Palliative Therapie des Pankreasadenokarzinoms

Zusammenfassung

Die palliative Therapie des Pankreasadenokarzinoms besteht aus Basistherapie (best supportive care/BSC), zu der insbesondere die Schmerz- und Ernährungstherapie gehört, sowie in einer palliativen antineoplastischen Therapie. Ergänzt wird dies durch interventionell-therapeutische endoskopische Maßnahmen, die den Gallefluss wiederherstellen oder die Kontinuität des oberen Darmlumens durch die Einlage von Endoprothesen wahren. Die Schmerztherapie wird heute standardmäßig nach dem WHO-Schema durchgeführt, während die Ernährungstherapie häufig vernachlässigt wird. Für die palliative Chemotherapie empfiehlt sich entweder Gemcitabine oder 5-FU. Kombinationen mit anderen Zytostatika oder Bestrahlung befinden sich derzeit - im Rahmen von Studien - im Erprobungsstadium. Eine Reihe von rationalen Therapiekonzepten hat sehr gute Ergebnisse in tierexperimentellen und präklinischen Experimenten gezeigt, jedoch haben nur wenige Ansätze den Weg in frühe klinische Studien (Phase I/II) gefunden.

Palliative therapy of pancreatic carcinoma

The palliative therapy of pancreatic carcinoma consists of best supportive care (BSC) including nutritional and pain therapy, and antineoplastic remedies. This is complemented by interventional endoscopy aiming to treat obstructive jaundice and/or gastric or duodenal obstruction by implantation of endoprostheses. Pain therapy is standardized for the most part according to the WHO guidelines; nutrition of the cancer patient, however, is sometimes disregarded. For palliative chemotherapy, 5-fluorouracil and gemcitabine can be recommended. Combinations thereof with other cytostatic drugs or radiation are subject to ongoing studies. A variety of novel therapeutic concepts, e. g. immunomodulation or suicide gene therapy, have demonstrated good effects in animal studies. Unfortunately, very few of these have entered clinical studies (phase I and phase II). This will be the focus of future research in this field.

Schlüsselwörter

Pankreaskarzinom - Therapie - Chemotherapie - Gentherapie

Key words

Pancreatic Carcinoma - Therapy - Review - Chemotherapy - Gene Therapy

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