Z Gastroenterol 2017; 55(12): 1344-1498
DOI: 10.1055/s-0043-121106
Leitlinie
© Georg Thieme Verlag KG Stuttgart · New York

S3-Leitlinie – Kolorektales Karzinom

Langversion 2.0 – November 2017–AWMF-Registernummer: 021/007OL
Wolff Schmiegel
1   Ruhr-Universität Bochum, Knappschaftskrankenhaus, Medizinische Universitätsklinik und Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Gastroenterologie und Hepatologie, Bochum
,
Barbara Buchberger
2   Essener Forschungsinstitut für Medizinmanagement GmbH, Essen
,
Markus Follmann
3   Office des Leitlinienprogramms Onkologie, Berlin
,
Ullrich Graeven
4   Kliniken Maria Hilf GmbH, Klinik für Hämatologie, Onkologie und Gastroenterologie, Mönchengladbach
,
Volker Heinemann
5   Klinikum Großhadern, III. Medizinische Klinik Hämatologie und Onkologie, München
,
Thomas Langer
3   Office des Leitlinienprogramms Onkologie, Berlin
,
Monika Nothacker
6   AWMF Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V., Berlin
,
Rainer Porschen
7   Klinikum Bremen-Ost, Klinik für Innere Medizin, Bremen
,
Claus Rödel
8   Universitätsklinikum Johann Wolfgang Goethe Universität, Klinik für Strahlentherapie und Onkologie, Frankfurt
,
Thomas Rösch
9   Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für interdisziplinäre Endoskopie, Hamburg
,
Wolfgang Schmitt
10   Klinikum Neuperlach, Klinik für Gastroenterologie, München
,
Simone Wesselmann
11   Deutsche Krebsgesellschaft, Berlin
,
Christian Pox***
12   St. Joseph-Stift Bremen, Medizinische Klinik, Bremen
› Author Affiliations
Further Information

Publication History

Publication Date:
06 December 2017 (online)

1. Informationen zu dieser Leitlinie

1.1. Herausgeber

Leitlinienprogramm Onkologie der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (AWMF), Deutschen Krebsgesellschaft e. V. und Deutschen Krebshilfe


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1.2. Federführende Fachgesellschaft

Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS)


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1.3. Finanzierung der Leitlinie

Diese Leitlinie wurde von der Deutschen Krebshilfe im Rahmen des Onkologischen Leitlinienprogramms gefördert.


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1.4. Kontakt

Leitlinienprogramm Onkologie Office
c/o Deutsche Krebsgesellschaft e. V.
Kuno-Fischer-Str. 8
14 057 Berlin
leitlinienprogramm@krebsgesellschaft.de
www.leitlinienprogramm-onkologie.de


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1.5. Zitierweise

Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF): S3-Leitlinie Kolorektales Karzinom, Langversion 2.0, 2017, AWMF-Registrierungsnummer: 021/007OL, http://www.leitlinienprogramm-onkologie.de/leitlinien/kolorektales-karzinom/ [Stand: TT.MM.JJJJ]


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1.6. Besonderer Hinweis

Die Medizin unterliegt einem fortwährenden Entwicklungsprozess, sodass alle Angaben, insbesondere zu diagnostischen und therapeutischen Verfahren, immer nur dem Wissensstand zurzeit der Drucklegung der Leitlinie entsprechen können. Hinsichtlich der angegebenen Empfehlungen zur Therapie und der Auswahl sowie Dosierung von Medikamenten wurde die größtmögliche Sorgfalt beachtet. Gleichwohl werden die Benutzer aufgefordert, die Beipackzettel und Fachinformationen der Hersteller zur Kontrolle heranzuziehen und im Zweifelsfall einen Spezialisten zu konsultieren. Fragliche Unstimmigkeiten sollen bitte im allgemeinen Interesse der OL-Redaktion mitgeteilt werden.

Der Benutzer selbst bleibt verantwortlich für jede diagnostische und therapeutische Applikation, Medikation und Dosierung.

