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Z Gastroenterol 2020; 58(06): 564-576
DOI: 10.1055/a-1149-2282
Review

Gastrointestinale Tumoren beim älteren und alten Patienten

Gastrointestinal tumors in older patients
Nadine Schulte
1   II. Medizinische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät, Universität Heidelberg
,
Matthias P. Ebert
1   II. Medizinische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät, Universität Heidelberg
,
Christoph Reissfelder
2   Chrirurgische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät, Universität Heidelberg
,
Nicolai Härtel
1   II. Medizinische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät, Universität Heidelberg
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Zusammenfassung

Ältere Patienten (65 Jahre und älter) stellen die Mehrheit der Patienten mit einer Krebsdiagnose dar. Für Ösophaguskarzinome liegt der Altersgipfel in der siebten bis achten Lebensdekade. Bei Magenkarzinomen ist 1/3 der Patienten älter als 75 Jahre, und ca. 45 % der Kolonkarzinom-Patienten sind ≥ 75 Jahre alt.

Aufgrund bestehender Komorbiditäten, altersbedingter Veränderungen und Polypharmazie stellen ältere und alte Patienten eine besondere Herausforderung in der Tumortherapie dar.

In Studien sind diese Patienten meist deutlich unterrepräsentiert, und dezidierte „Elderly“-Studien sind rar. Neue Operationsverfahren mit der minimalinvasiven Technik wie der Laparoskopie oder mit Telemanipulatoren liefern gerade für das Ösophagus- und Magenkarzinom Vorteile, die zukünftig für alte und ältere Patienten die postoperative Morbidität in Bezug auf kardiale und pulmonale Komplikationen deutlich senken können.

Bezüglich Chemotherapie zeigt sich eine gute Verträglichkeit von Fluoropyrimidinen und Oxaliplatin; von Triple-Therapien sollte eher Abstand genommen werden. Gerade die Immuntherapie bietet aufgrund des besseren Nebenwirkungsprofils eine interessante Alternative zur Standardchemotherapie.

Abstract

Older patients (65 years and over) represent the majority of patients with a cancer diagnosis. For oesophageal carcinomas, the age peak is in the seventh to eighth decade of life. In gastric carcinoma, 1/3 of patients are older than 75 years and approximately 45 % of colon carcinoma patients are ≥ 75 years old.

Due to existing comorbidities, age-related changes and polypharmacy, older patients present a special challenge in tumor therapy.

In studies, these patients are usually clearly under-represented and „elderly“-studies are rare.

New surgical procedures with laparoscopy and also robotic provide advantages for esophageal and gastric carcinoma, which in the future can reduce postoperative morbidity in relation to cardiac and pulmonary complications for old and older patients. The selection of suitable patients is essential here.

With regard to chemotherapy, fluoropyrimidines and oxaliplatin are well tolerated; triplet therapies should be avoided. Immunotherapy in particular offers an interesting alternative to standard chemotherapy due to its better side effect profile.

Schlüsselwörter

geriatrische Onkologie - Ösophaguskarzinom - Kolonkarzinom - Magenkarzinom

Key words

geriatric oncology - esophageal cancer - colorectal cancer - gastric cancer


Publication History

Received: 08 November 2019

Accepted: 26 March 2020

Article published online:
16 June 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

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