Neoadjuvante und adjuvante Therapie des Magenkarzinoms

Zusammenfassung

Neoadjuvante und adjuvante Therapiemodalitäten sind häufig bei lokal-fortgeschrittenen Magenkarzinomen eingesetzt worden. Die adjuvante Chemotherapie wird bis dato nicht als sehr gewinnbringend eingestuft und ist nach wie vor eine experimentelle Therapie. Seit der Veröffentlichung des Intergroup Trials 0116 im September 2001 wird die adjuvante Radiochemotherapie als Standardtherapie beim nodal-positiven Magenkarzinom in den USA empfohlen. Diese Studie ist aber in Europa und Japan heftig kritisiert worden, insbesondere aufgrund der inadäquaten Resektion. So erhielten 54 % der Patienten weniger als eine D1-Lymphadenektomie. Die neoadjuvante Chemotherapie erscheint sinnvoll, allerdings gibt es bis dato nur eine große randomisierte Studie aus Grossbritannien (die so genannte MAGIC Studie). Auch diese Studie hat inhärente Probleme, wie z. B. das minimalistische Staging, Defizite in der chirurgischen und histopathologischen Qualitätskontrolle (z. B. keine Angaben zur Häufigkeit der R1-Resektionen) und durch den Einschluss von Adenokarzinomen des distalen Ösophagus. Momentan kann keine der genannten multimodalen Therapieprinzipien als Standard bei der Behandlung des Magenkarzinoms empfohlen werden. Patienten, die diese Therapieformen erhalten, sollten bevorzugt innerhalb von kontrollierten Studien behandelt werden.

Abstract

Neoadjuvant and adjuvant treatment modalities have been tested widely in locally advanced gastric cancers. Adjuvant chemotherapy is not considered to be of significant benefit and such therapy for patients with resected gastric cancer is investigational. In the USA, the use of postoperative radiochemotherapy is considered a standard of care after the publication of the Intergroup Study 0116 in September 2001. The study has been heavily criticized in Europe and Japan mainly due to inadequate surgery as 54 % of the patients received less than a D1-lymphadenectomy. Neoadjuvant chemotherapy appears to be attractive however, only one larger randomized trial has currently been reported from the United Kingdom (the so-called MAGIC Trial). This trial again has some inherent problems with minimal pretherapeutic staging, deficits in surgical and pathological quality control (i. e. frequency of R1-resections is unknown) and inclusion of esophageal adenocarcinomas. Currently none of these treatment modalities can be recommended as standard of care and patients receiving this type of treatment should therefore exclusively been treated within controlled trials.

Schlüsselwörter

multimodale Therapie - Chemotherapie - adjuvante Therapie - Radiochemotherapie - neoadjuvante Therapie - Magenkarzinom

Key words

multimodality treatment - chemotherapy - adjuvant therapy - chemoradiotherapy - neoadjuvant therapy - gastric cancer

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