In dieser Leitlinie sind eingetragene Warenzeichen (geschützte Warennamen) nicht besonders kenntlich gemacht. Es kann also aus dem Fehlen eines entsprechenden Hinweises nicht geschlossen werden, dass es sich um einen freien Warennamen handelt.

Das Werk ist in allen seinen Teilen urheberrechtlich geschützt. Jede Verwertung außerhalb der Bestimmung des Urhebergesetzes ist ohne schriftliche Zustimmung des Leitlinienprogramms Onkologie (OL) unzulässig und strafbar. Kein Teil des Werkes darf in irgendeiner Form ohne schriftliche Genehmigung des OL reproduziert werden. Dies gilt insbesondere für Vervielfältigungen, Übersetzungen, Mikroverfilmungen und die Einspeicherung, Nutzung und Verwertung in elektronischen Systemen, Intranets und dem Internet.


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1.7. Ziele des Leitlinienprogramms Onkologie

Die Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V., die Deutsche Krebsgesellschaft e. V. und die Deutsche Krebshilfe haben sich mit dem Leitlinienprogramm Onkologie (OL) das Ziel gesetzt, gemeinsam die Entwicklung und Fortschreibung und den Einsatz wissenschaftlich begründeter und praktikabler Leitlinien in der Onkologie zu fördern und zu unterstützen. Die Basis dieses Programms beruht auf den medizinisch-wissenschaftlichen Erkenntnissen der Fachgesellschaften und der DKG, dem Konsens der medizinischen Fachexperten, Anwender und Patienten sowie auf dem Regelwerk für die Leitlinienerstellung der AWMF und der fachlichen Unterstützung und Finanzierung durch die Deutsche Krebshilfe. Um den aktuellen Stand des medizinischen Wissens abzubilden und den medizinischen Fortschritt zu berücksichtigen, müssen Leitlinien regelmäßig überprüft und fortgeschrieben werden. Die Anwendung des AWMF-Regelwerks soll hierbei Grundlage zur Entwicklung qualitativ hochwertiger onkologischer Leitlinien sein. Da Leitlinien ein wichtiges Instrument der Qualitätssicherung und des Qualitätsmanagements in der Onkologie darstellen, sollten sie gezielt und nachhaltig in den Versorgungsalltag eingebracht werden. So sind aktive Implementierungsmaßnahmen und auch Evaluationsprogramme ein wichtiger Bestandteil der Förderung des Leitlinienprogramms Onkologie. Ziel des Programms ist es, in Deutschland professionelle und mittelfristig finanziell gesicherte Voraussetzungen für die Entwicklung und Bereitstellung hochwertiger Leitlinien zu schaffen. Denn diese hochwertigen Leitlinien dienen nicht nur dem strukturierten Wissenstransfer, sondern können auch in der Gestaltung der Strukturen des Gesundheitssystems ihren Platz finden. Zu erwähnen sind hier evidenzbasierte Leitlinien als Grundlage zum Erstellen und Aktualisieren von Disease-Management-Programmen oder die Verwendung von aus Leitlinien extrahierten Qualitätsindikatoren im Rahmen der Zertifizierung von Organtumorzentren.


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1.8. Verfügbare Dokumente zur Leitlinie und Implementierung

Bei diesem Dokument handelt es sich um die Langversion der S3-Leitlinie Kolorektales Karzinom, welche über die folgenden Seiten zugänglich ist:

Darüber hinaus wird die Langversion dieser Leitlinie in der Zeitschrift für Gastroenterologie veröffentlicht werden.

Neben der Langversion gibt es folgende ergänzende Dokumente zu dieser Leitlinie:

  • Kurzversion

  • drei Laienversionen (Patientenleitlinien) zu den Themen Früherkennung, frühes Stadium und fortgeschrittenes Stadium (werden derzeit aktualisiert)

  • Leitlinienreport

  • englische Version (wird derzeit aktualisiert)

  • separate Evidenzberichte bzw. Publikationen (Vorsorge, Früherkennung, präoperative Diagnostik, Therapeutisches Vorgehen bei Metastasierung und in der palliativen Situation: Analyse, Einsatz von Angiogenesehemmern und anti-EGFR-Antikörpern bei Patienten mit metastasiertem KRK)

Alle diese Dokumente werden ebenfalls auf den oben genannten Homepages abrufbar sein.


