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Rofo 2013; 185(8): 699-708
DOI: 10.1055/s-0033-1335818
Leitlinie
© Georg Thieme Verlag KG Stuttgart · New York

Aktualisierte S3-Leitlinie zur Diagnostik und Therapie des kolorektalen Karzinoms: Bedeutung für die Radiologische Diagnostik und Intervention

S3 Guideline – Diagnosis and Treatment of Colorectal Carcinoma: Relevance for Radiologic Imaging and Interventions
T. J. Vogl
1   Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Frankfurt
,
W. Schmiegel
2   Medizinische Universitätsklinik, Ruhr-Universität Bochum
,
C. Pox
2   Medizinische Universitätsklinik, Ruhr-Universität Bochum
,
P. L. Pereira
3   Klinik für Radiologie, Minimal-invasive Therapien und Nuklearmedizin, SLK Kliniken. Heilbronn
,
H. J. Brambs
4   Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm
,
P. Lux
5   Chirurgische Klinik, Universitätsklinikum Erlangen
,
S. Fischer
1   Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Frankfurt
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
26. Juni 2013 (online)

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Zusammenfassung

Die neue deutsche S3-Leitlinie „Kolorektales Karzinom“ entstand im Rahmen des Leitlinienprogramms Onkologie der AWMF, der Deutschen Krebsgesellschaft und der Deutschen Krebshilfe unter Federführung der Deutschen Gesellschaft für Verdauungs- und Stoffwechselkrankheiten (DGVS) und ersetzt die bisherige Leitlinie aus dem Jahr 2008.

Die Leitlinie führt mit den enthaltenen evidenzbasierten Therapieempfehlungen zahlreiche Neuerungen und Präzisierungen bezüglich Diagnostik und Therapie des Kolon- und Rektumkarzinoms ein. Es wurden insbesondere konsentierte Empfehlungen zur Methodik der Früherkennung, Verfahrenswahl in der präoperativen Diagnostik sowie für den Einsatz interventioneller radiologischer Therapieverfahren ausgesprochen.

Die Leitlinie weist zudem herausgearbeitete Qualitätsindikatoren auf, um mithilfe standardisierter Methoden der Qualitätssicherung patientenrelevante Prozesse zu optimieren.

Der vorliegende Artikel stellt die Bedeutung der aktuellen Verhaltensempfehlungen für die radiologische Diagnostik und Therapie dar und soll durch eine flächendeckendere Verbreitung der Qualitätssteigerung bei Patienteninformation und -versorgung dienen.

Abstract

The new German S3 guideline “Colorectal Carcinoma” was created as part of the German Guideline Program in Oncology of the Association of the Scientific Medical Societies in Germany, the German Cancer Society and the German Cancer Aid under the auspices of the German Society for Digestive and Metabolic Diseases and replaces the guideline from 2008.

With its evidence-based treatment recommendations, the guideline contains numerous updates and detailed definitions regarding the diagnosis and treatment of colon and rectal cancer. In particular, consensus-based recommendations regarding early detection, preoperative diagnostic method selection, and the use of interventional radiological treatment methods are detailed.

The guideline also includes quality indicators so that standardized quality assurance methods can be used to optimize patient-related processes.

The present article discusses the significance of the current recommendations for radiological diagnosis and treatment and is intended to enhance the quality of patient information and care by increasing distribution.

Key words

colorectal carcinoma - S3 guideline - treatment recommendations - staging - follow-up - interventional therapy - ablation
 

