Exokrines Pankreaskarzinom – Welche Neuerungen bringt die neue S3-Leitlinie?

Was ist neu?

Familiäre Belastung Definition der Zielgruppe, der genetische Untersuchungen zur Abklärung eines erhöhten Pankreaskarzinomrisikos angeboten werden soll.

Präoperative Ausbreitungsdiagnostik Bei einem potenziell resektablen Pankreaskarzinom soll zusätzlich zu einer Dünnschicht-CT sowie zum Ausschluss von Lebermetastasen eine Leber-MRT oder alternativ eine FDG-PET-CT durchgeführt werden.

Chirurgische Therapie Die rein anatomischen Kriterien hinsichtlich der Resektabilität eines Pankreaskarzinoms werden um biologische Faktoren (z.B. CA19–9-Wert) und den körperlichen Allgemeinzustand (ECOG) erweitert. Es besteht ein Zusammenhang zwischen der Zahl an Pankreasresektionen an einer Institution und der Letalität, sodass erstmals eine Mindestfallzahl von ≥ 20 Pankreasresektionen für ein Zentrum empfohlen wird.

Adjuvante und neoadjuvante nicht chirurgische Therapie Aktuell wird bei gutem ECOG-Performance-Status eine adjuvante Therapie mit mFOLFIRINOX empfohlen. Eine neoadjuvante Therapie wird bei einem grenzwertig (borderline) resektablen Pankreaskarzinom empfohlen. Falls das Pankreaskarzinom als lokal fortgeschritten eingeschätzt wird, soll eine initiale Chemotherapie erfolgen. In beiden Fällen (borderline und lokal fortgeschrittenen Tumoren) wird bei stabiler Erkrankung eine chirurgische Exploration empfohlen.

Palliative Therapie des Pankreaskarzinoms Vor allem Patient*innen mit einer guten körperlichen Leistungsfähigkeit profitieren von einer Kombinationschemotherapie.

Therapiestrategien in molekularen Subgruppen Bei Nachweis einer BRCA1/2-Keimbahnmutation sollten Patient*innen eine platinhaltige Kombinationschemotherapie erhalten und können von einer Erhaltungstherapie mit einem PARP-Inhibitor profitieren. Fitten Patient*innen sollte bei Progress des Tumors eine Zweitlinientherapie angeboten werden. Eine Strahlentherapie, alleinige Radiotherapie oder Radiochemotherapie kann bei lokal fortgeschrittenem Pankreaskarzinom ohne Hinweis auf Fernmetastasen angeboten werden.

Abstract

In 2020, worldwide 495,773 people were diagnosed with pancreatic ductal adenocarcinoma and 466,003 patients died from pancreatic cancer. Pancreatic cancer ranks 13th among cancer diagnosis and is the 7th most common cause of cancer-related deaths [1].

In Germany, each year approximately 10,000 people develop pancreatic cancer and around the same number of patients die from this disease [2]. The relative 5-year survival rate is only 10%. The majority of patients die within the year of diagnosis.

Incidence and mortality of pancreatic cancer have continuously increased over the recent years. There are multiple reasons for this finding: pancreatic cancer occurs more frequently in older patients which leads to a higher incidence in an aging society. There are no effective screening and early detection measures for sporadic pancreatic cancer. Therefore, the majority of patients are diagnosed at an advanced stage where the tumor is no longer amenable to curative treatment. Furthermore, the majority of pancreatic cancers is per se likely to constitute a disseminated disease, even if initial imaging suggests a localized, surgically amenable disease. This is reflected by the high rate of early metastases and the small number of patients with long-term survival after surgery with curative intent.

The S3 guideline exocrine pancreatic cancer aims to present the available evidence on epidemiology, molecular alterations, diagnostics, surgical and non-surgical treatment as well as palliative measures in order to support all those involved in the treatment of this tumor and to improve the care of patients.

To better address this need, the S3 guideline was updated again in 2022 and also changed to a living guideline with regular updates to further improve the timeliness of the guideline.

Schlüsselwörter

Pankreaskarzinom - multimodale Therapie - Leitlinie

Keywords

ductal pancreatic adenocarcinoma - pancreatic cancer - multimodal treatment - guideline

Publication History

Article published online:
31 May 2023

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