Positronen-Emissions-Tomographie bei Karzinomen des oberen Gastrointestinaltrakts

Zusammenfassung

Die Behandlungsmöglichkeiten bei gastro-ösophagealen Karzinomen reichen von der limitierten Resektion bis hin zu multimodaler Therapie in den lokalisierten Stadien und enden bei Chemotherapie und Symptom-orientierter Behandlung im Falle fortgeschrittener Erkrankung. Eine akkurate klinische Festlegung des Tumorstadiums sowie darüber hinausgehende prognostische und prädiktive Informationen bilden idealerweise die Grundlage für die Wahl des geeigneten Therapieverfahrens. Die Positronen-Emissions-Tomographie in Kombination mit der Computertomographie, heutzutage vorzugsweise in Form des Hybridbildgebungsverfahrens PET/CT, kann die Genauigkeit des klinischen Stagings verbessern und zusätzliche prognostische Informationen liefern. Darüber hinaus weisen die Erfahrungen spezialisierter Zentren darauf hin, dass PET auch die Responseevaluation im Rahmen präoperativer Chemotherapie oder Radiochemotherapie signifikant verbessern könnte. Dieser Artikel stellt den aktuellen Stellenwert der PET für das Staging und die multimodale Therapie gastro-ösophagealer Karzinome dar. Zum jetzigen Zeitpunkt bleibt allerdings unklar, ob die Prognose von Patienten tatsächlich verbessert werden kann, wenn man die PET in die Diagnostik und Behandlung gastro-ösophagealer Karzinome integriert. Prospektive Multicenterstudien werden benötigt, um die Genauigkeit metabolischer Schwellenwerte zu bestätigen und den Stellenwert PET-gesteuerter Behandlungsalgorithmen zu erhärten.

Abstract

Treatment options for gastro-esophageal cancers reach from limited resection to multimodality treatment in localized stages and end with chemotherapy and symptom-oriented care in advanced disease. Accurate clinical assessment as well as prognostic and predictive information is needed for selecting the appropriate treatment approach. Positron emission tomography (PET) in combination with computed tomography (CT) in a hybrid imaging modality PET/CT may refine the staging accuracy and add prognostic information. Moreover, experiences from diverse centers indicate that PET also might improve significantly the assessment of response to preoperative chemotherapy and chemoradiotherapy. This article outlines the current value of PET in the staging and multidisciplinary care of gastro-esophageal cancer. However, at this stage it remains unclear if the prognosis of patients can be improved by implementing PET in the management of these tumors. Prospective multicenter studies have to be performed to validate metabolic cut-off values and to proof the benefit of PET-guided treatment decisions.

Schlüsselwörter

Positronen-Emissions-Tomographie - Staging - Therapieansprechen - Ösophaguskarzinom - Magenkarzinom

Keywords

positron emission tomography - staging - treatment response - esophageal cancer - gastric cancer

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