  • Literatur

  • 1 Zauber AG, Winawer SJ, O‘Brien MJ et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012; 366: 687-696
    CrossrefPubMedGoogle Scholar
  • 2 Atkin WS, Edwards R, Kralj-Hans I et al. Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial. Lancet 2010; 375: 1624-1633
    CrossrefPubMedGoogle Scholar
  • 3 Pickhardt PJ, Choi JR, Hwang I et al. Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. New England Journal of Medicine 2003; 349: 2191-2200
    CrossrefPubMedGoogle Scholar
  • 4 De Haan MC, Van Gelder RE, Graser A et al. Diagnostic value of CT-colonography as compared to colonoscopy in an asymptomatic screening population: a meta-analysis. Eur Radiol 2011; 21: 1747-1763
    CrossrefPubMedGoogle Scholar
  • 5 El-Maraghi RH, Kielar AZ. CT Colonography Versus Optical Colonoscopy for Screening Asymptomatic Patients for Colorectal Cancer: A Patient, Intervention, Comparison, Outcome (PICO) Analysis. Academic Radiology 2009; 16: 564-571
    CrossrefPubMedGoogle Scholar
  • 6 Halligan S, Altman DG, Taylor SA et al. CT Colonography in the Detection of Colorectal Polyps and Cancer: Systematic Review, Meta-Analysis, and Proposed Minimum Data Set for Study Level Reporting. Radiology 2005; 237: 893-904
    CrossrefPubMedGoogle Scholar
  • 7 Cotton PB, Durkalski VL, Pinear BC et al. Computed tomographic colonography (virtual colonoscopy): A multicenter comparison with standard colonoscopy for detection of colorectal neoplasia. JAMA 2004; 291: 1713-1719
    CrossrefPubMedGoogle Scholar
  • 8 Rogalla P, Janka R, Baum U et al. CT colography: guideline of the Gastrointestinal Diagnostics Team of the German Radiological Society regarding the indication and technical implementation of endoluminal colon diagnostics using computed tomography (known as virtual colonoscopy). Fortschr Röntgenstr 2008; 180: 466-469
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 9 Purkayastha S, Tekkis PP, Athanasiou T et al. Magnetic resonance colonography versus colonoscopy as a diagnostic investigation for colorectal cancer: a meta-analysis. Clinical Radiology 2005; 60: 980-989
    CrossrefPubMedGoogle Scholar
  • 10 Hartmann D, Bassler B, Schilling D et al. Colorectal Polyps: Detection with Dark-Lumen MR Colonography versus Conventional Colonoscopy. Radiology 2006; 238: 143-149
    CrossrefPubMedGoogle Scholar
  • 11 Neri E, Giusti P, Battolla L et al. Colorectal cancer: role of CT colonography in preoperative evaluation after incomplete colonoscopy. Radiology 2002; 223: 615-619
    CrossrefPubMedGoogle Scholar
  • 12 Mitry E, Guiu B, Cosconea S et al. Epidemiology, management and prognosis of colorectal cancer with lung metastases: a 30-year population-based study. Gut 2010; 59: 1383-1388
    CrossrefPubMedGoogle Scholar
  • 13 Parnaby CN, Bailey W, Balasingam A et al. Pulmonary staging in colorectal cancer: a review. Colorectal Disease 2012; 14: 660-670
    CrossrefPubMedGoogle Scholar
  • 14 Floriani I, Torri V, Rulli E et al. Performance of imaging modalities in diagnosis of liver metastases from colorectal cancer: A systematic review and meta-analysis. Journal of Magnetic Resonance Imaging 2010; 31: 19-31
    CrossrefPubMedGoogle Scholar
  • 15 Niekel MC, Bipat S, Stoker J. Diagnostic Imaging of Colorectal Liver Metastases with CT, MR Imaging, FDG PET, and/or FDG PET/CT: A Meta-Analysis of Prospective Studies Including Patients Who Have Not Previously Undergone Treatment. Radiology 2010; 257: 674-684
    CrossrefPubMedGoogle Scholar
  • 16 Rafaelsen SR, Jakobsen A. Contrast-enhanced ultrasound vs multidetector-computed tomography for detecting liver metastases in colorectal cancer: a prospective, blinded, patient-by-patient analysis. Colorectal Disease 2011; 13: 420-425
    CrossrefPubMedGoogle Scholar
  • 17 Quaia E, D’Onofrio M, Palumbo A et al. Comparison of contrast-enhanced ultrasonography versus baseline ultrasound and contrast-enhanced computed tomography in metastatic disease of the liver: diagnostic performance and confidence. Eur Radiol 2006; 16: 1599-1609
    CrossrefPubMedGoogle Scholar
  • 18 Barton JB, Langdale LA, Cummins JS et al. The utility of routine preoperative computed tomography scanning in the management of veterans with colon cancer. The American Journal of Surgery 2002; 183: 499-503
    CrossrefPubMedGoogle Scholar
  • 19 Zbar AP, Rambarat C, Shenoy RK. Routine preoperative abdominal computed tomography in colon cancer: a utility study. Tech Coloproctol 2007; 11: 105-109
