Skip to main content
Erschienen in:

01.07.2009 | CME Weiterbildung • Zertifizierte Fortbildung

Neoadjuvantes Behandlungskonzept

Am Beispiel des fortgeschrittenen Rektumkarzinoms

verfasst von: Dr. G. Lahmer, R. Fietkau

Erschienen in: Die Onkologie | Ausgabe 7/2009

Einloggen, um Zugang zu erhalten

Zusammenfassung

Die onkologische neoadjuvante Therapie dient der Schädigung des Tumors bzw. der Reduktion der Tumormasse („debulking“) vor einem geplanten operativen Eingriff. In den letzten Jahren ist die neoadjuvante simultane Radiochemotherapie (RCT) integraler Bestandteil der multimodalen Therapie des fortgeschrittenen Rektumkarzinoms geworden. Sie geht im Vergleich zur vorherigen postoperativen Behandlung mit einer geringeren Akut- und Langzeittoxizität sowie geringeren Lokalrezidivraten einher. Die Strahlentherapie der RCT wird konventionell fraktioniert mit einer Einzeldosis von 1,8 Gy bis zu einer Gesamtdosis von 45–50,4 Gy appliziert. Simultan wird 5-Fluorouracil (5-FU) als Basismedikament verabreicht. Durch Integration weiterer Zytostatika konnte die Behandlung intensiviert werden. Im vorliegenden Beitrag werden Daten, die zur Änderung der Behandlungsstrategie des fortgeschrittenen Rektumkarzinoms geführt haben, dargestellt und Empfehlungen für die Praxis gegeben.
Literatur
1.
Zurück zum Zitat Alonso V, Salud A, Escudero P, Bueso P (2005) Phase II trial of preoperative chemoradiotherapy with irinotecan and infusional 5-fluorouracil in locally advanced operable rectal carcinoma. ASCO Annual Meeting Proceedings Part I. J Clin Oncol [Suppl] 23(16S):3542 Alonso V, Salud A, Escudero P, Bueso P (2005) Phase II trial of preoperative chemoradiotherapy with irinotecan and infusional 5-fluorouracil in locally advanced operable rectal carcinoma. ASCO Annual Meeting Proceedings Part I. J Clin Oncol [Suppl] 23(16S):3542
2.
Zurück zum Zitat Ammann K, Kirchmayr W, Klaus A et al (2003) Impact of neoadjuvant chemoradiation on anal sphincter function in patients with carcinoma of the midrectum and low rectum. Arch Surg 138:257–261PubMedCrossRef Ammann K, Kirchmayr W, Klaus A et al (2003) Impact of neoadjuvant chemoradiation on anal sphincter function in patients with carcinoma of the midrectum and low rectum. Arch Surg 138:257–261PubMedCrossRef
3.
Zurück zum Zitat Aschele C, Friso ML, Pucciarelli S et al (2005) A phase I–II study of weekly oxaliplatin, 5-fluorouracil continuous infusion and preoperative radiotherapy in locally advanced rectal cancer. Ann Oncol 16:1140–1146PubMedCrossRef Aschele C, Friso ML, Pucciarelli S et al (2005) A phase I–II study of weekly oxaliplatin, 5-fluorouracil continuous infusion and preoperative radiotherapy in locally advanced rectal cancer. Ann Oncol 16:1140–1146PubMedCrossRef
4.
Zurück zum Zitat Birbeck KF, Macklin CP, Tiffin NJ et al (2002) Rates of circumferential resection margin involvement vary between surgeons and predict outcomes in rectal cancer surgery. Ann Surg 235:449–457PubMedCrossRef Birbeck KF, Macklin CP, Tiffin NJ et al (2002) Rates of circumferential resection margin involvement vary between surgeons and predict outcomes in rectal cancer surgery. Ann Surg 235:449–457PubMedCrossRef
5.
Zurück zum Zitat Bonnen M, Crane C, Vauthey JN et al (2004) Long-term results using local excision after preoperative chemoradiation among selected T3 rectal cancer patients. Int J Radiat Oncol Biol Phys 60:1098–1105PubMedCrossRef Bonnen M, Crane C, Vauthey JN et al (2004) Long-term results using local excision after preoperative chemoradiation among selected T3 rectal cancer patients. Int J Radiat Oncol Biol Phys 60:1098–1105PubMedCrossRef
6.
Zurück zum Zitat Borschitz T, Wachtlin D, Mohler M et al (2008) Neoadjuvant chemoradiation and local excision for T2–3 rectal cancer. Ann Surg Oncol 15:712–720PubMedCrossRef Borschitz T, Wachtlin D, Mohler M et al (2008) Neoadjuvant chemoradiation and local excision for T2–3 rectal cancer. Ann Surg Oncol 15:712–720PubMedCrossRef
