Diagnostik und Therapie des kolorektalen Karzinoms

ZUSAMMENFASSUNG

Das kolorektale Karzinom (KRK) ist der häufigste Tumor des Gastrointestinaltraktes, weltweit der zweithäufigste Tumor bei Frauen und der dritthäufigste bei Männern. Die Koloskopie ist in Deutschland seit fast 20 Jahren als endoskopische Vorsorgeuntersuchung anerkannt. Die Steigerung der Polypen- und Adenomdetektionsrate ist ein stetiges Bestreben aller Endoskopiker. Anspruch jeder endoskopischen Therapie ist die komplette Entfernung des verdächtigen Befundes. Nach der aktuellen S3-Leitlinie wird zur Behandlung von Tumoren des unteren und mittleren Rektumdrittels im Stadium II/III (cT3/4 und/oder cN+) und im oberen Rektumdrittels bei Risikofaktoren eine neoadjuvante Radiochemotherapie (RCTx) empfohlen. Das Nebenwirkungsspektrum leitet sich maßgeblich aus dem Bestrahlungsvolumen, der Einzeldosis pro Fraktion, sowie der Gesamtdosis, der Behandlungsdauer und der konkomitant eingesetzten Chemotherapie ab. Während das Kolonkarzinom in der nicht metastasierten Situation primär operiert wird, stellt die neoadjuvante R(C)Tx den Standard beim lokal fortgeschrittenen Rektumkarzinom dar. Eine adjuvante Chemotherapie ist bei Patienten mit Kolonkarzinom im UICC-Stadium II mit Risikofaktoren und Stadium III indiziert. Die Therapie bei Kolonkarzinom in Stadium UICC IV richtet sich nach der Lokalisation und Anzahl der Metastasen sowie dem Allgemeinzustand des Patienten.

• Literatur

• 1 Mokdad AH, Dwyer-Lindgren L, Fitzmaurice C. et al. Trends and Patterns of Disparities in Cancer Mortality Among US Counties, 1980–2014. Jama 2017; 317: 388-406
• 2 Noone AM, Cronin KA, Altekruse SF. et al. Cancer Incidence and Survival Trends by Subtype Using Data from the Surveillance Epidemiology and End Results Program, 1992–2013. Cancer Epidemiol Biomarkers Prev 2017; 26: 632-641
• 3 Altenhof L. Projekt Wissenschaftliche Begleitung von Früherkennungs-Koloskopien in Deutschland Berichtszeitraum 2014.12. Jahresbericht, Version 2. Berlin/Köln. 2016 Im Internet: https://wwwzi-dmpde/Files/Koloskopie/Jahresbericht_2014_Darmkrebs_Frueherkennungpdf 2016
• 4 Hoffmeister M, Holleczek B, Zwink N. et al. Screening for Bowel Cancer: Increasing Participation via Personal Invitation. Deutsches Arzteblatt international 2017; 114: 87-93
• 5 Brenner H, Altenhofen L, Stock C. et al. Prevention, early detection, and overdiagnosis of colorectal cancer within 10 years of screening colonoscopy in Germany. Clin Gastroenterol Hepatol 2015; 13: 717-723
• 6 Kaminski MF, Regula J, Kraszewska E. et al. Quality indicators for colonoscopy and the risk of interval cancer. New Engl J Med 2010; 362: 1795-1803
• 7 Markowitz SD, Bertagnolli MM. Molecular origins of cancer: Molecular basis of colorectal cancer. New Engl J Med 2009; 361: 2449-2460
• 8 Ahn SB, Han DS, Bae JH. et al. The Miss Rate for Colorectal Adenoma Determined by Quality-Adjusted, Back-to-Back Colonoscopies. Gut Liver 2012; 6: 64-70
• 9 Leufkens AM, van Oijen MG, Vleggaar FP. et al. Factors influencing the miss rate of polyps in a back-to-back colonoscopy study. Endoscopy 2012; 44: 470-475
• 10 Aniwan S, Orkoonsawat P, Viriyautsahakul V. et al. The Secondary Quality Indicator to Improve Prediction of Adenoma Miss Rate Apart from Adenoma Detection Rate. Am J Gastroenterol 2016; 111: 723-729
• 11 Rastogi A, Early DS, Gupta N. et al. Randomized, controlled trial of standard-definition white-light, high-definition white-light, and narrow-band imaging colonoscopy for the detection of colon polyps and prediction of polyp histology. Gastrointest Endosc 2011; 74: 593-602
• 12 Lee SW, Chang JH, Ji JS. et al. Effect of Dynamic Position Changes on Adenoma Detection During Colonoscope Withdrawal: A Randomized Controlled Multicenter Trial. Am J Gastroenterol 2016; 111: 63-69
• 13 Cadoni S, Falt P, Rondonotti E. et al. Water exchange for screening colonoscopy increases adenoma detection rate: a multicenter, double-blinded, randomized controlled trial. Endoscopy 2017; 49: 456-467