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1.9. Zusammensetzung der Leitliniengruppe

1.9.1. Koordination und Redaktion

Prof. Dr. Wolff Schmiegel (Bochum) und PD Dr. Christian Pox (Bremen)

Leitliniensekretariat: Jutta Thurn (Bochum)


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1.9.2. Beteiligte Fachgesellschaften und Autoren

In [Tab. 1] sind die an der Ersterstellung und Aktualisierung beteiligten Fachgesellschaften und anderen Organisationen sowie die jeweils benannten Fachexperten/Fachexpertinnen aufgelistet. In [Tab. 2] sind die Mitglieder der jeweiligen Arbeitsgruppen aufgelistet.

Tab. 1

Beteiligte Fachgesellschaften und Organisationen.

Beteiligte Fachgesellschaften und Organisationen

Mandatsträger/beteiligte Experten

Arbeitsgemeinschaft „Supportive Maßnahmen in der Onkologie, Rehabilitation und Sozialmedizin“ in der DKG (ASORS)

J. Körber*, R. Caspari (Vertr.)***, H. Link*

Arbeitsgemeinschaft Deutscher Tumorzentren (ADT)

H. Barlag***

Arbeitsgemeinschaft für Psychoonkologie in der DKG (PSO)

P. Heußner

Arbeitsgemeinschaft Internistische Onkologie in der DKG (AIO)

M. Geissler***, R.-D. Hofheinz***, S. Stintzing***, V. Heinemann***, D. Arnold***, S. Hegewisch-Becker***, C.-H. Köhne***

Arbeitsgemeinschaft Konferenz Onkologische Kranken- und Kinderkrankenpflege in der DKG (KOK)

M. Landenberger*

Arbeitsgemeinschaft Onkologische Pathologie in der DKG (AOP)

G. Baretton*

Arbeitsgemeinschaft Onkologische Pharmazie in der DKG (OPH)

M. Höckel***

Arbeitsgemeinschaft Prävention und integrative Medizin in der Onkologie in der DKG (PRIO)

J. Hübner**

Arbeitsgemeinschaft Radiologische Onkologie in der DKG (ARO)

H. A. Wolff***

Arbeitsgemeinschaft Bildgebung und Radioonkologie in der DKG (ABO)

J. Menke***

Berufsverband Niedergelassener Gastroenterologen Deutschlands (bng)

A. Theilmeier*, B. Bokemeyer**

Bundesverband der Niedergelassenen Hämatologen und Onkologen in Deutschland (BNHO)

M. J. Eckart***

Bundesverband Deutscher Pathologen (BDP)

C. Wittekind**

Chirurgische Arbeitsgemeinschaft für Colo-Proktologie in der DGAV (CACP)

S. Post**

Chirurgische Arbeitsgemeinschaft für Minimal Invasive Chirurgie in der DGAV (CAMIC)

M. Walz**

Chirurgische Arbeitsgemeinschaft für Onkologie in der DGAV (CAO-V)

H.-R. Raab***, H. Lang*, J. Weitz**, M. Sailer**

Chirurgische Arbeitsgemeinschaft Onkololgie in der DKG (CAO)

C. T. Germer***

Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV)

A. Glitsch***, C. T. Germer***, W. Hohenberger**, M. Anthuber**, W. Bechstein**, K-W. Jauch**, K-H. Link**, H-R. Raab**

Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM)

J.-F. Chenot***, G. Egidi (Vertr)***

Deutsche Gesellschaft für Chirurgie (DGCH)

W. Hohenberger***, H.-R. Raab***

Deutsche Gesellschaft für Ernährungsmedizin (DGEM)