7.
Zurück zum Zitat Bosset JF, Collette L, Calais G et al (2006) Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 355:1114–1123PubMedCrossRef Bosset JF, Collette L, Calais G et al (2006) Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 355:1114–1123PubMedCrossRef
8.
Zurück zum Zitat Braendengen M, Tveit KM, Berglund A et al (2008) Randomized phase III study comparing preoperative radiotherapy with chemoradiotherapy in nonresectable rectal cancer. J Clin Oncol 26:3687–3694PubMedCrossRef Braendengen M, Tveit KM, Berglund A et al (2008) Randomized phase III study comparing preoperative radiotherapy with chemoradiotherapy in nonresectable rectal cancer. J Clin Oncol 26:3687–3694PubMedCrossRef
9.
Zurück zum Zitat Bujko K, Nowacki MP, Nasierowska-Guttmejer A et al (2004) Sphincter preservation following preoperative radiotherapy for rectal cancer: report of a randomised trial comparing short-term radiotherapy vs. conventionally fractionated radiochemotherapy. Radiother Oncol 72:15–24PubMedCrossRef Bujko K, Nowacki MP, Nasierowska-Guttmejer A et al (2004) Sphincter preservation following preoperative radiotherapy for rectal cancer: report of a randomised trial comparing short-term radiotherapy vs. conventionally fractionated radiochemotherapy. Radiother Oncol 72:15–24PubMedCrossRef
10.
Zurück zum Zitat Bujko K, Nowacki MP, Nasierowska-Guttmejer A et al (2006) Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. Br J Surg 93:1215–1223PubMedCrossRef Bujko K, Nowacki MP, Nasierowska-Guttmejer A et al (2006) Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. Br J Surg 93:1215–1223PubMedCrossRef
11.
Zurück zum Zitat Coquard R, Martin P, Ardiet J et al (2001) Preoperative chemoradiation in T3T4 rectal cancer: better pathological response and downstaging with infusional 5FU than with 5FU/Leucovorin. A comparative study. Proc Am Soc Clin Oncol 20:Abstract 2240 Coquard R, Martin P, Ardiet J et al (2001) Preoperative chemoradiation in T3T4 rectal cancer: better pathological response and downstaging with infusional 5FU than with 5FU/Leucovorin. A comparative study. Proc Am Soc Clin Oncol 20:Abstract 2240
12.
Zurück zum Zitat Dehni N, McNamara DA, Schlegel RD et al (2002) Clinical effects of preoperative radiation therapy on anorectal function after proctectomy and colonic J-pouch-anal anastomosis. Dis Colon Rectum 45:1635–1640PubMedCrossRef Dehni N, McNamara DA, Schlegel RD et al (2002) Clinical effects of preoperative radiation therapy on anorectal function after proctectomy and colonic J-pouch-anal anastomosis. Dis Colon Rectum 45:1635–1640PubMedCrossRef
13.
Zurück zum Zitat Dunst J, Debus J, Rudat V et al (2008) Neoadjuvant capecitabine combined with standard radiotherapy in patients with locally advanced rectal cancer: mature results of a phase II trial. Strahlenther Onkol 184:450–456PubMedCrossRef Dunst J, Debus J, Rudat V et al (2008) Neoadjuvant capecitabine combined with standard radiotherapy in patients with locally advanced rectal cancer: mature results of a phase II trial. Strahlenther Onkol 184:450–456PubMedCrossRef
14.
Zurück zum Zitat Fietkau R, Zettl H, Klocking S, Kundt G (2004) Incidence, therapy and prognosis of colorectal cancer in different age groups. A population-based cohort study of the Rostock Cancer Registry. Strahlenther Onkol 180:478–487PubMed Fietkau R, Zettl H, Klocking S, Kundt G (2004) Incidence, therapy and prognosis of colorectal cancer in different age groups. A population-based cohort study of the Rostock Cancer Registry. Strahlenther Onkol 180:478–487PubMed
15.