    CrossrefPubMedGoogle Scholar
  • 20 Dighe S, Purkayastha S, Swift I et al. Diagnostic precision of CT in local staging of colon cancers: a meta-analysis. Clinical Radiology 2010; 65: 708-719
    CrossrefPubMedGoogle Scholar
  • 21 Abdel-Nabi H, Doerr RJ, Lamonica DM et al. Staging of primary colorectal carcinomas with fluorine-18 fluorodeoxyglucose whole-body PET: correlation with histopathologic and CT findings. Radiology 1998; 206: 755-760
    PubMedGoogle Scholar
  • 22 Akiyoshi T, Oya M, Fujimoto Y et al. Comparison of preoperative whole-body positron emission tomography with MDCT in patients with primary colorectal cancer. Colorectal Disease 2009; 11: 464-469
    CrossrefPubMedGoogle Scholar
  • 23 Furukawa H, Ikuma H, Seki A et al. Positron emission tomography scanning is not superior to whole body multidetector helical computed tomography in the preoperative staging of colorectal cancer. Gut 2006; 55: 1007-1011
    CrossrefPubMedGoogle Scholar
  • 24 Kantorová I, Lipská L, Bêlohlávek O et al. Routine 18F-FDG PET Preoperative Staging of Colorectal Cancer: Comparison with Conventional Staging and Its Impact on Treatment Decision Making. J Nucl Med 2003; 44: 1784-1788
    PubMedGoogle Scholar
  • 25 Paskeviciute B, Bölling T, Brinkmann M et al. Impact of 18 F-FDG-PET/CT on Staging and Irradiation of Patients with Locally Advanced Rectal Cancer. Strahlentherapie und Onkologie 2009; 185: 260-265
    CrossrefPubMedGoogle Scholar
  • 26 Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWIG). Positronenemissionstomographie (PET und PET/CT) bei rezidivierendem kolorektalem Karzinom. 2012; D06-01: 111-11
    PubMedGoogle Scholar
  • 27 Taylor RA, Turoto S, Akhurst TJ. Evaluation with positron emission tomography before hepatic resection for metastatic colorectal cancer improves survival in patients with a high clinical risk score. In: Gastrointestinal Cancers Symposium – Abstract 240. 2007
    PubMedGoogle Scholar
  • 28 Ruers TJM, Wiering B, Sijp JRM van der et al. Improved Selection of Patients for Hepatic Surgery of Colorectal Liver Metastases with 18F-FDG PET: A Randomized Study. J Nucl Med 2009; 50: 1036-1041
    CrossrefPubMedGoogle Scholar
  • 29 Lubezky N, Metser U, Geva R et al. The Role and Limitations of 18-Fluoro-2-deoxy-d-glucose Positron Emission Tomography (FDG-PET) Scan and Computerized Tomography (CT) in Restaging Patients with Hepatic Colorectal Metastases Following Neoadjuvant Chemotherapy: Comparison with Operative and Pathological Findings. J Gastrointest Surg 2007; 11: 472-478
    CrossrefPubMedGoogle Scholar
  • 30 Adie S, Yip C, Chu F et al. Resection of liver metastases from colorectal cancer: does preoperative chemotherapy affect the accuracy of PET in preoperative planning?. ANZ J Surg 2009; 79: 358-361
    CrossrefPubMedGoogle Scholar
  • 31 Merkel S, Meyer T, Göhl J et al. Late locoregional recurrence in rectal carcinoma. Eur J Surg Oncol 2002; 28: 716-722
    CrossrefPubMedGoogle Scholar
  • 32 Ahmetoğlu A, Cansu A, Baki D et al. MDCT with multiplanar reconstruction in the preoperative local staging of rectal tumor. Abdom Imaging 2011; 36: 31-37
    CrossrefPubMedGoogle Scholar
  • 33 Puli SR, Reddy JBK, Bechtold ML et al. Accuracy of endoscopic ultrasound to diagnose nodal invasion by rectal cancers: a meta-analysis and systematic review. Ann. Surg. Oncol 2009; 16: 1255-1265
    CrossrefPubMedGoogle Scholar
  • 34 Bipat S, Glas AS, Slors FJM et al. Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging – a meta-analysis. Radiology 2004; 232: 773-783
    CrossrefPubMedGoogle Scholar
  • 35 N. I. f. C.E. Radiofrequency ablation for the treatment of colorectal metastases in the liver. London: o. J; 2011
    Google Scholar
  • 36 Kim KH, Yoon YS, Yu CS et al. Comparative analysis of radiofrequency ablation and surgical resection for colorectal liver metastases. J Korean Surg Soc 2011; 81: 25-34
    CrossrefPubMedGoogle Scholar
  • 37 Mulier S, Ruers T, Jamart J et al. Radiofrequency ablation versus resection for resectable colorectal liver metastases: time for a randomized trial? An update. Dig Surg 2008; 25: 445-460
    CrossrefPubMedGoogle Scholar
  • 38 Christophi C, Nikfarjam M, Malcontenti-Wilson C et al. Long-term survival of patients with unresectable colorectal liver metastases treated by percutaneous interstitial laser thermotherapy. World J Surg 2004; 28: 987-994
    CrossrefPubMedGoogle Scholar
