Multimodale Therapie des Ösophaguskarzinoms

Zusammenfassung

Aufgrund der heutigen Studienlage muss die chirurgische Resektion nach wie vor als das Therapieverfahren der Wahl beim resektablen Ösophaguskarzinom gelten. Ein Überlebensvorteil durch neoadjuvante oder adjuvante Therapiemodalitäten gegenüber der alleinigen Resektion ist jedoch aufgrund der aktuellen Datenlage wahrscheinlich. Hierbei ist die neoadjuvante Radiochemotherapie in Kombination mit der chirurgischen Resektion beim Plattenepithelkarzinom am wirksamsten. Die tendenziell erhöhte perioperative Morbidität und Mortalität nach neoadjuvanter Radiochemotherapie ist durch die Zentrumschirurgie zu minimieren. Beim Adenokarzinom des gastroösophagealen Übergangs zeigte eine neoadjuvante Chemotherapie Vorteile gegenüber der alleinigen Resektion. Für Patienten, bei denen eine radikale Operation mit transthorakaler Tumorresektion ein zu hohes Operationsrisiko darstellt, ist das transhiatale Vorgehen bei distal gelegenen Tumoren zu bevorzugen. Besonders für Hochrisikopatienten mit Plattenepithelkarzinomen des Ösophagus ist zumindest im mittelfristigen Verlauf die alleinige Radiochemotherapie im Vergleich zur Resektion eine mögliche Alternative. Somit sollte heute das Ösophaguskarzinom ein individualisiertes, multimodales Therapiekonzept inklusive Chirurgie, Radiotherapie und Chemotherapie zur Behandlungsgrundlage haben.

Abstract

Surgery is still the treatment of choice in patients with resectable oesophageal cancer. However, recent randomised controlled trials suggest beneficial effects of adjuvant or neoadjuvant treatment modalities on progression-free and overall survival compared to surgery alone. Neoadjuvant chemoradiotherapy in combination with surgery is most effective in squamous cell carcinomas. Increased perioperative morbidity and mortality should be minimised by surgery in a high-volume centre. In adenocarcinomas of the gastro-oesophageal junction neoadjuvant chemotherapy shows beneficial effects compared to surgery alone. A transhiatal resection should be preferred in distal oesophageal cancer compared to a transthoracic oesophageal resection if the patient is in poor condition. In all other cases a transthoracic resection remains the procedure of choice. Chemoradiotherapy alone is an alternative to surgery in high-risk patients with squamous cell carcinomas of the oesophagus. Therefore the treatment of patients with oesophageal cancer should always include an individualised, multimodal approach including surgery, chemotherapy, and radiotherapy.

Ösophagusresektion - Radiotherapie - Radiochemotherapie - Chemotherapie

esophageal resection - radiotherapy - chemoradiotherapy - chemotherapy

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