Zurück zum Zitat Fietkau R, Rodel C, Hohenberger W et al (2007) Rectal cancer delivery of radiotherapy in adequate time and with adequate dose is influenced by treatment center, treatment schedule, and gender and is prognostic parameter for local control: results of study CAO/ARO/AIO-94. Int J Radiat Oncol Biol Phys 67:1008–1019PubMed Fietkau R, Rodel C, Hohenberger W et al (2007) Rectal cancer delivery of radiotherapy in adequate time and with adequate dose is influenced by treatment center, treatment schedule, and gender and is prognostic parameter for local control: results of study CAO/ARO/AIO-94. Int J Radiat Oncol Biol Phys 67:1008–1019PubMed
16.
Zurück zum Zitat Folkesson J, Birgisson H, Pahlman L et al (2005) Swedish rectal cancer trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol 23:5644–5650PubMedCrossRef Folkesson J, Birgisson H, Pahlman L et al (2005) Swedish rectal cancer trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol 23:5644–5650PubMedCrossRef
17.
Zurück zum Zitat Fritzmann J, Hunerbein M, Slisow W et al (2004) Influence of preoperative (hyperthermic) radiochemotherapy on manometric anal sphincter function in locally advanced rectal cancer. Strahlenther Onkol 180:281–288PubMedCrossRef Fritzmann J, Hunerbein M, Slisow W et al (2004) Influence of preoperative (hyperthermic) radiochemotherapy on manometric anal sphincter function in locally advanced rectal cancer. Strahlenther Onkol 180:281–288PubMedCrossRef
18.
Zurück zum Zitat Frykholm GJ, Pahlman L, Glimelius B (2001) Combined chemo- and radiotherapy vs. radiotherapy alone in the treatment of primary, nonresectable adenocarcinoma of the rectum. Int J Radiat Oncol Biol Phys 50:427–434PubMedCrossRef Frykholm GJ, Pahlman L, Glimelius B (2001) Combined chemo- and radiotherapy vs. radiotherapy alone in the treatment of primary, nonresectable adenocarcinoma of the rectum. Int J Radiat Oncol Biol Phys 50:427–434PubMedCrossRef
19.
Zurück zum Zitat Gerard JP, Chapet O, Nemoz C et al (2003) Preoperative concurrent chemoradiotherapy in locally advanced rectal cancer with high-dose radiation and oxaliplatin-containing regimen: the Lyon R0-04 phase II trial. J Clin Oncol 21:1119–1124PubMedCrossRef Gerard JP, Chapet O, Nemoz C et al (2003) Preoperative concurrent chemoradiotherapy in locally advanced rectal cancer with high-dose radiation and oxaliplatin-containing regimen: the Lyon R0-04 phase II trial. J Clin Oncol 21:1119–1124PubMedCrossRef
20.
Zurück zum Zitat Glynne-Jones R, Sebag-Montefiore D, Maughan TS et al (2006) A phase I dose escalation study of continuous oral capecitabine in combination with oxaliplatin and pelvic radiation (XELOX-RT) in patients with locally advanced rectal cancer. Ann Oncol 17:50–56PubMedCrossRef Glynne-Jones R, Sebag-Montefiore D, Maughan TS et al (2006) A phase I dose escalation study of continuous oral capecitabine in combination with oxaliplatin and pelvic radiation (XELOX-RT) in patients with locally advanced rectal cancer. Ann Oncol 17:50–56PubMedCrossRef
21.
Zurück zum Zitat Gollins S, Myint S, Levine E, Bishop J (2006) Radiotherapy plus concurrent irinotecan (CPT-11) and capecitabine (CAP) as preoperative downstaging treatment for locally advanced inoperable rectal cancer: a phase I/II study. ASCO Annual Meeting Proceedings Part I. J Clin Oncol [Suppl] 24(18S):13519 Gollins S, Myint S, Levine E, Bishop J (2006) Radiotherapy plus concurrent irinotecan (CPT-11) and capecitabine (CAP) as preoperative downstaging treatment for locally advanced inoperable rectal cancer: a phase I/II study. ASCO Annual Meeting Proceedings Part I. J Clin Oncol [Suppl] 24(18S):13519
22.
Zurück zum Zitat Habr-Gama A, Perez RO, Nadalin W et al (2004) Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results. Ann Surg 240:711–718PubMed Habr-Gama A, Perez RO, Nadalin W et al (2004) Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results. Ann Surg 240:711–718PubMed
23.
