparoscopic staging in advanced
gastric carcinoma.
Endoscopy.
1999;
31
342-347
MissingFormLabel
- 13
Fiorica F, Cartei F, Enea M. et
al .
The impact of radiotherapy on survival in resectable
gastric carcinoma: a meta-analysis of literature data.
Cancer
Treat Rev.
2007;
33
729-740
MissingFormLabel
- 14
Glimelius B, Hoffman K, Graf W. et al .
Cost-effectiveness of palliative chemotherapy
in advanced gastrointestinal cancer.
Ann Oncol.
1995;
6
267-274
MissingFormLabel
- 15
Grenacher L, Hansmann J.
Radiologische Bildgebung
des oberen Gastrointestinaltraktes, Teil II Magen.
Radiologe.
2007;
47
71-88
MissingFormLabel
- 16
Hwang S W, Lee D H, Lee S H. et al .
Preoperative staging of gastric cancer
by endoscopic ultrasonography and multidetector-row computed tomography.
J Gastroenterol Hepatol.
2010;
25
512-518
MissingFormLabel
- 17
Janunger K G, Hafstrom L, Glimelius B.
Chemotherapy in gastric cancer: a review und updated meta-analysis.
Eur J Surg.
2002;
168
597-608
MissingFormLabel
- 18 Japanese Research Society
for Gastric Cancer .Japanese Classification of Gastric
Carcinoma, 1st engl en. Kanehara, Tokyo; 1995
MissingFormLabel
- 19
Kang Y K, Kang W K, Shin D B. et al .
Capecitabine/cisplatin
versus 5-fluorouracil/cisplatin as first-line therapy in
patients with advanced gastric cancer: a randomised phase III noninferiority
trial.
Ann Oncol.
2009;
20
666-673
MissingFormLabel
- 20
Kwee R M, Kwee T C.
Imaging in local
staging of gastric cancer: a systematic review.
J Clin
Oncol.
2007;
25
2107-2116
MissingFormLabel
- 21
Lorenzen S, Hentrich M, Haberl C. et al .
Split-dose docetaxel, cisplatin and leucovorin/fluorouracil
as first-line therapy in advanced gastric cancer and adenocarcinoma
of the gastroesophageal junction: results of a phase II trial.
Ann Oncol.
2007;
18
1673-1679
MissingFormLabel
- 22
Lordick F, Ott K, Novotny A. et
al .
R1 resection in the surgery of upper gastrointestinal
tumors: Relevance and therapeutic consequences.
Chirurg.
2007;
78
792-801
MissingFormLabel
- 23
Lordick F, Ott K, Weitz J, Jäger D.
The evolving role
of catumaxomab in gastric cancer.
Expert Opin Biol Ther.
2008;
8
1407-1415
MissingFormLabel
- 24
Macdonald J S, Smalley S R, Benedetti J. et al .
Chemoradiotherapy after surgery compared
with surgery alone for adenocarcinoma of the stomach or gastroesophageal
junction.
N Engl J Med.
2001;
345
725-30
MissingFormLabel
- 25
Murad A M, Santiago F F, Petroianu A. et al .
Modified therapy with 5-fluorouracil,
doxorubicin, and methotrexate in advanced gastric cancer.
Cancer.
1993;
72
37-41
MissingFormLabel
- 26
Puli S R, Batapati Krishna Reddy J, Bechtold M L. et al .
How good is endoscopic
ultrasound for TNM staging of gastric cancers? A meta-analysis and
systematic review.
World J Gastroenterol.
2008;
14
4011-4019
MissingFormLabel
- 27
Pyrhonen S, Kuitunen T, Nyandoto P, Kouri M.
Randomised comparison
of fluorouracil, epidoxorubicin and methotrexate (FEMTX) plus supportive
care with supportive care alone in patients with non-resectable gastric
cancer.
Br J Cancer.
1995;
71
587-591
MissingFormLabel
- 28
Rosen H R, Jatzko G, Repse S. et al .
Adjuvant intraperitoneal chemotherapy with
carbon-adsorbed mitomycin in patients with gastric cancer: results
of a randomized multicenter trial of the Austrian Working Group
for Surgical Oncology.
J Clin Oncol.
1998;
16
2733-2738
MissingFormLabel
- 29
Sakuramoto S, Sasako M, Yamaguchi T. et al .
Adjuvant chemotherapy for gastric cancer
with S-1, an oral fluoropyrimidine.
N Engl J Med.
2007;
357
1810-1820
MissingFormLabel
- 30
Schuhmacher C, Schlag P, Lordick F. et al .
Neoadjuvant chemotherapy versus surgery
alone for locally advanced adenocarcinoma of the stomach and cardia:
Randomized EORTC phase III trial #40 954.
J
Clin Oncol.
2009;
27
4510
MissingFormLabel
- 31 Scottish Intercollegiate
Guidelines Network .Management of Oesophageal and Gastric
Cancers. A National Clinical Guideline. Edinburgh; June 2006
MissingFormLabel
- 32
Siewert J R, Böttcher K, Stein H J, Roder J D.
Relevant
prognostic factors in gastric cancer: ten-year results of the German
Gastric Cancer Study.
Ann Surg.
1998;
228
449-461
MissingFormLabel
- 33 Sobin L H, Gospodarowicz M K, Wittekind C. UICC: TNM classification of malignant tumors.
7th edition. Oxford: Wiley-Blackwell; 2009
MissingFormLabel
- 34
Stahl M, Walz M K, Stuschke M. et al .
Phase III comparison of preoperative chemotherapy
compared with chemoradiotherapy in patients with locally advanced
adenocarcinoma of the esophagogastric junction.
J Clin Oncol.
2009;
27
851-856
MissingFormLabel
- 35
Van Cutsem E, Moiseyenko V M, Tjulandin S. et al .
Phase III study of docetaxel
and cisplatin plus fluorouracil compared with cisplatin and fluorouracil
as first-line therapy for advanced gastric cancer: a report of the V325
Study Group.
J Clin Oncol.
2006;
24
4991-4997
MissingFormLabel
- 36
van Westreenen H L, Westerterp M, Bossuyt P M. et al .
Systematic review
of the staging performance of 18F-fluorodeoxyglucose positron emission
tomography in esophageal cancer.
J Clin Oncol.
2004;
22
3805-12
MissingFormLabel
- 37
Witzig R, Schönberger B, Fink U. et al .
Delays in diagnosis and therapy of gastric
cancer and esophageal adenocarcinoma.
Endoscopy.
2006;
38
1122-1226
MissingFormLabel
- 38
Yan T D, Black D, Sugarbaker P H. et al .
A systematic review and meta-analysis of
the randomized controlled trials on adjuvant intraperitoneal chemotherapy
for resectable gastric cancer.
Ann Surg Oncol.
2007;
14
2702-2713
MissingFormLabel
- 39
Yoon S S, Yang H K.
Lymphadenectomy
for gastric adenocarcinoma: should west meet east?.
Oncologist.
2009;
14
871-882
MissingFormLabel
- 40
Zhao S L, Fang J Y.
The role of postoperative
adjuvant chemotherapy following curative resection for gastric cancer:
a meta-analysis.
Cancer Invest.
2008;
26
317-325
MissingFormLabel
Priv.-Doz. Dr. med. Florian Lordick
Chefarzt Medizinische Klinik III (Hämatologie
und Onkologie)
Celler Straße 13
38114
Braunschweig
Telefon: 0531/595-3224
Fax: 0531/595-3757
eMail: medklinik3@klinikum-braunschweig.de