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01.04.2008 | Leitthema

Neoadjuvante und perioperative Therapie des Magenkarzinoms

verfasst von: Prof. H. Wilke, N. Willich, H.-J. Meyer, M. Stahl

Erschienen in: Die Onkologie | Ausgabe 4/2008

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Zusammenfassung

In den letzten 20 Jahren sind in der Therapie von Adenokarzinomen des Magens und gastroösophagealen Übergangs deutliche Fortschritte gemacht worden. Dies gilt sowohl für die palliative Chemotherapie als auch für perioperative Therapien mit kurativem Behandlungsansatz. In randomisierten Studien konnte gezeigt werden, dass eine prä- und postoperative Chemotherapie im Vergleich zu alleiniger Chirurgie das krankheitsfreie Überleben und das Gesamtüberleben nach 5 Jahren signifikant um ca. 10–14% verbessert und zu keiner Erhöhung der postoperativen Morbidität und Letalität führt. Aufgrund dieser Ergebnisse wird jetzt die perioperative Chemotherapie bei Patienten mit einem lokal begrenzten und endosonographisch (EUS) als uT2–uT4 definierten Tumor als Therapie der Wahl angesehen. Die Rolle der präoperativen Chemostrahlentherapie ist noch nicht definitiv geklärt. Bisherige Studienergebnisse weisen daraufhin, dass diese Therapiemodalität sehr wirksam zu sein scheint. Dies gilt insbesondere für Adenokarzinome des gastroösophagealen Übergangs und des distalen Ösophagus. Eine postoperative (adjuvante) Chemotherapie kann derzeit nach R0-Resektion nicht empfohlen werden. In westlichen Studien wurde bisher kein relevanter Benefit für diese Therapiestrategie nachgewiesen. Die postoperative Chemostrahlentherapie ist nicht generell zu empfehlen. Sie stellt aber eine sinnvolle Behandlungsoption für Patienten dar, die nicht adäquat onkologisch operiert worden sind.
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Zurück zum Zitat Stahl M, Walz MK, Stuschke M et al. (2007) Preoperative chemotherapy (CTX) versus chemoradiotherapy (CRTX) in locally advanced esophagogastric adenocarcinomas: First results of a randomized phase III trial. J Clin Oncol (Suppl 18) 25: 200; Abstrakt 4511 Stahl M, Walz MK, Stuschke M et al. (2007) Preoperative chemotherapy (CTX) versus chemoradiotherapy (CRTX) in locally advanced esophagogastric adenocarcinomas: First results of a randomized phase III trial. J Clin Oncol (Suppl 18) 25: 200; Abstrakt 4511
Metadaten
Titel
Neoadjuvante und perioperative Therapie des Magenkarzinoms
verfasst von
Prof. H. Wilke
N. Willich
H.-J. Meyer
M. Stahl
Publikationsdatum
01.04.2008
Verlag
Springer-Verlag
Erschienen in
Die Onkologie / Ausgabe 4/2008
Print ISSN: 2731-7226
Elektronische ISSN: 2731-7234
DOI
https://doi.org/10.1007/s00761-008-1337-x

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