• 14 Corte C, Dahlenburg L, Selby W. et al. Hyoscine butylbromide administered at the cecum increases polyp detection: a randomized double-blind placebo-controlled trial. Endoscopy 2012; 44: 917-922
• 15 Gralnek IM. Emerging technological advancements in colonoscopy: Third Eye(R) Retroscope(R) and Third Eye(R) Panoramic(TM) , Fuse(R) Full Spectrum Endoscopy(R) colonoscopy platform, Extra-Wide-Angle-View colonoscope, and NaviAid(TM) G-EYE(TM) balloon colonoscope. Dig Endosc 2015; 27: 223-231
• 16 Ngu WS, Bevan R, Tsiamoulos ZP. et al. Improved adenoma detection with Endocuff Vision: the ADENOMA randomised controlled trial. Gut 2018; 68: 280-288
• 17 Klare P, Sander C, Prinzen M. et al. Automated polyp detection in the colorectum: a prospective study (with videos). Gastrointest Endosc 2019; 89: 576-582
• 18 Endoscopic Classification Review Group Update on the paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy 2005; 37: 570-578
• 19 Hewett DG, Kaltenbach T, Sano Y. et al. Validation of a simple classification system for endoscopic diagnosis of small colorectal polyps using narrow-band imaging. Gastroenterology 2012; 143: 599-607.e591
• 20 Kudo S, Tamura S, Nakajima T. et al. Diagnosis of colorectal tumorous lesions by magnifying endoscopy. Gastrointest Endosc 1996; 44: 8-14
• 21 Ferlitsch M, Moss A, Hassan C. et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2017; 49: 270-297
• 22 Suchy C. Endoskopische Submukosadissektion größerer flächiger oder sessiler kolorektaler Neoplasien: eine aktualisierte Fallserie mit 310 Interventionen. Z Gastroenterol 2018; 56: e371
• 23 Denzer U, Beilenhoff U, Eickhoff A. et al. [S2k guideline: quality requirements for gastrointestinal endoscopy, AWMF registry no. 021–022]. Z Gastroenterol 2015; 53: E1-227
• 24 Hassan C, Repici A, Sharma P. et al. Efficacy and safety of endoscopic resection of large colorectal polyps: a systematic review and meta-analysis. Gut 2016; 65: 806-820
• 25 De Ceglie A, Hassan C, Mangiavillano B. et al. Endoscopic mucosal resection and endoscopic submucosal dissection for colorectal lesions: A systematic review. Crit Rev Oncol Hematol 2016; 104: 138-155
• 26 Schmidt A, Beyna T, Schumacher B. et al. Colonoscopic full-thickness resection using an over-the-scope device: a prospective multicentre study in various indications. Gut 2018; 67: 1280-1289
• 27 S3-Leitlinie kolorektales Karzinom: Langversion 2.0 – November 2017 – AWMF-Registernummer: 021/007OL. Stuttgart: Thieme 2017 Im Internet: https://wwwawmforg/leitlinien/detail/ll/021-007OLhtml 2017
• 28 Folkesson J, Birgisson H, Pahlman L. et al. Swedish Rectal Cancer Trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol 2005; 23: 5644-5650
• 29 Sauer R, Liersch T, Merkel S. et al. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol 2012; 30: 1926-1933
• 30 Peeters KC, Marijnen CA, Nagtegaal ID. et al. The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg 2007; 246: 693-701
• 31 Ngan SY, Burmeister B, Fisher RJ. et al. Randomized trial of short-course radiotherapy versus long-course chemoradiation comparing rates of local recurrence in patients with T3 rectal cancer: Trans-Tasman Radiation Oncology Group trial 01.04. J Clin Oncol 2012; 30: 3827-3833
• 32 Bujko K, Wyrwicz L, Rutkowski A. et al. Long-course oxaliplatin-based preoperative chemoradiation versus 5 × 5 Gy and consolidation chemotherapy for cT4 or fixed cT3 rectal cancer: results of a randomized phase III study. Ann Oncol 2016; 27: 834-842
• 33 Pettersson D, Lorinc E, Holm T. et al. Tumour regression in the randomized Stockholm III Trial of radiotherapy regimens for rectal cancer. Br J Surg 2015; 102: 972-978 discussion 978
• 34 Rodel C, Graeven U, Fietkau R. et al. Oxaliplatin added to fluorouracil-based preoperative chemoradiotherapy and postoperative chemotherapy of locally advanced rectal cancer (the German CAO/ARO/AIO-04 study): final results of the multicentre, open-label, randomised, phase 3 trial. Lancet Oncol 2015; 16: 979-989