Zurück zum Zitat Habr-Gama A, Perez RO, Proscurshim I et al (2006) Patterns of failure and survival for nonoperative treatment of stage c0 distal rectal cancer following neoadjuvant chemoradiation therapy. J Gastrointest Surg 10:1319–1329PubMedCrossRef Habr-Gama A, Perez RO, Proscurshim I et al (2006) Patterns of failure and survival for nonoperative treatment of stage c0 distal rectal cancer following neoadjuvant chemoradiation therapy. J Gastrointest Surg 10:1319–1329PubMedCrossRef
24.
Zurück zum Zitat Hofheinz RD, Gerstenberg-Helldorf B von, Wenz F et al (2005) Phase I trial of capecitabine and weekly irinotecan in combination with radiotherapy for neoadjuvant therapy of rectal cancer. J Clin Oncol 23:1350–1357PubMedCrossRef Hofheinz RD, Gerstenberg-Helldorf B von, Wenz F et al (2005) Phase I trial of capecitabine and weekly irinotecan in combination with radiotherapy for neoadjuvant therapy of rectal cancer. J Clin Oncol 23:1350–1357PubMedCrossRef
25.
Zurück zum Zitat Hofheinz RD, Horisberger K, Woernle C et al (2006) Phase I trial of cetuximab in combination with capecitabine, weekly irinotecan and radiotherapy as neoadjuvant therapy for rectal cancer. Int J Radiat Oncol Biol Phys 66:1384–1390PubMed Hofheinz RD, Horisberger K, Woernle C et al (2006) Phase I trial of cetuximab in combination with capecitabine, weekly irinotecan and radiotherapy as neoadjuvant therapy for rectal cancer. Int J Radiat Oncol Biol Phys 66:1384–1390PubMed
26.
Zurück zum Zitat Kim JS, Cho MJ, Song KS, Yoon WH (2002) Preoperative chemoradiation using oral capecitabine in locally advanced rectal cancer. Int J Radiat Oncol Biol Phys 54:403–408PubMed Kim JS, Cho MJ, Song KS, Yoon WH (2002) Preoperative chemoradiation using oral capecitabine in locally advanced rectal cancer. Int J Radiat Oncol Biol Phys 54:403–408PubMed
27.
Zurück zum Zitat Kim JS, Cho MJ, Yoon WH, Song KS (2006) Comparison of the efficacy of oral capecitabine versus bolus 5-FU in preoperative radiotherapy of locally advanced rectal cancer. J Korean Med Sci 21:52–57PubMedCrossRef Kim JS, Cho MJ, Yoon WH, Song KS (2006) Comparison of the efficacy of oral capecitabine versus bolus 5-FU in preoperative radiotherapy of locally advanced rectal cancer. J Korean Med Sci 21:52–57PubMedCrossRef
28.
Zurück zum Zitat Klautke G, Feyerherd P, Ludwig K et al (2005) Intensified concurrent chemoradiotherapy with 5-fluorouracil and irinotecan as neoadjuvant treatment in patients with locally advanced rectal cancer. Br J Cancer 92:1215–1220PubMedCrossRef Klautke G, Feyerherd P, Ludwig K et al (2005) Intensified concurrent chemoradiotherapy with 5-fluorouracil and irinotecan as neoadjuvant treatment in patients with locally advanced rectal cancer. Br J Cancer 92:1215–1220PubMedCrossRef
29.
Zurück zum Zitat Klautke G, Kuchenmeister U, Foitzik T et al (2006) Concurrent chemoradiation with capecitabine and weekly irinotecan as preoperative treatment for rectal cancer: results from a phase I/II study. Br J Cancer 94:976–981PubMedCrossRef Klautke G, Kuchenmeister U, Foitzik T et al (2006) Concurrent chemoradiation with capecitabine and weekly irinotecan as preoperative treatment for rectal cancer: results from a phase I/II study. Br J Cancer 94:976–981PubMedCrossRef
30.
Zurück zum Zitat Klautke G, Kuchenmeister U, Foitzik T et al (2007) Intensified irinotecan-based neoadjuvant chemoradiotherapy in rectal cancer: four consecutive designed studies to minimize acute toxicity and to optimize efficacy measured by pathologic complete response. Radiother Oncol 85:379–384PubMedCrossRef Klautke G, Kuchenmeister U, Foitzik T et al (2007) Intensified irinotecan-based neoadjuvant chemoradiotherapy in rectal cancer: four consecutive designed studies to minimize acute toxicity and to optimize efficacy measured by pathologic complete response. Radiother Oncol 85:379–384PubMedCrossRef
31.
