Download PDF
Gastroenterologie up2date 2007; 3(1): 17-32
DOI: 10.1055/s-2007-966186
Ösophagus/Magen/Duodenum

© Georg Thieme Verlag Stuttgart · New York

Aktuelle Diagnostik und Therapie des Magenkarzinoms

Markus  Möhler, Peter  R.  Galle
Further Information

Publication History

Publication Date:
02 April 2007 (online)

Also available at
    Permissions and Reprints All articles of this category

Einleitung

Karzinome des Magens und gastroösophagealen Übergangs gehören weltweit zu den häufigsten tumorbedingten Todesursachen. Denn trotz kurativer Resektion zeigen Patienten bereits in frühen Stadien II - III ein schlechtes 5-Jahres-Überleben mit einem hohen Risiko für ein Lokalrezidiv, lymphogene Mikrometastasen oder organische Fernmetastasierung. Zusätzlich steigt die Inzidenz der Kardia- und Barrett-Karzinome.

Da sich in den letzten Jahren aber zahlreiche positive Änderungen in Diagnostik und Therapie ergeben haben, stellen diese Karzinome heute eine Herausforderung für gastroenterologisch tätige Internisten und den überweisenden Hausarzt dar. Aufgrund zahlreicher etablierter interdisziplinärer Therapiekonzepte und der Gründung organbezogener Tumorzentren ist der klassische Überweisungsweg vom Hausarzt zum Gastroenterologen und danach zum Chirurgen nicht mehr ausreichend.

Die neoadjuvanten, adjuvanten und palliativen Therapiestrategien, die im Laufe der letzten Jahre entwickelt wurden, werden in diesem Artikel daher nach Stadien getrennt diskutiert.