• 35 Valentini V, Gambacorta MA, Barbaro B. et al. International consensus guidelines on Clinical Target Volume delineation in rectal cancer. Radiother Oncol 2016; 120: 195-201
• 36 Wee CW, Kang HC, Wu HG. et al. Intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy in rectal cancer treated with neoadjuvant concurrent chemoradiation: a meta-analysis and pooled-analysis of acute toxicity. Jpn J Clin Oncol 2018; 48: 458-466
• 37 Maas M, Beets-Tan RG, Lambregts DM. et al. Wait-and-see policy for clinical complete responders after chemoradiation for rectal cancer. J Clin Oncol 2011; 29: 4633-4640
• 38 Habr-Gama A, Gama-Rodrigues J, Sao Juliao GP. et al. Local recurrence after complete clinical response and watch and wait in rectal cancer after neoadjuvant chemoradiation: impact of salvage therapy on local disease control. Int J Radiat Oncol Biol Phys 2014; 88: 822-828
• 39 Bernier L, Balyasnikova S, Tait D. et al. Watch-and-Wait as a Therapeutic Strategy in Rectal Cancer. Curr Colorectal Cancer Rep 2018; 14: 37-55
• 40 Ruppert R, Junginger T, Ptok H. et al. Oncological outcome after MRI-based selection for neoadjuvant chemoradiotherapy in the OCUM Rectal Cancer Trial. Br J Surg 2018; 105: 1519-1529
• 41 Battersby NJ, How P, Moran B. et al. Prospective Validation of a Low Rectal Cancer Magnetic Resonance Imaging Staging System and Development of a Local Recurrence Risk Stratification Model: The MERCURY II Study. Ann Surg 2016; 263: 751-760
• 42 Nigri G, Petrucciani N, Ferla F. et al. Neoadjuvant chemotherapy for resectable colorectal liver metastases: what is the evidence? Results of a systematic review of comparative studies. Surgeon 2015; 13: 83-90
• 43 Nordlinger B, Sorbye H, Glimelius B. et al. Perioperative FOLFOX4 chemotherapy and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC 40983): long-term results of a randomised, controlled, phase 3 trial. Lancet Oncol 2013; 14: 1208-1215
• 44 Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1986; 1: 1479-1482
• 45 Kapiteijn E, Putter H, van de Velde CJ. Impact of the introduction and training of total mesorectal excision on recurrence and survival in rectal cancer in The Netherlands. Brit J Surg 2002; 89: 1142-1149
• 46 Kitz J, Fokas E, Beissbarth T. et al. Association of Plane of Total Mesorectal Excision With Prognosis of Rectal Cancer: Secondary Analysis of the CAO/ARO/AIO-04 Phase 3 Randomized Clinical Trial. JAMA Surg 2018; 153: e181607
• 47 Bosch SL, Nagtegaal ID. What is „good quality“ in rectal cancer surgery? The pathologist’s perspective. Recent Results Cancer Res 2014; 203: 41-46
• 48 Hohenberger W, Weber K, Matzel K. et al. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation--technical notes and outcome. Colorectal Dis 2009; 11: 354-364 discussion 364–355
• 49 Bertelsen CA, Neuenschwander AU, Jansen JE. et al. Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery: a retrospective, population-based study. Lancet Oncol 2015; 16: 161-168
• 50 Wang C, Gao Z, Shen K. et al. Safety, quality and effect of complete mesocolic excision vs non-complete mesocolic excision in patients with colon cancer: a systemic review and meta-analysis. Colorectal Dis 2017; 19: 962-972
• 51 Strey CW, Wullstein C, Adamina M. et al. Laparoscopic right hemicolectomy with CME: standardization using the „critical view“ concept. Surg Endosc 2018; 32: 5021-5030
• 52 Schwenk W, Haase O, Neudecker J. et al. Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev 2005. Cd003145
• 53 Martinez-Perez A, Carra MC, Brunetti F. et al. Short-term clinical outcomes of laparoscopic vs open rectal excision for rectal cancer: A systematic review and meta-analysis. World J Gastroenterol 2017; 23: 7906-7916
• 54 Abraham NS, Young JM, Solomon MJ. Meta-analysis of short-term outcomes after laparoscopic resection for colorectal cancer. Brit J Surg 2004; 91: 1111-1124
