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Dtsch Med Wochenschr 2021; 146(22): 1457-1467
DOI: 10.1055/a-1391-5124
Dossier

Die neoadjuvante und adjuvante Therapie des resektablen Kolonkarzinoms: Aktuelle Standards und Entwicklungen

Neoadjuvant and adjuvant therapy of resectable colon cancerCurrent standards and developments

Autoren

  • Volker Heinemann

  • Sebastian Stintzing

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Die vorliegende Übersichtsarbeit konzentriert sich auf die perioperative Diagnose und Behandlung des resezierbaren Kolonkarzinoms. In UICC-Stadien, die mit einem höheren Rezidivrisiko verbunden sind, ist die adjuvante Chemotherapie nach Resektion des Primärtumors ein etablierter Standard. Erste Daten weisen zwar auch auf den Nutzen einer neoadjuvanten, präoperativen Chemotherapie hin, eine endgültige Bewertung steht jedoch noch aus.

Abstract

The present review focusses on perioperative diagnosis and treatment of resectable colon cancer. In UICC stages associated with a higher risk of recurrence, adjuvant chemotherapy after resection of the primary tumor is an established standard. While initial data also indicate the benefit of Neoadjuvant, pre-operative chemotherapy, a final evaluation is still pending. The main focus of molecular testing in the perioperative setting is the analysis of microsatellite instability, which should routinely be performed in defined subgroups. In UICC stage II without risk factors, adjuvant therapy has a limited benefit and therefore is not a preferred option. In UICC stage II with risk factors, adjuvant therapy can be performed. The approach here is based on the recommendations applicable to stage III. In UICC stage III with low risk, adjuvant chemotherapy with CAPOX for 3 months is preferentially recommended. In UICC stage III with high risk, adjuvant chemotherapy over 6 months is recommended, preferentially with FOLFOX. Microsatellite instability (MSI) is clearly associated with favorable prognosis in non-metastatic colon cancer. However, it cannot be considered a predictive factor for the efficacy of adjuvant chemotherapy. Specifically, recent data of the IDEA study have opened the arena for shared decision making between physicians and patients allowing to define individual treatment approaches based on common assessment of risks and benefits. After completion of perioperative treatment, structured follow-up is of great importance and should be carried out according to the recommendations of the S3 guideline.

Schlüsselwörter

Kolonkarzinom - molekulare Subgruppen - adjuvante Therapie - neoadjuvante Therapie - gemeinsame Entscheidungsfindung

Key words

colon cancer - molecular subgroups - adjuvant therapy - neoadjuvant therapy - shared decision making


Publikationsverlauf

Artikel online veröffentlicht:
05. November 2021

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