Zurück zum Zitat Liersch T, Langer C, Ghadimi BM et al (2006) Lymph node status and TS gene expression are prognostic markers in stage II/III rectal cancer after neoadjuvant fluorouracil-based chemoradiotherapy. J Clin Oncol 24:4062–4068PubMedCrossRef Liersch T, Langer C, Ghadimi BM et al (2006) Lymph node status and TS gene expression are prognostic markers in stage II/III rectal cancer after neoadjuvant fluorouracil-based chemoradiotherapy. J Clin Oncol 24:4062–4068PubMedCrossRef
32.
Zurück zum Zitat Machiels JP, Duck L, Honhon B et al (2005) Phase II study of preoperative oxaliplatin, capecitabine and external beam radiotherapy in patients with rectal cancer: the RadiOxCape study. Ann Oncol 16:1898–1905PubMedCrossRef Machiels JP, Duck L, Honhon B et al (2005) Phase II study of preoperative oxaliplatin, capecitabine and external beam radiotherapy in patients with rectal cancer: the RadiOxCape study. Ann Oncol 16:1898–1905PubMedCrossRef
33.
Zurück zum Zitat Marijnen CA, Nagtegaal ID, Kapiteijn E et al (2003) Radiotherapy does not compensate for positive resection margins in rectal cancer patients: report of a multicenter randomized trial. Int J Radiat Oncol Biol Phys 55:1311–1320PubMed Marijnen CA, Nagtegaal ID, Kapiteijn E et al (2003) Radiotherapy does not compensate for positive resection margins in rectal cancer patients: report of a multicenter randomized trial. Int J Radiat Oncol Biol Phys 55:1311–1320PubMed
34.
Zurück zum Zitat Mehta VK, Cho C, Ford JM et al (2003) Phase II trial of preoperative 3D conformal radiotherapy, protracted venous infusion 5-fluorouracil, and weekly CPT-11, followed by surgery for ultrasound-staged T3 rectal cancer. Int J Radiat Oncol Biol Phys 55:132–137PubMedCrossRef Mehta VK, Cho C, Ford JM et al (2003) Phase II trial of preoperative 3D conformal radiotherapy, protracted venous infusion 5-fluorouracil, and weekly CPT-11, followed by surgery for ultrasound-staged T3 rectal cancer. Int J Radiat Oncol Biol Phys 55:132–137PubMedCrossRef
35.
Zurück zum Zitat Mitchell E, Anne P, Fry R, Ahmad N (2001) Combined mortality therapy of locally advanced or recurrent adenocarcinoma of the rectum: report of a phase I trial of chemotherapy (CT) with CPT-11, 5-FU and concomitant irradiation (RT). Proc Am Soc Clin Oncol 20:Abstract 519) Mitchell E, Anne P, Fry R, Ahmad N (2001) Combined mortality therapy of locally advanced or recurrent adenocarcinoma of the rectum: report of a phase I trial of chemotherapy (CT) with CPT-11, 5-FU and concomitant irradiation (RT). Proc Am Soc Clin Oncol 20:Abstract 519)
36.
Zurück zum Zitat Nagtegaal ID, Quirke P (2008) What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol 26:303–312PubMedCrossRef Nagtegaal ID, Quirke P (2008) What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol 26:303–312PubMedCrossRef
37.
Zurück zum Zitat Ngan SY, Michael M, Mackay J et al (2004) A phase I trial of preoperative radiotherapy and capecitabine for locally advanced, potentially resectable rectal cancer. Br J Cancer 91:1019–1024PubMed Ngan SY, Michael M, Mackay J et al (2004) A phase I trial of preoperative radiotherapy and capecitabine for locally advanced, potentially resectable rectal cancer. Br J Cancer 91:1019–1024PubMed
38.
Zurück zum Zitat O’Connell MJ, Martenson JA, Wieand HS et al (1994) Improving adjuvant therapy for rectal cancer by combining protracted-infusion fluorouracil with radiation therapy after curative surgery. N Engl J Med 331:502–507CrossRef O’Connell MJ, Martenson JA, Wieand HS et al (1994) Improving adjuvant therapy for rectal cancer by combining protracted-infusion fluorouracil with radiation therapy after curative surgery. N Engl J Med 331:502–507CrossRef
39.
Zurück zum Zitat Peeters KC, Van de Velde CJ, Leer JW et al (2005) Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients – a Dutch colorectal cancer group study. J Clin Oncol 23:6199–6206PubMedCrossRef Peeters KC, Van de Velde CJ, Leer JW et al (2005) Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients – a Dutch colorectal cancer group study. J Clin Oncol 23:6199–6206PubMedCrossRef