• 55 Hewett PJ, Allardyce RA, Bagshaw PF. et al. Short-term outcomes of the Australasian randomized clinical study comparing laparoscopic and conventional open surgical treatments for colon cancer: the ALCCaS trial. Ann Surg 2008; 248: 728-738
• 56 Green BL, Marshall HC, Collinson F. et al. Long-term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer. Brit J Surg 2013; 100: 75-82
• 57 Di B, Li Y, Wei K. et al. Laparoscopic versus open surgery for colon cancer: a meta-analysis of 5-year follow-up outcomes. Surg Oncol 2013; 22: e39-43
• 58 Athanasiou CD, Markides GA, Kotb A. et al. Open compared with laparoscopic complete mesocolic excision with central lymphadenectomy for colon cancer: a systematic review and meta-analysis. Colorectal Dis 2016; 18: O224-235
• 59 Cleary RK, Morris AM, Chang GJ. et al. Controversies in Surgical Oncology: Does the Minimally Invasive Approach for Rectal Cancer Provide Equivalent Oncologic Outcomes Compared with the Open Approach?. Ann Surg Oncol 2018; 25: 3587-3595
• 60 Stevenson AR, Solomon MJ, Lumley JW. et al. Effect of Laparoscopic-Assisted Resection vs Open Resection on Pathological Outcomes in Rectal Cancer: The ALaCaRT Randomized Clinical Trial. Jama 2015; 314: 1356-1363
• 61 Fleshman J, Branda M, Sargent DJ. et al. Effect of Laparoscopic-Assisted Resection vs Open Resection of Stage II or III Rectal Cancer on Pathologic Outcomes: The ACOSOG Z6051 Randomized Clinical Trial. Jama 2015; 314: 1346-1355
• 62 Jeong SY, Park JW, Nam BH. et al. Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol 2014; 15: 767-774
• 63 Benz S, Barlag H, Gerken M. et al. Laparoscopic surgery in patients with colon cancer: a population-based analysis. Surg Endosc 2017; 31: 2586-2595
• 64 Draeger T, Volkel V, Gerken M. et al. Long-term oncologic outcomes after laparoscopic versus open rectal cancer resection: a high-quality population-based analysis in a Southern German district. Surg Endosc 2018; 32: 4096-4104
• 65 Klinger AL, Green H, Monlezun DJ. et al. The Role of Bowel Preparation in Colorectal Surgery: Results of the 2012–2015 ACS-NSQIP Data. Ann Surg 2019; 269: 671-677
• 66 Kiran RP, Murray AC, Chiuzan C. et al. Combined preoperative mechanical bowel preparation with oral antibiotics significantly reduces surgical site infection, anastomotic leak, and ileus after colorectal surgery. Ann Surg 2015; 262: 416-425 discussion 423–415
• 67 Roos D, Dijksman LM, Tijssen JG. et al. Systematic review of perioperative selective decontamination of the digestive tract in elective gastrointestinal surgery. Brit J Surg 2013; 100: 1579-1588
• 68 Gillis C, Buhler K, Bresee L. et al. Effects of Nutritional Prehabilitation, With and Without Exercise, on Outcomes of Patients Who Undergo Colorectal Surgery: A Systematic Review and Meta-analysis. Gastroenterology 2018; 155: 391-410.e394
• 69 Moran J, Guinan E, McCormick P. et al. The ability of prehabilitation to influence postoperative outcome after intra-abdominal operation: A systematic review and meta-analysis. Surgery 2016; 160: 1189-1201
• 70 Penna M, Hompes R, Arnold S. et al. Transanal Total Mesorectal Excision: International Registry Results of the First 720 Cases. Ann Surg 2017; 266: 111-117
• 71 Ma B, Gao P, Song Y. et al. Transanal total mesorectal excision (taTME) for rectal cancer: a systematic review and meta-analysis of oncological and perioperative outcomes compared with laparoscopic total mesorectal excision. BMC cancer 2016; 16: 380
• 72 Spinoglio G, Bianchi PP, Marano A. et al. Robotic Versus Laparoscopic Right Colectomy with Complete Mesocolic Excision for the Treatment of Colon Cancer: Perioperative Outcomes and 5-Year Survival in a Consecutive Series of 202 Patients. Ann Surg Oncol 2018; 25: 3580-3586
• 73 Park JS, Kang H, Park SY. et al. Long-term oncologic after robotic versus laparoscopic right colectomy: a prospective randomized study. Surg Endosc 2018.
