Diagnostik, Staging und Therapie des Magenkarzinoms

Zusammenfassung

Während die Inzidenz des Magenkarzinoms im Westen kontinuierlich sinkt, stellt es weltweit nach wie vor eine der häufigsten tumorbedingten Todesursachen dar. Für die große Mehrheit der sporadischen Tumoren ist die molekulare Pathogenese weiterhin im Detail ungeklärt, für einzelne familiäre Karzinomformen konnten ursächliche Keimbahnmutationen detektiert werden. Nur die onkologisch radikale Resektion bietet Aussicht auf Heilung, dabei wird die Prognose vom Tumorstadium bestimmt - leider befinden sich im Westen noch immer etwa zwei Drittel der Patienten in einem fortgeschrittenen Stadium bei Diagnose.

Die Ergebnisse der chirurgischen Therapie sind auf einem Plateau angelangt, im Stadium IIIB und IV (UICC) gelingt nur in etwa 40 % eine prognostisch entscheidende R0-Resektion, und auch bei erfolgter kurativer Resektion ist die Rezidivrate - stadienabhängig - sehr hoch. Der Nutzen einer neoadjuvanten Chemotherapie bei lokal irresektablen Tumoren konnte in Phase-II-Studien hinreichend belegt werden. Weniger klar ist das Vorgehen in der adjuvanten Situation: Hier gilt es, den Nutzen einer Radiochemotherapie auch unter erfolgter systematischer Lymphadenektomie zu beweisen. In der palliativen Situation gelten derzeit platinbasierte 5-FU-Hochdosisprotokolle als Standard, dem sich moderne Substanzen wie Taxane oder Irinotecan bislang nicht als überlegen erwiesen haben.

Abstract

In spite of a continuously decreasing incidence in Western countries, gastric cancer remains a major health problem world-wide and a leading cause of cancer-related deaths. The molecular pathogenesis of the vast majority of sporadic tumours has not yet been clarified in detail, while for some familial cancer types causal germline mutations have been identified. Only radical resection offers a chance of cure and the prognosis is determined by the stage of disease at diagnosis. Unfortunately, about two-thirds of patients are still diagnosed in a late stage. The results of surgery have reached a plateau of effectiveness, in stages III and IV (UICC) an R0 resection will be possible in only about 40 % of cases and even, after successful curative resection, the prognosis is limited due to a high recurrence rate. The benefit of neoadjuvant chemotherapy in locally advanced cancers has been verified in phase II studies. Less clear is the adjuvant situation - the benefit of adjuvant radiochemotherapy after systematic lymphadenectomy awaits to be proven. In the palliative situation platinum-based high-dose 5-FU infusion protocols are currently the standard therapy.

Schlüsselwörter

Magenkarzinom - Diagnostik - Staging - Therapie - adjuvant - neoadjuvant - palliativ - Übersicht

Key words

Gastric cancer - diagnosis - staging - therapy - adjuvant - neoadjuvant - palliative - review

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