Welchen Einfluss hat die neoadjuvante Strahlenchemotherapie auf postoperative Wundinfektionen?

Zusammenfassung

Neoadjuvante Strahlenchemotherapiekonzepte werden zunehmend bei fortgeschrittenen Stadien des Ösophagus- und Rektumkarzinoms eingesetzt. Das Ziel besteht in der Regel darin, ein downstaging zu erzielen und somit die Prognose für den betroffenen Patienten zu verbessern. In einigen Studien zu neoadjuvanten Kombinationstherapien konnte dieses Ziel erreicht werden. Jedoch ist anzumerken, dass nach neoadjuvanten Strahlenchemotherapiekonzepten eine erhöhte postoperative Morbidität und Mortalität verzeichnet wurde. Insbesondere die Rektumkarzinomchirurgie war nach neoadjuvanten Kombinationstherapien mit hohen Raten an perianalen Wundinfekten und sakralen Abszessen behaftet. Dies können wir nach einer ersten Datenanalyse in unserem Krankengut bestätigen.

Abstract

In advanced oesophageal- and rectal cancer the use of multimodal treatment concepts is increasing. A downstaging of the tumor is mostly the target to obtain a better prognosis for the patient. After neoadjuvant combinationtherapies the target was reached in some studies. But it is to notice that after preoperative radiochemotherapy a higher postoperative morbidity and mortality was noticed. Especially in surgery of rectal cancer higher rates of postoperative perianal Woundinfections and sacral abscesses were reported. In our own first datas we can confirm these facts.

Neoadjuvante Strahlenchemotherapie - Ösophaguskarzinom - Rektumkarzinom - Wundinfektion

