Zusammenfassung
Das Ösophagus- und Magenkarzinom stellen weltweit zwei der Haupttodesursachen durch
maligne Erkrankungen dar. Dazu ist das Adenokarzinom der Speiseröhre aktuell die schnellst
ansteigende bösartige Grunderkrankung in den westlichen Ländern. Da diese Tumorformen
zumeist in einem fortgeschrittenen Stadium diagnostiziert werden, ist häufig ein multimodales
Therapieprozedere erforderlich. Trotz großer Fortschritte sowohl der Operationstechniken
als auch neoadjuvanter/adjuvanter Behandlungsstrategien, profitieren nur ca. 20 %
der Patienten mit einem fortgeschrittenen Ösophaguskarzinom von einer neoadjuvanten
Therapie. Aus diesem Grund ist es notwendig prädiktive/prognostische Faktoren zu etablieren,
die ein individuelles Behandlungskonzept ermöglichen. Mittels innovativer, molekularbiologischer
Techniken ist es jedoch in den letzten Jahren gelungen, Marker zu beschreiben, die
eine Response-Prädiktion neoadjuvanter und adjuvanter Therapien beim Ösophagus- und
Magenkarzinom zulassen. Dabei wurden verschiedenartige Faktoren beschrieben, wie z.
B. angiogenetische Faktoren, Enzyme involviert in DNS-Reparaturmechansimen, Faktoren
des 5-Fluorouracil-Metabolismus, Tumorsuppressorgene oder Wachstumsfaktor-Rezeptoren.
Die zumeist retrospektiv erzielten Studienergebnisse sind Erfolg versprechend, müssen
aber in prospektiven Studien validiert werden.
Abstract
Esophageal and gastric carcinomas constitute a major cause of cancer deaths worldwide
and esophageal adenocarcinoma is currently the most rapidly increasing cancer in the
Western world. These tumors are usually detected at an advanced stage, requiring a
multimodal concept. Despite improvements in surgical techniques as well as neoadjuvant/adjuvant
therapies, for example less than 20 % of the patients with advanced esophageal cancer
benefit from neoadjuvant therapy. Therefore predictive/prognostic markers are necessary
to achieve an individual management concerning (radio-) chemotherapy and increase
efficacy. Recently molecular markers have been identified using innovative, molecularbiological
technologies to predict response to neoadjuvant and adjuvant therapies in esophageal
and gastric cancer. These factors are enzymes of angiogenesis, enzymes involved in
the DNA-repair-system, factors of the 5-fluorouracil metabolism, tumorsupressor genes
or growth-factor receptors. These markers found mainly in retrospective studies are
prom-ising but prospective studies are needed to validate these mark-ers.
Schlüsselwörter
Ösophagus-/Magenkarzinom - Response-Prädiktion - molekulare Faktoren
Key words
Esophageal/gastric cancer - response prediction - molecular factors
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Prof. Dr. med. H. J. Lenz
University of Southern California · Norris Comprehensive Cancer Center
1441 Eastlake Ave.
Suite 3456
Los Angeles
CA 90033
Email: lenz@usc.edu