Palliativtherapie beim Ösophaguskarzinom

Zusammenfassung

Hintergrund: Die Palliativtherapie von Patienten mit inkurablem Ösophaguskarzinom erfordert ein breites Spektrum unterschiedlicher Maßnahmen zur Linderung der Beschwerden. Methoden: Operative Verfahren (palliative Tumorresektion, Bypass-Verfahren) sind infolge der hohen Letalität nur noch selten indiziert. Im Vordergrund stehen neben allgemeinen Palliativmaßnahmen symptomorientierte Verfahren zur Beseitigung der Dysphagie und Sicherstellung der Nahrungsaufnahme, insbesondere der endoskopisch oder radiologisch eingebrachte Stent, bei Versagen die Ernährungssonde und tumorspezifische Maßnahmen (Brachytherapie, Radiochemotherapie, Chemotherapie). Diskussion: Die Wahl richtet sich nach den Beschwerden, der Tumorsituation, dem Allgemeinzustand und den Wünschen des Patienten. Nach Möglichkeit sollte für jeden Patienten ein individuelles Behandlungskonzept interdisziplinär erstellt und abhängig vom Krankheitsverlauf modifiziert werden. Schlussfolgerung: Aufgabe künftiger Studien wird es sein, die optimale Kombination einer rein symptomatischen Behandlung mit tumorspezifischen Maßnahmen unter dem Aspekt der erreichbaren Lebensqualität zu klären.

Abstract

Background: Palliative therapy for patients with incurable oesophageal cancer necessitates a broad spectrum of different measures to relieve symptoms. Methods: Surgical procedures (palliative tumour resections, bypass surgery) are rarely indicated on account of the high morbidity. Preeminent treatment options to eliminate dysphagia and to ensure food passage are endoscopic procedures, in particular, the endoscopically or radiologically guided stent implantation. In case of failure, a percutaneous feeding tube and general palliative measures are required. Furthermore tumour-specific therapies (brachytherapy, radiochemotherapy, chemotherapy) are applied. Discussion: The choice of the procedure is based on the symptoms, the tumour situation, the patients’ general status, and their preferences. If possible, an individual, interdisciplinary treatment concept for each patient should be designed and modified according to the course of the disease. Conclusions: It should be the aim of future studies to elucidate the optimal combination of a merely symptomatic treatment with tumour-specific measures under the aspect of the achievable quality of life.

Schlüsselwörter

Ösophaguskarzinom - Palliativtherapie - Dysphagie - Stent - Radiochemotherapie

Key words

oesophageal carcinoma - palliative therapy - dysphagia - stent - radiochemotherapy

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