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Zentralbl Chir 2011; 136(4): 312-316
DOI: 10.1055/s-0031-1271578
Übersicht

© Georg Thieme Verlag KG Stuttgart ˙ New York

Ösophaguskarzinom: Aktueller Stand der multimodalen Therapie

Oesophageal Cancer: Current Status of Multimodality TherapyD. Vallböhmer1 , W. Schröder1 , J. Brabender1 , A. H. Hölscher1
  • 1Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie; Universität zu Köln, Deutschland
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Publication History

Publication Date:
23 August 2011 (online)

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Zusammenfassung

Multimodale Therapiekonzepte wurden in den letzten Jahren in der Behandlung des lokal fort­geschrittenen Ösophaguskarzinoms (cT3 / 4Nx) etabliert. Dabei kommt vor allem die neoadjuvante Radiochemotherapie oder die alleinige Chemotherapie zum Einsatz. Die aktuell vorliegenden Metaanalysen zur neoadjuvanten Therapie des lokal fortgeschrittenen Ösophaguskarzinoms weisen nur einen Prognosevorteil von 5–10 % bezüglich der 5-Jahres-Überlebensrate für die Gesamtgruppe der behandelten Patienten auf. Patienten mit einem sehr guten histopathologischen Ansprechen zeigen jedoch ausgezeichnete Über­lebens­wahrscheinlichkeiten trotz eines initial fort­geschrittenen Tumorstadiums. Patienten mit ­einem schlechten histopathologischen Ansprechen haben keinen Vorteil oder eher einen Pro­gno­senachteil. Deshalb wären prädiktive Marker, die eine individualisierte multimodale Therapie beim lokal fortgeschrittenen Ösophaguskarzinom ermöglichen würden, von großer Bedeutung. 

Abstract

Multimodality treatment options have been wide­ly promoted in the therapy for locally ad­vanced oesophageal cancer (cT3 / 4Nx). Generally neo­adjuvant chemotherapy and combined radio­chemotherapy are frequently used in this setting. The recent meta-analyses evaluating randomised trials of different neoadjuvant therapy protocols prior to surgery for patients with locally advanced oesophageal cancer showed only a modest im­prove­ment in survivial of 5–10 % survival at 5 years. In contrast, the meta-analyses reveal that patients with excellent histopathological re­sponses seem to highly benefit from neoadjuvant regimens. Patients with poor histopathological responses have no benefit but rather disadvan­tegeous prognoses. Therefore, predictive markers to allow individualisation of multimodality treatment in locally advanced esophageal cancer are urgently needed. 