S. C. Bischoff**, J. Ockenga**,
W. Scheppach**

Deutsche Gesellschaft für Hämatologie und Onkologie (DGHO)

M. Geissler***, R.-D. Hofheinz***,
S. Stintzing***, V. Heinemann***,
D. Arnold***, S. Hegewisch-Becker***, C.-H. Köhne***,
M. Heike**, T. Höhler**

Deutsche Gesellschaft für Humangenetik (GfH)

N. Rahner**, J. Epplen**

Deutsche Gesellschaft für Innere Medizin (DGIM)

T. Seufferlein***, J.F. Riemann**

Deutsche Gesellschaft für interventionelle Radiologie und minimal-invasive Therapie (DeGIR)

P. L. Pereira***

Deutsche Gesellschaft für Klinische Chemie und Laboratoriumsmedizin (DGKL)

S. Holdenrieder***, M. Neumaier*** C. Wagener**

Deutsche Gesellschaft für Koloproktologie (DGK)

W. Hohenberger***

Deutsche Gesellschaft für Nuklearmedizin (DGN)

H. Amthauer***, K. Scheidhauer**, H. Ahmadzadehfar***

Deutsche Gesellschaft für Pathologie (DGP)

A. Tannapfel*, A. Jung***, T. Kirchner*, P. Schirmacher***, G. Baretton*, C. Wittekind**

Deutsche Gesellschaft für Radioonkologie (DEGRO)

C. Rödel*, W. Budach***, H. Schmidberger***, R. Sauer**

Deutsche Gesellschaft für Rehabilitationswissenschaften (DGRW)

J. Körber***

Deutsche Gesellschaft Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS)

R. Kiesslich***, W. Schmitt***, F. Kolligs*, H. Neuhaus***, C. Pox*, T. Rösch***, J. Trojan***, R. Porschen*, G. Folprecht***, U. Graeven*, M. Ebert***, W. Schmiegel*, T. Seufferlein***, J.F. Riemann**, S. C. Bischoff**, J. Ockenga**, W. Scheppach**, A. Sieg**, K. Schulmann**, B. Bokemeyer**, U. Melle**, A. Reinacher-Schick**, A. Holstege**

Deutsche Morbus Crohn/Colitis Ulcerosa Vereinigung (DCCV)

C. Witte**

Deutsche Röntgengesellschaft (DRG)

A. Schreyer***, T. J. Vogl*, C. Stroszczynski (Vertr)***, H-J. Brambs**, P. L. Pereira**

Deutscher Hausärzteverband (HÄV)

P. Engeser**

Eingeladene Fachexperten (ohne Stimmrecht)

H.Brenner**, P. Lux**

Felix-Burda-Stiftung

C. Maar**

Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen (AQUA)

S. Ludt**

Stiftung Lebensblicke

J.F. Riemann**

Vereinigung für Stomaträger und für Menschen mit Darmkrebs (Deutsche ILCO)

M. Hass*

Zentralinstitut der Kassenärztlichen Versorgung in der BRD (ZI)

L. Altenhofen**

Zeitraum der Beteiligung: * = 2011 – 2017 (Version 1 und 2); ** = 2011 – 2012 (Version 1); *** = 2013 – 2017 (Version 2).

Tab. 2

Mitglieder der Arbeitsgruppen.

Arbeitsgruppe

Mitglieder der Arbeitsgruppe (AG-Leiter fett markiert)

Kapitel 3: Prävention asymptomatische Bevölkerung

J.F. Riemann, S. C. Bischoff, F. Kolligs, J. Ockenga, W. Scheppach

Kapitel 4: Früherkennung/Vorsorge asymptomatische Bevölkerung

C. Pox, A. Sieg, L. Altenhofen, H-J. Brambs, H. Brenner, P. Engeser, A. Theilmeier

Kapitel 5: Risikogruppen

N. Rahner, K. Schulmann, G. Baretton, B. Bokemeyer, J. Epplen, U. Melle, R. Porschen, J. Weitz, C. Witte

Kapitel 6: Endoskopie: Durchführung und Polypenmanagement

T. Rösch, W. Schmitt, G. Baretton, A. Glitsch, R. Kiesslich, F. Kolligs, H. Neuhaus, C. Pox, A. Schreyer, A. Tannapfel, A. Theilmeier, J. Trojan

