Funktionelle Folgen von Radiotherapie, Chemotherapie und Operation bei der Behandlung des Rektumkarzinoms

Zusammenfassung

Hintergrund

Die Behandlung des Rektumkarzinoms orientiert sich am Tumorstadium, der Lage sowie morphologischen und biologischen Risikofaktoren. Sie erfolgt multimodal mittels Chirurgie, Strahlentherapie und Chemotherapie. In einer Vielzahl von Fällen existieren mehrere Behandlungskorridore, die teils ähnliche, teils unterschiedliche funktionelle Einschränkungen bedingen können. Vergleiche der funktionellen Ergebnisse der verschiedenen Behandlungsmodalitäten liegen derzeit nur eingeschränkt vor.

Methoden

In diesem narrativen Review werden die funktionellen Folgen verschiedener Behandlungsstrategien des Rektumkarzinoms des mittleren und unteren Drittels basierend auf einer Literaturrecherche dargestellt.

Ergebnisse

Diese Arbeit analysiert die Evidenzlage zu den funktionellen Outcomes der einzelnen Therapieformen, insbesondere hinsichtlich Stuhlkontinenz, Harn- und Sexualfunktion. Das funktionelle Ergebnis nach organerhaltenden Strategien scheint hinsichtlich der Stuhlfrequenz geringfügig besser im Vergleich zur alleinigen chirurgischen Therapie zu sein, jedoch sind dem eine chemotherapieinduzierte Polyneuropathie und radiogene Toxizitäten wie Zystitis, Radionekrose oder Fistelbildung entgegenzusetzen. Zudem kumulieren bei inkompletter Remission die funktionellen Nebenwirkungen von perioperativer und operativer Therapie. Wenigen Tagen Behandlungsdauer bei chirurgischer Therapie steht die deutlich längere Behandlungsdauer einer totalen neoadjuvanten Therapie gegenüber. Eine abschließende Bewertung auf dem Boden der aktuellen Studienlage ist derzeit nur eingeschränkt möglich.

Schlussfolgerung

Diese Arbeit hebt die Bedeutung einer differenzierten Aufklärung der Patienten über funktionelle Konsequenzen, Therapiedauer und mögliche Komplikationen hervor und bietet eine Entscheidungshilfe für eine individuelle Therapieplanung unter Berücksichtigung der Lebensqualität.

Abstract

Background

Treatment of rectal cancer is multimodal and based on tumour stage and location, as well as morphological and biological risk factors – using surgery, radiotherapy, and chemotherapy. In a large number of cases, there are several treatment options, some of which can cause similar and some of which can cause different functional limitations. Comparisons of functional outcomes between different treatment modalities are currently limited.

Methods

This narrative review presents the functional outcomes of different treatment strategies for middle and lower third rectal cancer, as based on a literature search.

Results

This paper analyses the evidence on the functional outcomes of different treatment strategies, especially regarding fecal continence, urinary and sexual function. The functional outcome after organ-preserving strategies appears to be slightly better in terms of stool frequency compared to surgical therapy alone, but this has to be weighed up against chemotherapy-induced polyneuropathy and radiogenic toxicities such as cystitis, radionecrosis or fistula formation. In addition, the functional side effects of perioperative and surgical therapy accumulate in the event of incomplete remission. A few days of treatment during surgical therapy contrast with the significantly more protracted treatment of total neoadjuvant therapy. A conclusive evaluation based on the current evidence is only possible to a limited extent.

Conclusion

This study emphasises the importance of providing patients with detailed information about the functional consequences, duration of treatment and possible complications and offers a decision-making aid for planning individual treatment, taking quality of life into account.

Schlüsselwörter

Rektumkarzinom - funktionelles Ergebnis - totale neoadjuvante Therapie - Rektumresektion - Strahlentherapie

Keywords

rectal cancer - functional outcome - total neoadjuvant therapy - rectal resection - Radiation therapy

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