Literatur

  • 1 Bollschweiler E. et al . High rate of lymph-node metastasis in submucosal esophageal squamous-cell carcinomas and adenocarcinomas.  Endoscopy. 2006;  38 149-156
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Bollschweiler E. et al . Staging of esophageal carcinoma: lenght of tumor and number of involved regional lymph nodes. Are these independent prognostic factors?.  J Surg Oncol. 2006;  94 355-363
    CrossrefPubMedGoogle Scholar
  • 3 Nagano H. et al . Indications for gastrectomy after incomplete EMR for early gastric cancer.  Gastric Cancer. 2005;  8 149-154
    CrossrefPubMedGoogle Scholar
  • 4 Deutschland A.B.-b. K.i .Krebs in Deutschland, Häufigkeiten und Trends. Saarbrücken; Verlag 2000: 24-26
    Google Scholar
  • 5 Neugut A I, Hayek M, Howe G. Epidemiology of gastric cancer.  Semin Oncol. 1996;  23 281-291
    PubMedGoogle Scholar
  • 6 Sawada T, Muto T. Familial adenomatous polyposis: should patients undergo surveillance of the upper gastrointestinal tract?.  Endoscopy. 1995;  27 6-11
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Park W S. et al . Frequent somatic mutations of the beta-catenin gene in intestinal-type gastric cancer.  Cancer Res. 1999;  59 4257-4260
    PubMedGoogle Scholar
  • 8 Messmann H, Schlottmann K. Role of endoscopy in the staging of esophageal and gastric cancer.  Semin Surg Oncol. 2001;  20 78-81
    CrossrefPubMedGoogle Scholar
  • 9 Ziegler K. et al . Comparison of computed tomography, endosonography, and intraoperative assessment in TN staging of gastric carcinoma.  Gut. 1993;  34 604-610
    CrossrefPubMedGoogle Scholar
  • 10 Siewert J R, Stein H J. Classification of adenocarcinoma of the oesophagogastric junction.  Br J Surg. 1998;  85 1457-1459
    CrossrefPubMedGoogle Scholar
  • 11 Cuschieri A. et al . Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Surgical Co-operative Group.  Br J Cancer. 1999;  79 1522-1530
    CrossrefPubMedGoogle Scholar
  • 12 Bonenkamp J J. et al . Comparison of factors influencing the prognosis of Japanese, German, and Dutch gastric cancer patients.  World J Surg. 1993;  17 410-414; discussion 415
    CrossrefPubMedGoogle Scholar
  • 13 Bottcher K. et al . [Risk of surgical therapy of stomach cancer in Germany. Results of the German 1992 Stomach Cancer Study. German Stomach Cancer Study Group (‘92)].  Chirurg. 1994;  65 298-306
    PubMedGoogle Scholar
  • 14 Falcone A. Future strategies and adjuvant treatment of gastric cancer.  Ann Oncol. 2003;  14(Suppl 2) ii45-47
    PubMedGoogle Scholar
  • 15 Macdonald J S. et al . Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction.  N Engl J Med. 2001;  345 725-730
    CrossrefPubMedGoogle Scholar
  • 16 Lee J H, Han H S, Kim Y W. et al . Laparoscopic wedge resection with handsewn closure for gastroduodenal tumors.  J Laparoendosc Adv Surg Tech A. 2003;  13 349-353
    CrossrefPubMedGoogle Scholar
  • 17 Tada M, Tanaka Y, Matsuo N. et al . Mucosectomy for gastric cancer: current status in Japan.  J Gastroenterol Hepatol. 2000;  15(Suppl) D98-102
    CrossrefPubMedGoogle Scholar
  • 18 Takeo Y. et al . Endoscopic mucosal resection for early esophageal cancer and esophageal dysplasia.  Hepatogastroenterology. 2001;  48 453-457
    PubMedGoogle Scholar
  • 19 Ono H. Endoscopic submucosal dissection for early gastric cancer.  Chin J Dig Dis. 2005;  6 119-121
    PubMedGoogle Scholar
  • 20 Kunisaki C. et al . Appropriate lymph node dissection for early gastric cancer based on lymph node metastases.  Surgery. 2001;  129 153-157
    CrossrefPubMedGoogle Scholar
  • 21 Gotoda T. et al . Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers.  Gastric Cancer. 2000;  3 219-225
    CrossrefPubMedGoogle Scholar
  • 22 Janunger K G, Hafstrom L, Nygren P. et al . A systematic overview of chemotherapy effects in gastric cancer.  Acta Oncol. 2001;  40 309-326
    PubMedGoogle Scholar
  • 23 Cunningham D. et al . Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer.  N Engl J Med. 2006;  355 11-20
    CrossrefPubMedGoogle Scholar
  • 24 Menges M. et al . Low toxic neoadjuvant cisplatin, 5-fluorouracil and folinic acid in locally advanced gastric cancer yields high R-0 resection rate.  J Cancer Res Clin Oncol. 2003;  129 423-429
    CrossrefPubMedGoogle Scholar
  • 25 Ajani J A. et al . Phase II trial of preoperative chemoradiation in patients with localized gastric adenocarcinoma (RTOG 9904): quality of combined modality therapy and pathologic response.  J Clin Oncol. 2006;  24 3953-3958
    CrossrefPubMedGoogle Scholar
  • 26 Klautke G. et al . Neoadjuvant radiochemotherapy in locally advanced gastric carcinoma.  Strahlenther Onkol. 2004;  180 695-700
    CrossrefPubMedGoogle Scholar
  • 27 Moehler M, Schimanski C C, Gockel I. et al . (Neo)adjuvant strategies of advanced gastric carcinoma: time for a change?.  Dig Dis. 2004;  22 345-350
    CrossrefPubMedGoogle Scholar
  • 28 Hohler T, Mohler M. [New chemotherapeutic options in advanced gastric cancer].  Onkologie. 2003;  26(Suppl 7) 54-59
    CrossrefPubMedGoogle Scholar
  • 29 Webb A. et al . Randomized trial comparing epirubicin, cisplatin, and fluorouracil versus fluorouracil, doxorubicin, and methotrexate in advanced esophagogastric cancer.  J Clin Oncol. 1997;  15 261-267
    PubMedGoogle Scholar
  • 30 Ross P. et al . Prospective randomized trial comparing mitomycin, cisplatin, and protracted venous-infusion fluorouracil (PVI 5-FU) with epirubicin, cisplatin, and PVI 5-FU in advanced esophagogastric cancer.  J Clin Oncol. 2002;  20 1996-2004
    CrossrefPubMedGoogle Scholar
  • 31 Vanhoefer U. et al . Final results of a randomized phase III trial of sequential high-dose methotrexate, fluorouracil, and doxorubicin versus etoposide, leucovorin, and fluorouracil versus infusional fluorouracil and cisplatin in advanced gastric cancer: A trial of the European Organization for Research and Treatment of Cancer Gastrointestinal Tract Cancer Cooperative Group.  J Clin Oncol. 2000;  18 2648-2657
    PubMedGoogle Scholar
  • 32 Gadgeel S M. et al . Phase II study of paclitaxel and carboplatin in patients with advanced gastric cancer.  Am J Clin Oncol. 2003;  26 37-41
    CrossrefPubMedGoogle Scholar
  • 33 Van Cutsem E. et al . Phase III study of docetaxel and cisplatin plus fluorouracil compared with cisplatin and fluorouracil as first-line therapy for advanced gastric cancer: a report of the V325 Study Group.  J Clin Oncol. 2006;  24 4991-4997
    CrossrefPubMedGoogle Scholar
  • 34 Roth A D, Ajani J. Docetaxel-based chemotherapy in the treatment of gastric cancer.  Ann Oncol. 2003;  14(Suppl 2) ii41-44
    PubMedGoogle Scholar
  • 35 Boku N. et al . Phase II study of a combination of irinotecan and cisplatin against metastatic gastric cancer.  J Clin Oncol. 1999;  17 319-323
    PubMedGoogle Scholar
  • 36 Moehler M. et al . Randomised phase II evaluation of irinotecan plus high-dose 5-fluorouracil and leucovorin (ILF) vs 5-fluorouracil, leucovorin, and etoposide (ELF) in untreated metastatic gastric cancer.  Br J Cancer. 2005;  92 2122-2128
    CrossrefPubMedGoogle Scholar
  • 37 Bouche O. et al . Randomized multicenter phase II trial of a biweekly regimen of fluorouracil and leucovorin (LV5FU2), LV5FU2 plus cisplatin, or LV5FU2 plus irinotecan in patients with previously untreated metastatic gastric cancer: a Federation Francophone de Cancerologie Digestive Group Study - FFCD 9803.  J Clin Oncol. 2004;  22 4319-4328
    CrossrefPubMedGoogle Scholar
  • 38 Al-Batran S E. et al . Phase II trial of biweekly infusional fluorouracil, folinic acid, and oxaliplatin in patients with advanced gastric cancer.  J Clin Oncol. 2004;  22 658-663
    CrossrefPubMedGoogle Scholar
  • 39 Wagner A D, Grothe W, Haerting J. et al . Chemotherapy in advanced gastric cancer: a systematic review and meta-analysis based on aggregate data.  J Clin Oncol. 2006;  24 2903-2909; Review
    CrossrefPubMedGoogle Scholar

PD Dr. Markus Möhler

Johannes-Gutenberg Universität Mainz
I. Medizinische Klinik und Poliklinik

Langenbeckstraße 1
55101 Mainz

Email: moehler@mail.uni-mainz.de

      >