Was muss der Allgemein- und Viszeralchirurg von der Strahlentherapie wissen? – Strahlentherapeutische Aspekte in der Allgemein- und Viszeralchirurgie

Zusammenfassung

Strahlentherapeutische Verfahren sind fester Bestandteil multimodaler onkologischer Therapiekonzepte im Bereich der Allgemein- und Viszeralchirurgie. Dazu gehören einerseits kurativ intendierte Therapieansätze wie die neoadjuvante (präoperative) Radiotherapie des lokoregionär fortgeschrittenen und insbesondere als N(+) diagnostizierten Ösophagus- und Rektumkarzinoms, die definitive, simultan-kombinierte Radiochemotherapie des lokal fortgeschrittenen, inoperablen bzw. hochsitzenden (oralseitigen) Ösophaguskarzinoms, die definitive Radiotherapie des Analkarzinoms (Sphinktererhalt) oder die prä- bzw. postoperative Radiotherapie bei Weichteilsarkomen. In selektierten Fällen kann die kurativ intendierte Strahlentherapie v. a. beim Ösophaguskarzinom (und Rektumkarzinom) yT0-Stadien erzielen, sodass eine nachfolgende Operation u. U. ausgespart werden kann. Solche Sonderfälle, in denen selbstverständlich eine engmaschige klinische und bildgebende Nachsorge erforderlich ist, stellen eine Herausforderung hinsichtlich der Handhabung im und Integration in den klinischen Alltag dar. Im Rahmen der interdisziplinären Tumorboards können durch die Integration der Strahlentherapie in mehrschichtige multimodale Therapiekonzepte mit kurativem Ansatz verbesserte Kontroll- und Überlebensraten bei klinisch akzeptabler Toxizität erreicht werden. Hier stellen nicht invasive, lokal-ablative strahlentherapeutische Verfahren wie die extrakranielle stereotaktische Radiotherapie effektive und praktikable Behandlungsmöglichkeiten etwa von Lebermetastasen beim oligometastasierten kolorektalen Karzinom dar, wodurch hohe lokale Kontrollraten erreicht werden können. Dieser Übersichtsartikel soll einen Überblick zu den für den Allgemein- und Viszeralchirurgen relevanten strahlentherapeutischen Aspekten im Rahmen der multimodalen Tumortherapie geben und fokussiert sich auf die Therapie des Rektum-, Ösophagus- und Analkarzinoms sowie der Weichteilsarkome und hepatischen Metastasen bei oligometastasiertem kolorektalen Karzinom.

Abstract

Radiooncological therapies are an integral part of the multimodal oncological treatment concepts in general and abdominal surgery. These include therapeutic approaches with a curative intention such as the neoadjuvant (pre-operative) radiotherapy of locoregionally advanced and/or N+ oesophageal and rectal cancer, definitive combined chemoradiotherapy of locally advanced, unresectable oesophageal cancer or oesophageal tumour lesions of the upper third, definitive radiotherapy of anal cancer (sphincter sparing) and pre- or post-operative radiotherapy of soft tissue sarcoma on the one hand. A yT0 stage achieved as characteristic of a curative effect by radiation in oesophageal and rectal cancer (omitting subsequent surgical intervention, naturally under clinical and imaging-based controls within short-term follow-up intervals) can be considered as a very interesting set-up with regard to its reasonable integration in daily clinical practice, which needs to be further and critically discussed. By integrating radiotherapy in interdisciplinary therapy concepts, improved tumour control and survival rates with clinically acceptable toxicity can be achieved. On the other hand, non-invasive, locally ablative radiooncological therapies such as extracranial stereotactic body radiotherapy constitute an effective and feasible treatment method for liver metastases in oligometastatic colorectal cancer or other tumour entities according to the decisions by the institutional tumour board, offering high local tumour control rates which can be part of multistep, multimodal procedures with curative intention. This review aims at providing an overview for the general and abdominal surgeon, outlining relevant radiooncological treatment aspects in the multimodal cancer therapy with a focus on the treatment of rectal, oesophageal and anal cancer as well as soft tissue sarcoma and hepatic metastases in oligometastatic colorectal cancer.

Schlüsselwörter

neoadjuvante Radiotherapie - extrakranielle stereotaktische Radiotherapie (ESRT) - Weichteilsarkom - Lebermetastasen - Rektumkarzinom - Analkarzinom - Ösophaguskarzinom

Key words

neoadjuvant radiotherapy - stereotactic body radiotherapy (SBRT) - soft tissue sarcoma - liver metastases - rectal cancer - anal cancer - oesophageal cancer

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