Schlüsselwörter

Ösophaguskarzinom - multimodale Therapie - Response-Prädiktion

Key words

oesophageal cancer - multimodality treatment - response prediction

Literatur

  • 1 Hölscher A H, Vallböhmer D. Surgical treatment of esophageal tumors including local ablation.  Zentralbl Chir. 2007;  132 18-36
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Lerut T, Moons J, Coosemans W et al. Multidisciplinary treatment of ­advanced cancer of the esophagus and gastroesophageal junction: a European center's approach.  Surg Oncol Clin N Am. 2008;  17 485-502
    CrossrefPubMedGoogle Scholar
  • 3 Bhansali M S, Vaidya J S, Bhatt R G et al. Chemotherapy for carcinoma of the esophagus: a comparison of evidence from meta-analyses of randomized trials and of historical control studies.  Ann Oncol. 1996;  7 355-359
    CrossrefPubMedGoogle Scholar
  • 4 Urschel J D, Vasan H, Blewett C J. A meta-analysis of randomized controlled trials that compared neoadjuvant chemotherapy and surgery to surgery alone for resectable esophageal cancer.  Am J Surg. 2002;  183 274-279
    CrossrefPubMedGoogle Scholar
  • 5 Urschel J, Vasan H. A meta-analysis of randomized controlled trials that compared neoadjuvant chemoradiation and surgery to surgery alone for resectable esophageal cancer.  Am J Surg. 2003;  185 538-543
    CrossrefPubMedGoogle Scholar
  • 6 Kaklamanos I G, Walker G R, Ferry K et al. Neoadjuvant treatment for ­resectable cancer of the esophagus and the gastroesophageal junction: a meta-analysis of randomized clinical trials.  Ann Surg Oncol. 2003;  10 754-761
    CrossrefPubMedGoogle Scholar
  • 7 Malthaner R, Wong R, Rumble R et al. Neoadjuvant or adjuvant therapy for resectable esophageal cancer: a systematic review and meta-analy­sis.  BMC Med. 2004;  2 35
    CrossrefPubMedGoogle Scholar
  • 8 Fiorica F, Di Bona D, Schepis F et al. Preoperative chemoradiotherapy for esophageal cancer: a systematic review and meta-analysis.  Gut. 2004;  53 925-930
    CrossrefPubMedGoogle Scholar
  • 9 Greer S, Goodney P, Sutton J et al. Neoadjuvant chemoradiotherapy for esophageal carcinoma: a meta-analysis.  Surgery. 2005;  137 172-177
    CrossrefPubMedGoogle Scholar
  • 10 Vogt K, Fenlon D, Rhodes S et al. Preoperative chemotherapy for resectable thoracic esophageal cancer. Cochrane Database of Systematic Reviews 2006 3 CD001556
    Google Scholar
  • 11 Gebski V, Burmeister B, Smithers B M Australian Gastro-Intestinal Trials Group et al.,. Survival benefits from neoadjuvant chemoradiotherapy or chemotherapy in oesophageal carcinoma: a meta-analysis.  Lancet Oncol. 2007;  8 226-234
    CrossrefPubMedGoogle Scholar
  • 12 Jin H L, Zhu H, Ling T S et al. Neoadjuvant chemoradiotherapy for resectable esophageal carcinoma: a meta-analysis.  World J Gastroenterol. 2009;  15 5983-5991
    CrossrefPubMedGoogle Scholar
  • 13 Baldus S E, Mönig S P, Schröder W et al. Regression of oesophageal car­cinomas after neoadjuvant radiochemotherapy: criteria of the histo­pathological evaluation.  Pathologe. 2004;  25 421-427
    CrossrefPubMedGoogle Scholar
  • 14 Schneider P M, Baldus S E, Metzger R et al. Histomorphologic tumor regression and lymph node metastases determine prognosis following neoadjuvant radiochemotherapy for esophageal cancer: implications for response classification.  Ann Surg. 2005;  242 684-692
    CrossrefPubMedGoogle Scholar
  • 15 Vallböhmer D, Hölscher A H, DeMeester S et al. A multicenter study of survival after neoadjuvant radiotherapy / chemotherapy and esophagectomy for ypT0N0M0R0 esophageal cancer.  Ann Surg. 2010;  252 744-749
    CrossrefPubMedGoogle Scholar
  • 16 Fok M, McShane J, Law S YK et al. Prospective randomised study in the treatment of oesophageal carcinoma.  Asian J Surg. 1994;  17 223-229
    PubMedGoogle Scholar
  • 17 Launois B, Delarue D, Campion J P et al. Preoperative radiotherapy for carcinoma of the esophagus.  Surg Gynecol Obstet. 1981;  153 690-692
    PubMedGoogle Scholar
  • 18 Gignoux M, Roussel A, Paillot B et al. The value of preoperative radiotherapy in esophageal cancer: results of a study of the E.O.R.T.C.  World J Surg. 1987;  11 426-432
    CrossrefPubMedGoogle Scholar
  • 19 Wang M, Gu X Z, Yin W et al. Randomized clinical trial on the combination of preoperative irradiation and surgery in the treatment of esophageal carcinoma: report on 206 patients.  Int J Radiat Oncol Biol Phys. 1989;  16 325-327
    CrossrefPubMedGoogle Scholar
  • 20 Nygaard K, Hagen S, Hansen H S et al. Preoperative radiotherapy prolongs survival in operable esophageal carcinoma: a randomized, multicenter study of preoperative radiotherapy and chemotherapy. The second Scandinavian trial in esophageal cancer.  World J Surg. 1992;  16 1104-1109