• 74 Prete FP, Pezzolla A, Prete F. et al. Robotic Versus Laparoscopic Minimally Invasive Surgery for Rectal Cancer: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Ann Surg 2018; 267: 1034-1046
• 75 Andre T, Boni C, Navarro M. et al. Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage II or III colon cancer in the MOSAIC trial. J Clin Oncol 2009; 27: 3109-3116
• 76 Gray R, Barnwell J, McConkey C. et al. Adjuvant chemotherapy versus observation in patients with colorectal cancer: a randomised study. Lancet 2007; 370: 2020-2029
• 77 Bastos DA, Ribeiro SC, de Freitas D. et al. Combination therapy in high-risk stage II or stage III colon cancer: current practice and future prospects. Ther Adv Med Oncol 2010; 2: 261-272
• 78 Schmidt M, Quante M. [The IDEA Intergroup Study – New standard in adjuvant treatment of stage III colorectal cancer]. Z Gastroenterol 2018; 56: 398-400
• 79 Poultsides GA, Servais EL, Saltz LB. et al. Outcome of primary tumor in patients with synchronous stage IV colorectal cancer receiving combination chemotherapy without surgery as initial treatment. J Clin Oncol 2009; 27: 3379-3384
• 80 Cremolini C, Loupakis F, Antoniotti C. et al. FOLFOXIRI plus bevacizumab versus FOLFIRI plus bevacizumab as first-line treatment of patients with metastatic colorectal cancer: updated overall survival and molecular subgroup analyses of the open-label, phase 3 TRIBE study. Lancet Oncol 2015; 16: 1306-1315
• 81 Venook AP, Niedzwiecki D, Lenz HJ. et al. Effect of First-Line Chemotherapy Combined With Cetuximab or Bevacizumab on Overall Survival in Patients With KRAS Wild-Type Advanced or Metastatic Colorectal Cancer: A Randomized Clinical Trial. Jama 2017; 317: 2392-2401
• 82 Colucci G, Gebbia V, Paoletti G. et al. Phase III randomized trial of FOLFIRI versus FOLFOX4 in the treatment of advanced colorectal cancer: a multicenter study of the Gruppo Oncologico Dell’Italia Meridionale. J Clin Oncol 2005; 23: 4866-4875
• 83 Van Cutsem E, Cervantes A, Adam R. et al. ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann Oncol 2016; 27: 1386-1422
• 84 van Erning FN, Elferink MA, Bos AC. et al. RE: Primary Tumor Location as a Prognostic Factor in Metastatic Colorectal Cancer. J Natl Cancer Inst 2015; 107 (09)
• 85 Zhou M, Yu P, Qu J. et al. Efficacy of Bevacizumab in the First-Line Treatment of Patients with RAS Mutations Metastatic Colorectal Cancer: a Systematic Review and Network Meta-Analysis. Cell Physiol Biochem 2016; 40: 361-369
• 86 Cunningham D, Lang I, Marcuello E. et al. Bevacizumab plus capecitabine versus capecitabine alone in elderly patients with previously untreated metastatic colorectal cancer (AVEX): an open-label, randomised phase 3 trial. Lancet Oncol 2013; 14: 1077-1085
• 87 Overman MJ, Lonardi S, Wong KYM. et al. Durable Clinical Benefit With Nivolumab Plus Ipilimumab in DNA Mismatch Repair-Deficient/Microsatellite Instability-High Metastatic Colorectal Cancer. J Clin Oncol 2018; 36: 773-779
• 88 Sartore-Bianchi A, Trusolino L, Martino C. et al. Dual-targeted therapy with trastuzumab and lapatinib in treatment-refractory, KRAS codon 12/13 wild-type, HER2-positive metastatic colorectal cancer (HERACLES): a proof-of-concept, multicentre, open-label, phase 2 trial. Lancet Oncol 2016; 17: 738-746
• 89 Zhao L, Wang J, Li H. et al. Meta-analysis comparing maintenance strategies with continuous therapy and complete chemotherapy-free interval strategies in the treatment of metastatic colorectal cancer. Oncotarget 2016; 7: 33418-33428