40.
Zurück zum Zitat Peeters KC, Marijnen CA, Nagtegaal ID et al (2007) The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg 246:693–701PubMedCrossRef Peeters KC, Marijnen CA, Nagtegaal ID et al (2007) The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg 246:693–701PubMedCrossRef
41.
Zurück zum Zitat Pietsch AP, Fietkau R, Klautke G et al (2007) Effect of neoadjuvant chemoradiation on postoperative fecal continence and anal sphincter function in rectal cancer patients. Int J Colorectal Dis 22:1311–1317PubMedCrossRef Pietsch AP, Fietkau R, Klautke G et al (2007) Effect of neoadjuvant chemoradiation on postoperative fecal continence and anal sphincter function in rectal cancer patients. Int J Colorectal Dis 22:1311–1317PubMedCrossRef
42.
Zurück zum Zitat Pollack J, Holm T, Cedermark B et al (2006) Late adverse effects of short-course preoperative radiotherapy in rectal cancer. Br J Surg 93:1519–1525PubMedCrossRef Pollack J, Holm T, Cedermark B et al (2006) Late adverse effects of short-course preoperative radiotherapy in rectal cancer. Br J Surg 93:1519–1525PubMedCrossRef
43.
Zurück zum Zitat Rodel C, Grabenbauer GG, Papadopoulos T et al (2003) Phase I/II trial of capecitabine, oxaliplatin and radiation for rectal cancer. J Clin Oncol 21:3098–3104PubMedCrossRef Rodel C, Grabenbauer GG, Papadopoulos T et al (2003) Phase I/II trial of capecitabine, oxaliplatin and radiation for rectal cancer. J Clin Oncol 21:3098–3104PubMedCrossRef
44.
Zurück zum Zitat Rodel C, Martus P, Papadoupolos T et al (2005) Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol 23:8688–8696PubMedCrossRef Rodel C, Martus P, Papadoupolos T et al (2005) Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol 23:8688–8696PubMedCrossRef
45.
Zurück zum Zitat Rodel C, Liersch T, Hermann RM et al (2007) Multicenter phase II trial of chemoradiation with oxaliplatin for rectal cancer. J Clin Oncol 25:110–117PubMedCrossRef Rodel C, Liersch T, Hermann RM et al (2007) Multicenter phase II trial of chemoradiation with oxaliplatin for rectal cancer. J Clin Oncol 25:110–117PubMedCrossRef
46.
Zurück zum Zitat Rodel C, Arnold D, Hipp M et al (2008) Phase I–II trial of cetuximab, capecitabine, oxaliplatin and radiotherapy as preoperative treatment in rectal cancer. Int J Radiat Oncol Biol Phys 70:1081–1086PubMed Rodel C, Arnold D, Hipp M et al (2008) Phase I–II trial of cetuximab, capecitabine, oxaliplatin and radiotherapy as preoperative treatment in rectal cancer. Int J Radiat Oncol Biol Phys 70:1081–1086PubMed
47.
Zurück zum Zitat Ronzoni M, Ceresoli G, Passoni P et al (2001) Preoperative neoadiuvant radio-chemotherapy for T3–T4 rectal cancer. Proc Am Soc Clin Oncol 20:Abstract 2245 Ronzoni M, Ceresoli G, Passoni P et al (2001) Preoperative neoadiuvant radio-chemotherapy for T3–T4 rectal cancer. Proc Am Soc Clin Oncol 20:Abstract 2245
48.
Zurück zum Zitat Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740PubMedCrossRef Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740PubMedCrossRef
49.
Zurück zum Zitat Sebag-Montefiore D, Glynne-Jones R, Falk S et al (2005) A phase I/II study of oxaliplatin when added to 5-fluorouracil and leucovorin and pelvic radiation in locally advanced rectal cancer: a Colorectal Clinical Oncology Group (CCOG) study. Br J Cancer 93:993–998PubMedCrossRef Sebag-Montefiore D, Glynne-Jones R, Falk S et al (2005) A phase I/II study of oxaliplatin when added to 5-fluorouracil and leucovorin and pelvic radiation in locally advanced rectal cancer: a Colorectal Clinical Oncology Group (CCOG) study. Br J Cancer 93:993–998PubMedCrossRef
50.
