Neoadjuvante Therapie beim Rektumkarzinom – für wen, wie und mit welchem Ziel?

Zusammenfassung

In den letzten Jahrzehnten wurden erhebliche Fortschritte in der Behandlung des Rektumkarzinoms erzielt, die zu einer Reduktion der Lokalrezidivrate und einer Verbesserung der Prognose geführt haben. Die noch aktuelle S3-Leitlinie zum kolorektalen Karzinom empfiehlt die neoadjuvante Therapie bei Tumoren des mittleren und unteren Rektums im UICC-Stadium II und III. Die primäre Operation wird weiterhin bei UICC-I-Tumoren empfohlen, wobei für bestimmte Subgruppen, wie cT1/2-Tumoren mit fraglichem Lymphknotenbefall, Ausnahmen diskutiert werden. Aktuelle Studien konzentrieren sich auf multimodale Therapiekonzepte, insbesondere auf die total neoadjuvante Therapie (TNT), die in mehreren Phase-II- und Phase-III-Studien untersucht wurde. Darüber hinaus werden Therapien mit selektivem Verzicht auf eine neoadjuvante Bestrahlung sowie organerhaltende Ansätze untersucht. Die vorliegende Übersichtsarbeit gibt einen umfassenden Überblick über die aktuelle Evidenzlage zur neoadjuvanten Therapie des Rektumkarzinoms, beleuchtet neue multimodale Therapieansätze und diskutiert zukünftige Herausforderungen und Möglichkeiten, um die Therapie stadiengerecht zu optimieren und Patienten individuell bestmöglich zu behandeln.

Abstract

Over the past few decades, considerable progress has been made in the treatment of rectal cancer, leading to a reduction in local recurrence rates and an improvement in prognosis. The current German S3 guideline on colorectal cancer recommends neoadjuvant therapy for UICC stage II and III tumours of the middle and lower rectum. Primary surgery is still recommended for UICC I tumours, although exceptions are being discussed for certain subgroups, such as cT1/2 tumours with questionable nodal involvement. Current trials are focusing on multimodality treatment concepts, in particular total neoadjuvant therapy (TNT), which has been examined in several phase II and phase III trials. Therapies with selective omission of neoadjuvant radiotherapy and organ-preserving approaches are also being investigated. This review provides a comprehensive overview of the current evidence on neoadjuvant treatment of rectal cancer, highlights new multimodal treatment approaches, and discusses future challenges and opportunities to optimise treatment according to stage and to provide patients with the best possible individualised treatment.

Schlüsselwörter

Rektumkarzinom - neoadjuvante Radiochemotherapie - totale neoadjuvante Therapie - Watch & Wait - Rektumresektion - neoadjuvante Chemotherapie

Keywords

neoadjuvant radiochemotherapy - neoadjuvant chemotherapy - rectal carcinoma/cancer - rectum resection - total neoadjuvant therapy - watch & wait

Publication History

Received: 15 October 2024

Accepted: 06 February 2025

Article published online:
08 April 2025

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