Multimodale Therapie des Ösophaguskarzinoms

Zusammenfassung

Das Ösophaguskarzinom stellt trotz aller Fortschritte in der Diagnostik und Therapie weiterhin eine Tumorentität mit limitierter Prognose dar. Bei Karzinomen, die sich auf die Mukosa beschränken, hat sich die endoskopische Resektion als wesentliches Therapieverfahren entwickelt. Die Chirurgie ist weiterhin das Standardverfahren bei Patienten mit lokal begrenzten (cT1/T2, N0) und lokal fortgeschrittenen Karzinomen (cT3, T4, Nx). Im Zuge der multimodalen Therapie haben sich neoadjuvante Behandlungskonzepte mittels Radiochemotherapie oder alleiniger Chemotherapie bei Patienten mit lokal fortgeschrittenen Tumoren fest etabliert. In der metastasierten Situation steht die palliative Radio- bzw. Chemotherapie als Behandlungskonzept zur Verfügung; allerdings ist die Effizienz dieser Therapien eingeschränkt. Diese Übersichtsarbeit gibt den aktuellen Stand der multimodalen Therapie wieder.

Abstract

Despite major progress in clinical diagnostics and therapy, esophageal carcinoma represents a tumor entity with limited prognosis. In case of carcinoma restricted to mucosa endoscopic resection has developed into an important therapeutic method. Surgical resection represents the standard procedure for patients with locally limited (cT1/T2, N0) and advanced carcinoma (cT3, T4, Nx). In multimodal therapy neoadjuvant treatment concepts with chemotherapy or radiochemotherapy for patients with locally advanced tumors are well established. In case of metastatic disease palliative radio- and chemotherapy represent a treatment concept, however therapy efficiency is very limited. This review reflects the current status of multimodal therapy.

Schlüsselwörter

Ösophaguskarzinom - Staging - chirurgische Resektion - neoadjuvante Radiochemotherapie

Keywords

esophageal carcinoma - staging - surgical resection - neoadjuvant radiochemotherapy