Zurück zum Zitat Sebag-Montefiore D, Steele R, Quirke P et al (2006) Routine short course pre-op radiotherapy or selective post-op chemoradiotherapy for resectable rectal cancer? Preliminary results of the MRC CR07 randomised trial. ASCO Annual Meeting Proceedings Part I. J Clin Oncol [Suppl] 24(18S):3511 Sebag-Montefiore D, Steele R, Quirke P et al (2006) Routine short course pre-op radiotherapy or selective post-op chemoradiotherapy for resectable rectal cancer? Preliminary results of the MRC CR07 randomised trial. ASCO Annual Meeting Proceedings Part I. J Clin Oncol [Suppl] 24(18S):3511
51.
Zurück zum Zitat Turitto G, Panelli G, Frattolillo A et al (2006) Phase II study of neoadjuvant concurrent chemioradiotherapy with oxaliplatin-containing regimen in locally advanced rectal cancer. Front Biosci 11:1275–1279PubMedCrossRef Turitto G, Panelli G, Frattolillo A et al (2006) Phase II study of neoadjuvant concurrent chemioradiotherapy with oxaliplatin-containing regimen in locally advanced rectal cancer. Front Biosci 11:1275–1279PubMedCrossRef
52.
Zurück zum Zitat Valero G, Lujan JA, Hernandez Q et al (2003) Neoadjuvant radiation and chemotherapy in rectal cancer does not increase postoperative complications. Int J Colorectal Dis 18:495–499PubMedCrossRef Valero G, Lujan JA, Hernandez Q et al (2003) Neoadjuvant radiation and chemotherapy in rectal cancer does not increase postoperative complications. Int J Colorectal Dis 18:495–499PubMedCrossRef
53.
Zurück zum Zitat Van Duijvendijk P, Slors JF, Taat CW et al (2002) Prospective evaluation of anorectal function after total mesorectal excision for rectal carcinoma with or without preoperative radiotherapy. Am J Gastroenterol 97:2282–2289 Van Duijvendijk P, Slors JF, Taat CW et al (2002) Prospective evaluation of anorectal function after total mesorectal excision for rectal carcinoma with or without preoperative radiotherapy. Am J Gastroenterol 97:2282–2289
54.
Zurück zum Zitat Videtic GM, Fisher BJ, Perera FE et al (1998) Preoperative radiation with concurrent 5-fluorouracil continuous infusion for locally advanced unresectable rectal cancer. Int J Radiat Oncol Biol Phys 42:319–324PubMed Videtic GM, Fisher BJ, Perera FE et al (1998) Preoperative radiation with concurrent 5-fluorouracil continuous infusion for locally advanced unresectable rectal cancer. Int J Radiat Oncol Biol Phys 42:319–324PubMed
55.
Zurück zum Zitat Wibe A, Rendedal PR, Svensson E et al (2002) Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer. Br J Surg 89:327–334PubMedCrossRef Wibe A, Rendedal PR, Svensson E et al (2002) Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer. Br J Surg 89:327–334PubMedCrossRef
56.
Zurück zum Zitat Willett C, Duda D, Boucher Y, di Tomaso E (2007) Phase I/II study of neoadjuvant bevacizumab with radiation therapy and 5-fluorouracil in patients with rectal cancer: initial results. ASCO Annual Meeting Proceedings Part I. J Clin Oncol [Suppl] 25(18S):4041 Willett C, Duda D, Boucher Y, di Tomaso E (2007) Phase I/II study of neoadjuvant bevacizumab with radiation therapy and 5-fluorouracil in patients with rectal cancer: initial results. ASCO Annual Meeting Proceedings Part I. J Clin Oncol [Suppl] 25(18S):4041
57.
Zurück zum Zitat Yoon W, Choi J, Kim J et al (2001) Enhanced tumoricidal effect of preoperative chemoradiation using capecitabine for locally advanced rectal cancer. Proc Am Soc Clin Oncol 20:Abstract 2165 Yoon W, Choi J, Kim J et al (2001) Enhanced tumoricidal effect of preoperative chemoradiation using capecitabine for locally advanced rectal cancer. Proc Am Soc Clin Oncol 20:Abstract 2165
Metadaten
Titel
Neoadjuvantes Behandlungskonzept
Am Beispiel des fortgeschrittenen Rektumkarzinoms
verfasst von
Dr. G. Lahmer
R. Fietkau
Publikationsdatum
01.07.2009
Verlag
Springer-Verlag
Erschienen in
Die Onkologie / Ausgabe 7/2009
Print ISSN: 2731-7226
Elektronische ISSN: 2731-7234
DOI
https://doi.org/10.1007/s00761-009-1647-7

