nach oben

Die Onkologie

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.

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

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

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

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

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

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

Bosset JF, Collette L, Calais G et al (2006) Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 355:1114–1123PubMedCrossRef

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740PubMedCrossRef

49.

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.

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.

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.

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.

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.

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.

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.

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.

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

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

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

Neoadjuvantes Behandlungskonzept

Am Beispiel des fortgeschrittenen Rektumkarzinoms

Zusammenfassung

Neu im Fachgebiet Onkologie

Alphablocker schützt vor Miktionsproblemen nach der Biopsie

Antikörper-Wirkstoff-Konjugat hält solide Tumoren in Schach

Mammakarzinom: Senken Statine das krebsbedingte Sterberisiko?

Labor, CT-Anthropometrie zeigen Risiko für Pankreaskrebs

Update Onkologie

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

Zusammenfassung

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 7/2009

Körperliche Bewegung und Sport zur Prävention und Behandlung von Krebskrankheiten

Interventionelle Verfahren in der Tumorschmerztherapie

Ein Fortbildungsformat etabliert sich

Schmerztherapie bei onkologischen Patienten

Chirurgische Maßnahmen zur Symptomlinderung bei Tumorschmerz

Psychologische Aspekte in der Tumorschmerzbehandlung

Neu im Fachgebiet Onkologie

Alphablocker schützt vor Miktionsproblemen nach der Biopsie

Antikörper-Wirkstoff-Konjugat hält solide Tumoren in Schach

Mammakarzinom: Senken Statine das krebsbedingte Sterberisiko?

Labor, CT-Anthropometrie zeigen Risiko für Pankreaskrebs

Update Onkologie