• Literatur

• 1 Esophagus and esophagogastric junction. In: Edge SB, Byrd DR, Compton CC, et al. (Hrsg.). AJCC Cancer Staging Manual. 7th. ed. New York, NY: Springer; 2010: 103-111
• 2 Krebs in Deutschland 2007/2008. . 8. Ausgabe. Berlin: Robert Koch-Institut (Hrsg.) und die Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V. (Hrsg.); 2012
• 3 Refluxösophagitis und prämaligne Läsionen des Ösophagus. In: Gossner L, Ell C. Empfehlungen der Deutschen Gesellschaft für Verdauungs- und Stoffwechselkrankheiten (DGVS) für die Durchführung endoskopischer Untersuchungen. 3. Auflage 2002: 57-64
• 4 Allum WH, Blazeby JM, Griffin SM et al. Association of upper gastrointestinal surgeons of Great Britain and Ireland, the British Society of Gastroenterology and the British Association of Surgical Oncology. Guidelines for the management of oesophageal and gastric cancer. Gut 2011; 60: 1449-1472
• 5 Bailey LA, Khan OA, Reddy M et al. Does laparoscopic mobilisation of the stomach as part of a trans-thoracic oesophageal resection result in improved peri-operative outcomes as compared with an open approach?. Int J Surg 2012; 10: 421-424
• 6 Bailey L, Khan O, Willows E et al. Open and laparoscopically assisted oesophagectomy: a prospective comparative study. Eur J Cardiothorac Surg 2013; 43: 268-273
• 7 Behrens A, May A, Manner H et al. Esophageal precancerous lesions: early diagnosis, treatment and preservation of quality of life. Internist 2013; 54: 683-690
• 8 Bennett C, Vakil N, Bergman J et al. Consensus statements for management of Barrett's dysplasia and early-stage esophageal adenocarcinoma, based on a Delphi process. Gastroenterology 2012; 143: 336-346
• 9 Biere SS, Maas KW, Cuesta MA et al. Cervical or thoracic anastomosis after esophagectomy for cancer: a systematic review and meta-analysis. Dig Surg 2011; 28: 29-35
• 10 Biere SS, van Berge Henegouwen MI et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet 2012; 379: 1887-1892
• 11 Bollschweiler E, Baldus SE, Schröder W et al. High rate of lymph-node metastasis in submucosal esophageal squamous-cell carcinomas and adenocarcinomas. Endoscopy 2006; 38: 149-156
• 12 Briez N, Piessen G, Torres F et al. Effects of hybrid minimally invasive oesophagectomy on major postoperative pulmonary complications. Br J Surg 2012; 99: 1547-1553
• 13 Burmeister BH, Thomas JM, Burmeister EA et al. Is concurrent radiation therapy required in patients receiving preoperative chemotherapy for adenocarcinoma of the oesophagus? A randomised phase II trial. Eur J Cancer 2011; 47: 354-360
• 14 Carboni F, Lorusso R, Santoro R et al. Adenocarcinoma of the esophagogastric junction: the role of abdominal-transhiatal resection. Ann Surg Oncol 2009; 16: 304-310
• 15 Ciocirlan M, Lapalus MG, Hervieu V et al. Endoscopic mucosal resection for squamous premalignant and early malignant lesions of the esophagus. Endoscopy 2007; 39: 24-29
• 16 Ell C, May A, Pech O et al. Curative endoscopic resection of early esophageal adenocarcinoma (Barrett’s cancer). Gastrointest Endosc 2007; 65: 3-10
• 17 Godoy MC, Bruzzi JF, Viswanathan C et al. Multimodality imaging evaluation of esophageal cancer: staging, therapy assessment, and complications. Abdom Imaging 2013; 38: 974-993
• 18 Herskovic A, Martz K, Al-Sarraf M et al. Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus. N Engl J Med 1992; 326: 1593-1598
• 19 Hulscher JB, van Sandick JW, de Boer AG et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 2002; 347: 1662-1669
• 20 Kim HS, Kim HJ, Kim SY et al. Second-line chemotherapy versus supportive cancer treatment in advanced gastric cancer: a meta-analysis. Ann Oncol 2013; 24: 2850-2854
• 21 Lordick F, Ott K, Krause BJ. Positronen-Emissions-Tomographie bei Karzinomen des oberen Gastrointestinaltraktes. Dtsch Med Wochenschr 2011; 136: 1061-1066
• 22 Lowe VJ, Booya F, Fletcher JG et al. Comparison of positron emission tomography, computed tomography, and endoscopic ultrasound in the initial staging of patients with esophageal cancer. Mol Imaging Biol 2005; 7: 422-430
• 23 Luketich JD, Pennathur A, Awais O et al. Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg 2012; 256: 95-103
• 24 Malthaner RA, Wong RK, Rumble RB et al. Members of the Gastrointestinal Cancer Disease Site Group of Cancer Care Ontario's Program in Evidence-based Care. Neoadjuvant or adjuvant therapy for resectable esophageal cancer: a systematic review and meta-analysis. BMC Med 2004; 2: 35
• 25 Mariette C, Piessen G, Triboulet JP. Therapeutic strategies in oesophageal carcinoma: role of surgery and other modalities. Lancet Oncol 2007; 8: 545-553
• 26 Nagpal K, Ahmed K, Vats A et al. Is minimally invasive surgery beneficial in the management of esophageal cancer? A meta-analysis. Surg Endosc 2010; 24: 1621-1629
• 27 Omloo JM, Lagarde SM et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the mid/distal esophagus: five-year survival of a randomized clinical trial. Ann Surg 2007; 246: 992-1000
• 28 Ott K, Lordick F, Blank S et al. Gastric cancer: surgery in 2011. Langenbecks Arch Surg 2011; 396: 743-758
• 29 Pech O, May A, Gossner L et al. Curative endoscopic therapy in patients with early esophageal squamous-cell carcinoma or high-grade intraepithelial neoplasia. Endoscopy 2007; 39: 30-35
• 30 Pech O, Bollschweiler E, Manner H et al. Comparison between endoscopic and surgical resection of mucosal esophageal adenocarcinoma in Barrett's esophagus at two high-volume centers. Ann Surg 2011; 254: 67-72
• 31 Pennathur A, Gison MK, Jobe BA et al. Oesophageal carcinoma. Lancet 2013; 381: 400-412
• 32 Peyre CG, Hagen JA, DeMeester SR et al. The number of lymph nodes removed predicts survival in esophageal cancer: an international study on the impact of extent of surgical resection. Ann Surg 2008; 248: 549-556
• 33 Pöttgen C, Stuschke M. Radiotherapy versus surgery within multimodality protocols for esophageal cancer-a meta-analysis of the randomized trials. Cancer Treat Rev 2012; 38: 599-604
• 34 Polkowski M. Endosonographic staging of upper intestinal malignancy. Best Pract Res Clin Gastroenterol 2009; 23: 649-661
• 35 Ronellenfitsch U, Schwarzbach M, Hofheinz R et al. GE Adenocarcinoma Meta-analysis Group. Perioperative chemo(radio)therapy versus primary surgery for resectable adenocarcinoma of the stomach, gastroesophageal junction and lower esophagus. Cochrane Database Syst Rev 2013; 31;5 CD008107
• 36 Schiesser M, Schneider PM. Surgical strategies for adenocarcinoma of the esophagogastric junction. Recent Results Cancer Res 2010; 182: 93-106
• 37 Simard EP, Ward EM, Siegel R et al. Cancers with increasing incidence trends in the United States: 1999 through 2008. CA Cancer J Clin 2012; 62: 118-128
• 38 Sjoquist KM, Burmeister BH, Smithers BM et al. Australasian Gastro-Intestinal Trials Group. Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: an updated meta-analysis. Lancet Oncol 2011; 12: 681-692
• 39 Stahl M, Walz MK, Stuschke M et al. Phase III comparison of preoperative chemotherapy compared with chemoradiotherapy in patients with locally advanced adenocarcinoma of the esophagogastric junction. J Clin Oncol 2009; 27: 851-856
• 40 van Vilsteren FG, Pouw RE, Seewald S et al. Stepwise radical endoscopic resection versus radiofrequency ablation for Barrett's oesophagus with high-grade dysplasia or early cancer: a multicentre randomised trial. Gut 2011; 60: 765-773
• 41 Wiedmann MW, Mössner J. New and emerging combination therapies for esophageal cancer. Cancer Manag Res 2013; 5: 133-146
• 42 Yajima S, Oshima Y, Shimada H. Neck dissection for thoracic esophageal squamous cell carcinoma. Int J Surg Oncol 2012; 2012: 750456
• 43 Earlom R, Cunho-Melo JR. Oesophageal squamous cell carcinoma: II. A Critical view of radiotherapy. Br J Surg 1980; 67: 457-461