Weitere Artikel der Ausgabe 7/2009

Die Onkologie 7/2009 Zur Ausgabe

Einführung zum Thema

Tumorschmerztherapie

Neu im Fachgebiet Onkologie

Die beste Jahreszeit für eine Krebsimmuntherapie

16.07.2024 Onkologische Immuntherapie Nachrichten

Die Wirksamkeit von Checkpointhemmern scheint klinisch relevanten saisonalen Schwankungen zu unterliegen. Patienten mit fortgeschrittenem nichtkleinzelligem Lungenkarzinom etwa hatten das beste Outcome, wenn die PD-1-Inhibitor-Infusionen in den Wintermonaten starteten.

Partielle Nephrektomie: Videoanalysen zur Verbesserung der chirurgischen Qualität

16.07.2024 Nephrektomie Nachrichten

Je versierter Operateurinnen und Operateure sind, desto geringer ist das Risiko für Komplikationen. Eine kleine US-Studie spricht dafür, dass das auch bei Roboter-assistierten Nephrektomien gilt – und dass sich Op.-Videos für die Beurteilung eignen.        

S3-Leitlinie Endometriumkarzinom aktualisiert

15.07.2024 Endometriumkarzinom Nachrichten

Die angepasste Version der S3-Leitlinie Endometriumkarzinom enthält unter anderem Empfehlungen zu Risikofaktoren, wie der Hormonersatztherapie, sowie darüber, wann eine vaginale Brachytherapie und wann eine Perkutanbestrahlung angebracht ist.

Warum junge Brustkrebspatientinnen die endokrine Therapie absetzen

15.07.2024 Mammakarzinom Nachrichten

Bei jungen Brustkrebspatientinnen ist die Wahrscheinlichkeit groß, dass sie eine adjuvante endokrine Therapie vorzeitig absetzen. In einer europäischen Kohorte wurden dafür zwei Risikofaktoren identifiziert, die bei der Behandlung berücksichtigt werden sollten.

Update Onkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.