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Multimodale Therapie bei Adenokarzinomen des ösophagogastralen Übergangs

Multimodal treatment of adenocarcinoma of the esophagogastric junction

  • Leitthema
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Die Prognose resektabler Adenokarzinome des ösophagogastralen Übergangs (AEG) ist kritisch.

Ziel

Die aktuelle Datenlage zu multimodalen Therapiekonzepten und eine evidenzbasierte Therapieempfehlung werden dargestellt.

Material und Methoden

Eine Literaturrecherche zu klinischen Phase-II- und -III-Studien der zurückliegenden 25 Jahre über PubMed wurde durchgeführt. Es erfolgte eine Sichtung der aktuellen deutschen, europäischen, und nordamerikanischen Leitlinien.

Ergebnisse

Zur Behandlung resektabler AEG wird ein multimodales Vorgehen unter Berücksichtigung von Chirurgie, Chemotherapie und ggf. Strahlentherapie empfohlen, um die insgesamt kritische Prognose zu verbessern. Multimodale Therapie führt im Vergleich zu alleiniger Chirurgie zu einer relativen Risikoreduktion für den Endpunkt Tod um ca. 20–35 %. In der standarddefinierenden CROSS-Studie überlebten nach 5 Jahren 33 % der Patienten nach alleiniger Chirurgie im Vergleich zu 43 % nach multimodaler Therapie. In prospektiv-randomisierten kontrollierten Studien führte sowohl die neoadjuvante Radiochemotherapie als auch die perioperative Chemotherapie zu einer Verbesserung des Gesamtüberlebens. Beide Behandlungsmethoden sind in erfahrenen Händen und unter Studienbedingungen sicher und führen zu keiner Erhöhung der postoperativen Mortalität.

Schlussfolgerung

Entsprechend der aktuellen wissenschaftlichen Evidenz soll bei resektablen AEG entweder eine präoperative Radiochemotherapie oder eine perioperative Chemotherapie erfolgen.

Abstract

Background

The prognosis of resectable adenocarcinoma of the esophagogastric junction is critical.

Objective

To outline the current evidence for multimodal treatment concepts and to give evidence-based treatment recommendations.

Material and methods

A literature search was carried out for clinical phase II and III studies within the past 25 years via PubMed. Review of the current German, European and North American guidelines.

Results

Multimodal treatment concepts are recommended for improving survival outcomes of patients with resectable adenocarcinoma of the esophagogastric junction. These concepts include surgery, chemotherapy and optionally radiotherapy. The relative risk reduction for the endpoint death is improved by 20–35% when applying multimodal treatment as compared to surgery alone. This translates into a 5‑year overall survival rate of 33% after surgery alone as compared to 43% with neoadjuvant therapy in the pivotal CROSS study. Prospective controlled trials showed that both neoadjuvant chemoradiotherapy and also perioperative chemotherapy can be safely administered in experienced centers and lead to improved overall survival and do not increase postoperative mortality.

Conclusion

According to current scientific evidence, either preoperative chemoradiotherapy or perioperative chemotherapy are recommended for resectable adenocarcinoma of the gastroesophageal junction.

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Authors and Affiliations

  1. Medizinische Klinik I (Hämatologie, Zelltherapie, Internistische Onkologie, Hämostaseologie), Universitäres Krebszentrum Leipzig (UCCL), Universitätsklinikum Leipzig, Liebigstr. 22, 04103, Leipzig, Deutschland

    Florian Lordick

  2. Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax-, und Gefäßchirurgie, Universitätsklinikum Leipzig, Leipzig, Deutschland

    Ines Gockel

Authors
  1. Florian Lordick
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  2. Ines Gockel
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Correspondence to Florian Lordick.

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Interessenkonflikt

F. Lordick und I. Gockel geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Lordick, F., Gockel, I. Multimodale Therapie bei Adenokarzinomen des ösophagogastralen Übergangs. Onkologe 25, 1086–1094 (2019). https://doi.org/10.1007/s00761-019-00658-9

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  • DOI: https://doi.org/10.1007/s00761-019-00658-9

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