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DOI: 10.1055/s-2001-11139
Multimodale Therapiekonzepte beim Ösophaguskarzinom
Publikationsverlauf
Publikationsdatum:
31. Dezember 2001 (online)
![](https://www.thieme-connect.de/media/viszeralchirurgie/200101/lookinside/thumbnails/10.1055-s-2001-11139-1.jpg)
Zusammenfassung.
Eine stadiengerechte Therapie von Patienten mit Ösophaguskarzinom erfordert präoperativ eine exakte Erfassung der Tumorausdehnung und eine präzise Stadieneinteilung. Bei Patienten mit einem lokal begrenzten Ösophaguskarzinom (Stadium I-IIB bzw. T1-T2/N0 - N1/M0) ist die En-bloc-Ösophagektomie mit Lymphadenektomie die Therapie der ersten Wahl. Bei Patienten mit einem lokoregionär fortgeschrittenen Oesophaguskarzinom (Stadium III bzw. T3 - T4/N0 - N1/M0) ist besonders bei suprabifurkaler Tumorlokalisation eine primäre R0-Resektion problematisch. Unter den multimodalen Therapieverfahren führt vor allem die neoadjuvante Radiochemotherapie im Vergleich zur alleinigen Operation bei einer signifikanten Anzahl von Patienten zum Down-Staging des Primärtumors und Zunahme der R0-Resektionsrate, welche mit einer Reduktion der Lokalrezidivrate und Verlängerung des rezidivfreien Intervalls einhergehen kann. Allerdings ist diese Vorbehandlung mit einer beachtenswerten Toxizität und einer gesteigerten postoperativen Mortalität assoziiert, so dass die Suche nach verbesserten Modalitäten kombinierter Behandlung (z.B. lokale Hyperthermie) und der Einsatz neuer zytostatischer Substanzen Aufgabe der Zukunft ist.
Multimodality therapy in esophageal carcinoma.
Once the diagnosis of esophageal cancer is established, the decision on treatment will depend on the stage of the disease. Since improvement of prognosis can only be expected in patients with complete removal of their tumor, preoperative staging plays a pivotal role in the decision-making process. En bloc esophagectomy together with the regional lymph nodes remains the treatment of choice in medically fit patients with localized esophageal carcinoma (Stage I-IIB, T1 - T2/N0 - N1/M0). Due to early involvement of mediastinal structures, curative resection is unlikely to be achieved in patients with locally advanced esophageal carcinoma (Stage III, T3 - T4/N0 - N1/M0). Most available data indicate that neoadjuvant radiochemotherapy leads in a significant number of patients to downstaging of the tumor, increases the rate of R0 resection, improves local tumor control, and prolongs the recurrence free interval. However, neoadjuvant radiochemotherapy resulted in a marked increase of morbidity and postoperative mortality and survival without improvement of survival. At present, neoadjuvant therapy is still experimental and there is no consensus for an optimal treatment regimen. Its use outside of an investigational setting can not be recommended. Future research must focus on more effective and less toxic neoadjuvant modalities (e. g. new chemotherapy agents, hyperthermia).
Schlüsselwörter:
Multimodale Therapie - Ösophaguskarzinom
Key words:
Multimodality therapy - Esophageal carcinoma
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Prof. Dr. med. Dr. h. c. P. M. Schlag
Klinik für Chirurgie und Chirurgische OnkologieUniversitätsklinikum Charité, Campus Berlin-BuchRobert-Rössle-Klinik am Max-Delbrück-Centrum für Molekulare Medizin
Lindenberger Weg 80
13125 Berlin
Telefon: 030-9417-1400
Fax: 030-9417-1404
eMail: schlag@rrk-berlin.de