Neodajuvant - Radiochemotherapy

Literatur

• 1 Green F L, Stewart A K, Norton H J. A new TNM staging strategy for node positive (stage III) rectal cancer: an analysis of 5 988 patients.  Proc Am Soc Clin Oncol. 2003;  22 251
• 2 Colorectal Cancer Collaborative Group . Adjuvant radiotherapy for rectal cancer a systematic overview of 8 507 patients from 22 randomized trials.  Lancet. 2001;  358 1291
• 3 Cooper R, Sebag-Montefiore D. Pre-operative chemoradiotherapy for locally advanced carcinoma of the rectum : acute toxicity, pathological response and outcome.  Radiother Oncol. 2000;  56 257
• 4 Molls M. Prä-und postoperative Radiotherapie mit und ohne Chemotherapie beim Rectumcarcinom.  Chirurg. 1994;  65 569-575
• 5 Cedermark B, Johansson H, Rutqvist L E, Wilking N. The Stockholm I trial of preoperative short term radiotherapy in operable rectal cancer: A prospective randomised controlled trial.  Cancer. 1995;  75 2269-2275
• 6 Holm T, Rutqvist L E, Johansson H, Cedermark B. Postoperative mortality in rectal cancer treated with or without preoperative radiotherapy: causes and risk factors.  Br J Surg. 1996;  83 964-968
• 7 Pahlman L, Glimelius B. Pre or postoperative radiotherapy in rectal and rectosigmoid carcinoma.  Ann Surg. 1990;  211 187-195
• 8 Stockholm Colorectal Cancer Study Group . Randomized study on preoperative radiotherapy in rectal carcinoma.  Ann Surg Oncol. 1996;  3 423-430
• 9 Rau B, Hohenberger P, Gellermann J, Hünerbein M, Hildebrandt B, Schneider U, Riess H, Wust P, Schlag P M. T4 Rektumkarzinom - Operative und multimodale Therapie.  Chirurg. 2002;  73 147-153
• 10 Le Prise E, Etienne P L, Meunier B, Maddern G, Ben Hassel M, Gedouin D. A randomized study of chemotherapy, radiation therapy, and surgery versus surgery for localized squamous cell carcinoma of the esophagus.  Cancer. 1994;  73 1779-1784
• 11 Urba S, Orringer M, Turrisi A, Whyte R, Iannettoni M, Forastiere A. A randomized trial comparing surgery to preoperative concomitant chemoradiation plus surgery in patients with resectable esophageal cancer: updated analysis.  Proc Am Soc Clin Oncol. 1997;  16 A983
• 12 Bosset J F, Gignoux M, Triboulet J P, Tiret E, Mantion G, Elias D. Chemoradiotherapy followed by surgery compared with surgery alone in squamous cell cancer of the esophagus.  N Engl J Med. 1997;  337 161-167
• 13 Walsh T N, Noonan N, Hollywood D. et al . A comparison of multimodal therapy and surgery for esophageal adenocarcinoma.  N Engl J Med. 1996;  335 462-467
• 14 Goldberg P A, Nicholls R J, Porter N H. Long term results of a randomized trial of short-course-low-dose adjuvant preoperative radiotherapy for rectal cancer: reduction in local treatment failure.  Eur J Cancer. 1994;  30 1602-1606
• 15 Sauer R, Fietkau R, Wittekind C. et al . Adjuvant versus neoadjuvant radiochemotherapy for locally advanced rectal cancer. A progress report of a phase III randomized trial (protocol CAO/ARO/AIO-94).  Strahlenther Onkol. 2001;  177 173-181
• 16 Frykholm G, Glimelius B, Pahlman L. Preoperative irridiation with or without chemotherapy (MFL) in the treatment of primarily nonresectable adenocarcinoma of the rectum. Results from two consecutive studies.  Eur J Cancer Clin Oncol. 1989;  25 1535-1541
• 17 Chan A, Wong A, Langevin J, Khoo R. Preoperative recurrent 5-fluorouracil infusion, mitomycin C and pelvic radiation therapy in tethered and fixed rectal carcinoma.  Int J Radiat Oncol Biol Phys. 1993;  25 791-799
• 18 Shumate C R, Rich T A, Skibber J M, Ajani J A, Ota D M. Preoperative chemotherapy and radiation therapy for locally advanced primary and recurrent rectal carcinoma. A report of surgical morbidity.  Cancer. 1993;  71 3690-3696
• 19 Chen E, Mohiuddin M, Brodovsky H, Fishbein G, Marks G. Downstaging of advanced rectal cancer following combined preoperative chemotherapy and high dose radiation.  Int J Oncol Biol Phys. 1994;  30 169-175
• 20 Minsky B D, Cohen A, Enker W, Kelsen D, Kemeny N, Ilson D, Guillem J, Saltz L, Frankel J, Conti J. Preoperative 5-fluorouracil, low-dose leucovorin, and concurrent radiation therapy for rectal cancer.  Cancer. 1994;  73 273-280
• 21 Weinstein G D, Rich T A, Shumate C R, Skibber J M, Cleary K R, Ajani J A, Ota D M. Preoperative infusional chemoradiation and surgery with or without an electron beam intraoperative boost for advanced primary rectal cancer.  Int J Oncol Biol Phys. 1995;  32 197-204
• 22 Rich T A, Gunderson L L. Radical nonoperative management of early rectal cancer.  Int J Radiat Oncol Biol Phys. 1995;  31 677-678
• 23 Chari R S, Tyler D S, Anscher M S, Russel R N, Clary B M, Hathorn J, Seigler H F. Preoperative radiation and chemotherapy in the treatment of adenocarcinoma of the rectum.  Ann Surg. 1995;  221 778-787
• 24 Ichikawa D, Yamaguchi T, Yoshioka Y, Sawai K, Takahashi T. Prognostic evaluation of preoperative combined treatment for advanced cancer in the lower rectum with radiation, intraluminal hyperthermia, and 5-fluorouracil suppository.  Am J Surg. 1996;  171 346-350
• 25 Liedman B, Johnsson E, Merke C, Ruth M, Lundell L. Preoperative adjuvant Radiochemotherapy may increase the risk in patients undergoing thoracoabdominal esophageal resections.  Digestive Surgery. 2001;  18 169-175
• 26 Kelley S T, Coppola D, Karl R C. Neoadjuvant chemoradiotherapy is not associated with higher complication rate vs. surgery alone in patients undergoing esophagectomy.  J Gastrointest Surg. 2004;  8 227-232
• 27 Imdahl A, Schoffel U, Ruf G. Impact of neoadjuvant therapy of perioperative mobidity in patients with esophageal cancer.  Am J Surg. 2004;  187 64-68