    CrossrefPubMedGoogle Scholar
  • 21 Arnott S J, Duncan W, Kerr G R et al. Low dose preoperative radiotherapy for carcinoma of the oesophagus: results of a randomized clinical trial.  Radiother Oncol. 1992;  24 108-113
    CrossrefPubMedGoogle Scholar
  • 22 Arnott S J, Duncan W, Gignoux M et al. Preoperative radiotherapy for esophageal carcinoma. Cochrane Database Syst Rev 2005 4 CD001799
    Google Scholar
  • 23 Malthaner R, Fenlon D. Preoperative chemotherapy for resectable thoracic esophageal cancer. Cochrane Database Syst Rev 2003 4 CD001556
    Google Scholar
  • 24 Medical Research Council Oesophageal Cancer Working Group . Surgi­cal resection with or without preoperative chemotherapy in oesophageal cancer: a randomised controlled trial.  Lancet. 2002;  359 1727-1733
    CrossrefPubMedGoogle Scholar
  • 25 Wijnhoven B P, van Lanschot J J, Tilanus H W et al. Neoadjuvant chemo­radiotherapy for esophageal cancer: a review of meta-analyses.  World J Surg. 2009;  33 2606-2614
    CrossrefPubMedGoogle Scholar
  • 26 Gaast A V, van Hagen P, Hulshof M et al. Effect of preoperative concurrent chemoradiotherapy on survival of patients with resectable esophageal or esophagogastric junction cancer: Results from a multicenter randomized phase III study.  J Clin Oncol. 2010;  28 15s (abstract 4004)
    PubMedGoogle Scholar
  • 27 Bollschweiler E, Metzger R, Drebber U et al. Histological type of esophageal cancer might affect response to neo-adjuvant radiochemotherapy and subsequent prognosis.  Ann Oncol. 2009;  20 231-238
    PubMedGoogle Scholar
  • 28 Ruhstaller T, Pless M, Dietrich D et al. Cetuximab in Combination With Chemoradiotherapy Before Surgery in Patients With Resectable, Lo­cally Advanced Esophageal Carcinoma: A Prospective, Multicenter Phase I B / II Trial (SAKK 75 / 06).  J Clin Oncol. 2011;  29 626-639
    CrossrefPubMedGoogle Scholar
  • 29 Gibson M K, Catalano P J, Kleinberg L et al. E2205: A phase II study to measure response rate and toxicity of neoadjuvant chemoradiotherapy (CRT) with oxaliplatin (OX) and infusional 5-fluorouracil (5-FU) plus cetuximab (C) followed by postoperative docetaxel (DT) and C in patients with operable adenocarcinoma of the esophagus.  J Clin Oncol. 2010;  28 15s (abstract 4064)
    PubMedGoogle Scholar
  • 30 Lordick F. Neoadjuvant therapy for squamous cell carcinoma of the esophagus.  Chirurg. 2005;  76 1025-1032
    CrossrefPubMedGoogle Scholar
  • 31 Semrau R, Vallböhmer D, Hölscher A H et al. Neoadjuvant therapy of adenocarcinomas of the upper gastrointestinal tract. Status of radiotherapy.  Chirurg. 2009;  80 1035-1041
    CrossrefPubMedGoogle Scholar
  • 32 Ruol A, Rizzetto C, Castoro C et al. Interval between neoadjuvant chemoradiotherapy and surgery for squamous cell cancer of the thoracic esophagus.  Ann Surg. 2010;  252 788-796
    CrossrefPubMedGoogle Scholar
  • 33 Bollschweiler E, Besch S, Drebber U et al. Influence of Neoadjuvant Chemoradiation on the Number and Size of Analyzed Lymph Nodes in Esophageal Cancer.  Ann Surg Oncol. 2010;  17 3187-3194
    CrossrefPubMedGoogle Scholar
  • 34 Schneider P M, Metzger R, Schaefer H et al. Response evaluation by endoscopy, rebiopsy, and endoscopic ultrasound does not accurately predict histopathologic regression after neoadjuvant chemoradiation for esophageal cancer.  Ann Surg. 2008;  248 902-908
    CrossrefPubMedGoogle Scholar
  • 35 Lordick F, Ott K, Krause B J et al. PET to assess early metabolic response and to guide treatment of adenocarcinoma of the oesophagogastric junction: the MUNICON phase II trial.  Lancet Oncol. 2007;  8 797-805
    CrossrefPubMedGoogle Scholar
  • 36 Vallböhmer D, Hölscher A H, Dietlein M et al. [18F]-Fluorodeoxyglucose-positron emission tomography for the assessment of histopathologic response and prognosis after completion of neoadjuvant chemoradiation in esophageal cancer.  Ann Surg. 2009;  250 888-894
    CrossrefPubMedGoogle Scholar
  • 37 Vallböhmer D, Brabender J, Metzger R et al. Genetics in the Pathogenesis of Esophageal Cancer: Possible Predictive and Prognostic Factors.  J Gastrointest Surg. 2010;  23 185-190
    PubMedGoogle Scholar

Prof. Dr. A. H. Hölscher

Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie · Universität zu Köln

Kerpener Str. 62

50937 Köln

Deutschland

Phone: 02 21 / 4 78 48 01

Fax: 02 21 / 4 78 48 43

Email: Arnulf.Hoelscher@medizin.uni-koeln.de

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