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01.10.2003 | Leitthema

Indikationen zur neoadjuvanten Therapie beim Rektumkarzinom

verfasst von: F. Zimmermann, Prof. Dr. M. Molls

Erschienen in: Die Chirurgie | Ausgabe 10/2003

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Zusammenfassung

Prä- wie postoperative adjuvante Therapien haben beim lokal fortgeschrittenen, prognostisch resektablen Rektumkarzinom (R0-Resektion) die Ergebnisse verbessert. Grundsätzlich gilt in diesen Stadien des Rektumkarzinoms (T3/4 N0 M0; jedes T-Stadium N+M0) immer noch der interdisziplinäre Konsens der Deutschen Krebsgesellschaft, der sich für die postoperative adjuvante Radiochemotherapie ausspricht. Nach zahlreichen klinischen Studien mit guten Resultaten wird international mittlerweile die präoperative adjuvante Therapie bevorzugt. Sie scheint bei vergleichsweise höherer Compliance der Patienten auch besser toleriert zu werden. Die alleinige hypofraktionierte präoperative Radiotherapie über 3–4 Felder, der in kürzester Zeit die Operation folgt, stellt beim primär resektablen T3-Tumor eine Therapieoption dar. Ein zusätzlicher Nutzen kann von einer konventionell fraktionierten simultanen Radiochemotherapie (Einzeldosis im Bereich von 2 Gy, Gesamtdosis über 40 Gy, Chemotherapie basiert auf 5-FU), der die Operation erst nach mehreren Wochen folgt, erwartet werden. Dringend zu empfehlen ist eine präoperative Therapie bei T4-Tumoren, bei denen der Chirurg von einer R1- oder R2-Resektion ausgehen muss. Die Wahrung der Kontinenz kann bei Einhaltung der erforderlichen chirurgischen Radikalität (Ziel: R0-Resektion!) in Einzelfällen ein weiteres Ziel der multimodalen Therapie sein.

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Titel: Indikationen zur neoadjuvanten Therapie beim Rektumkarzinom
verfasst von: F. Zimmermann
Prof. Dr. M. Molls
Publikationsdatum: 01.10.2003
Verlag: Springer-Verlag
Erschienen in: Die Chirurgie / Ausgabe 10/2003
Print ISSN: 2731-6971
Elektronische ISSN: 2731-698X
DOI: https://doi.org/10.1007/s00104-003-0739-y

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