  • 39 Welsh JS, Kennedy AS, Thomadsen B. Selective Internal Radiation Therapy (SIRT) for liver metastases secondary to colorectal adenocarcinoma. Int J Radiat Oncol Biol Phys 2006; 66: S62-S73
    PubMedGoogle Scholar
  • 40 Mancini R, Carpanese L, Sciuto R et al. A multicentric phase II clinical trial on intra-arterial hepatic radiotherapy with 90yttrium SIR-spheres in unresectable, colorectal liver metastases refractory to i. v. chemotherapy: preliminary results on toxicity and response rates. In Vivo 2006; 20: 711-714
    PubMedGoogle Scholar
  • 41 Solbiati L, Livraghi T, Goldberg SN et al. Percutaneous radio-frequency ablation of hepatic metastases from colorectal cancer: long-term results in 117 patients. Radiology 2001; 221: 159-166
    CrossrefPubMedGoogle Scholar
  • 42 Vogl TJ, Straub R, Eichler K et al. Malignant Liver Tumors Treated with MR Imaging-guided Laser-induced Thermotherapy: Experience with Complications in 899 Patients (2,520 lesions). Radiology 2002; 225: 367-377
    CrossrefPubMedGoogle Scholar
  • 43 Shibata T, Niinobu T, Ogata N et al. Microwave coagulation therapy for multiple hepatic metastases from colorectal carcinoma. Cancer 2000; 89: 276-284
    CrossrefPubMedGoogle Scholar
  • 44 Liang P, Dong B, Yu X et al. Evaluation of long-term therapeutic effects of ultrasound-guided percutaneous microwave ablation of liver metastases. Zhonghua Yi Xue Za Zhi 2006; 86: 806-810
    PubMedGoogle Scholar
  • 45 Hermanek PJr, Wiebelt H, Riedl S et al. Long-term results of surgical therapy of colon cancer. Results of the Colorectal Cancer Study Group. Chirurg 1994; 65: 287-297
    PubMedGoogle Scholar
  • 46 Wichmann MW, Müller C, Hornung HM et al. Results of long-term follow-up after curative resection of Dukes A colorectal cancer. World J Surg 2002; 26: 732-736
    CrossrefPubMedGoogle Scholar
  • 47 Körner H, Söreide K, Stokkeland PJ et al. Systematic follow-up after curative surgery for colorectal cancer in Norway: a population-based audit of effectiveness, costs, and compliance. J Gastrointest Surg 2005; 9: 320-328
    CrossrefPubMedGoogle Scholar
  • 48 Kievit J. Colorectal cancer follow-up: a reassessment of empirical evidence on effectiveness. Eur J Surg Oncol 2000; 26: 322-328
    CrossrefPubMedGoogle Scholar
  • 49 Bülow S, Christensen IJ, Harling H et al. Recurrence and survival after mesorectal excision for rectal cancer. Br J Surg 2003; 90: 974-980
    CrossrefPubMedGoogle Scholar
  • 50 Berman JM, Cheung RJ, Weinberg DS. Surveillance after colorectal cancer resection. Lancet 2000; 355: 395-399
    CrossrefPubMedGoogle Scholar
  • 51 Schoemaker D, Black R, Giles L et al. Yearly colonoscopy, liver CT, and chest radiography do not influence 5-year survival of colorectal cancer patients. Gastroenterology 1998; 114: 7-14
    CrossrefPubMedGoogle Scholar
  • 52 Kjeldsen BJ, Kronborg O, Fenger C et al. A prospective randomized study of follow-up after radical surgery for colorectal cancer. Br J Surg 1997; 84: 666-669
    CrossrefPubMedGoogle Scholar
  • 53 Jeffery GM, Hickey BE, Hider P. Follow-up strategies for patients treated for non-metastatic colorectal cancer. Cochrane Database Syst Rev 2002; CD002200
    PubMedGoogle Scholar
  • 54 Hünerbein M, Totkas S, Moesta KT et al. The role of transrectal ultrasound-guided biopsy in the postoperative follow-up of patients with rectal cancer. Surgery 2001; 129: 164-169
    CrossrefPubMedGoogle Scholar
  • 55 Pietra N, Sarli L, Costi R et al. Role of follow-up in management of local recurrences of colorectal cancer: a prospective, randomized study. Dis Colon Rectum 1998; 41: 1127-1133
    CrossrefPubMedGoogle Scholar
  • 56 Desch CE, Benson 3rd AB, Somerfield MR et al. Colorectal cancer surveillance: 2005 update of an American Society of Clinical Oncology practice guideline. J Clin Oncol 2005; 23: 8512-8519
    CrossrefPubMedGoogle Scholar
  • 57 Winawer S, Fletcher R, Rex D et al. Colorectal cancer screening and surveillance: clinical guidelines and rationale-Update based on new evidence. Gastroenterology 2003; 124: 544-560
    CrossrefPubMedGoogle Scholar
  • 58 Sobhani I, Tiret E, Lebtahi R et al. Early detection of recurrence by 18FDG-PET in the follow-up of patients with colorectal cancer. Br J Cancer 2008; 98: 875-880
    CrossrefPubMedGoogle Scholar
  • 59 Selvaggi F, Cuocolo A, Sciaudone G et al. FGD-PET in the follow-up of recurrent colorectal cancer. Colorectal Dis 2003; 5: 496-500
    CrossrefPubMedGoogle Scholar