Multimodale Therapie beim lokal fortgeschrittenen Magenkarzinom

Zusammenfassung

Lokal fortgeschrittene Magenkarzinome sind durch eine ungünstige Prognose charakterisiert, die jedoch verbessert werden kann, wenn die chirurgische Therapie in ein multimodales Behandlungskonzept eingebettet ist. Die angestrebten Ziele einer neoadjuvanten Therapie liegen in der präoperativen Reduktion des Primärtumors, einer Verbesserung der T- und N-Kategorie und einer frühen Therapie von Mikrometastasen. In kontrollierten klinischen Studien konnte gezeigt werden, dass eine neoadjuvante Chemotherapie als auch eine kombinierte Radiochemotherapie bei Tumoren des gastroösophagealen Übergangs zu einer Verbesserung der primären R₀-Resektionsrate, des progressionsfreien Überlebens und des Gesamtüberlebens führt. Insbesondere Patienten mit lokal fortgeschrittenen Tumoren profitieren von diesem Konzept, während in frühen Tumorstadien dieses kontrovers diskutiert wird. Nonresponder profitieren von der neoadjuvanten Therapie nicht, wodurch einer Response-Evaluation bzw. Response-Prädiktion eine besondere Bedeutung zukommt. Da bei fortgeschrittenen Karzinomen die Wahrscheinlichkeit für Lymphknotenmetastasen hoch ist, sollte auch nach erfolgreicher neoadjuvanter Therapie eine Gastrektomie mit D₂-Lymphadenektomie durchgeführt werden. Der Artikel beschreibt aktuelle Entwicklungen auf diesem Gebiet.

Abstract

Locally advanced gastric cancers are characterized by poor prognosis. Clinical outcome can be improved if surgery becomes part of a multimodal treatment approach. The purpose of neoadjuvant treatment includes downsizing of the primary tumor, improvement of the T- and N- categories, and early therapy of micrometastasis. Several controlled clinical trials showed that neoadjuvant chemotherapy as well as neoadjuvant combined radio-chemotherapy, especially for tumors of the gastroesophageal junction, can improve the rate of primary R0 resections, relapse-free survival, and overall survival. While patients with locally advanced tumors clearly benefit from this strategy, the approach is still controversial in patients with early stage disease. Nonresponders do not benefit from neoadjuvant therapy. Therefore, response evaluation and response prediction are of great importance. After successful neoadjuvant chemotherapy, patients should undergo gastrectomy with D₂-lymphadenectomy because of a high probability of lymph node metastasis. This article summarizes current developments in this field.

Schlüsselwörter

Neoadjuvant - Chemotherapie - Radiochemotherapie - Magenkarzinom

Keywords

neoadjuvant - chemotherapy - radio chemotherapy - gastric cancer

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