Kapitel 7: Präoperative Diagnostik und Chirurgie

W. Hohenberger, S. Post, M. Anthuber, W. Bechstein, U. Graeven, M. Hass, M. Heike, K-W. Jauch, T. Kirchner, H. Lang, K-H. Link, P. Pereira, H-R. Raab, A. Reinacher-Schick, C. Rödel, M. Sailer, R. Sauer, K. Scheidhauer, A. Tannapfel, T. Vogl, C. Wagener, M. Walz, C. Wittekind

Kapitel 8: Adjuvante und neoadjuvante Therapie

C. Rödel, R. Porschen, W. Budach, G. Folprecht, M. Geissler, R.-D. Hofheinz, W. Hohenberger, S. Holdenrieder, J. Körber, J. Menke, H.-R. Raab, H. Schmidberger, S. Stintzing

Kapitel 9: Therapeutisches Vorgehen bei Metastasierung und in der palliativen Situation

V. Heinemann, U. Graeven, H. Amthauer, D. Arnold, R. Caspari, J.-F. Chenot, M. Ebert, M. J. Eckart, G. Egidi, C. T. Germer, M. Hass, S. Hegewisch-Becker, M. Höckel, A. Jung, T. Kirchner, C.-H. Köhne, M. Landenberger, H. Lang, H. Link, M. Neumaier, P. L. Pereira, P. Schirmacher, W. Schmiegel, T. Seufferlein, C. Stroszczynski, T. J. Vogl, H. A. Wolff

Kapitel 10: Nachsorge

A. Holstege, P. Heußner, T. Höhler, J. Hübner, J. Körber, M. Landenberger, H. Link

Qualitätsindikatoren

S. Wesselmann, T. Langer, H. Ahmadzadehfar, D. Arnold, G. Baretton, H. Barlag, M. Ebert, M. Hass, V. Heinemann, W. Hohenberger, T. Kirchner, C.H. Köhne, F. Kolligs, M. Nothacker

Darüber hinaus wurde die Aktualisierung der Leitlinie 2017 in Zusammenarbeit mit der DGP (Deutsche Gesellschaft für Palliativmedizin) vorgenommen.


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1.9.3. Patientenbeteiligung

Die Leitlinie wurde unter direkter Beteiligung von Patientenvertretern erstellt. Frau Maria Hass (Deutsche ILCO) sowie C. Witte (DCCV) waren an der Aktualisierung der Leitlinie beteiligt und nahmen mit eigenem Stimmrecht an den Konsensuskonferenzen teil.


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1.9.4. Methodische Begleitung

durch das Leitlinienprogramm Onkologie

  • Prof. Dr. Ina Kopp (AWMF), Marburg (2011/2012)

  • Dr. Monika Nothacker, MPH (AWMF), Berlin (2013 – 2017)

  • Dr. Markus Follmann, MPH MSc (DKG), Berlin (2011 – 2017)

  • Dipl.-Soz.Wiss. Thomas Langer (DKG), Berlin (2013 – 2017)

Durch externe Auftragnehmer:

  • Dr. Barbara Buchberger (Literaturrecherche und Qualitätsbewertung)

  • Dr. med. Simone Wesselmann, MBA (Aktualisierung der Qualitätsindikatoren)


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1.10. Verwendete Abkürzungen

Abkürzung

Erläuterung

AFAP

Attenuierte FAP

ADR

Adenomdetektionsrate

AHB

Anschlussheilbehandlung

ASS

Acetylsalicylsäure

AWMF

Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften

BMI

Body-Mass-Index

BSC

Best supportive Care

CEA

Karzinoembryonales Antigen

CT

Computer-Tomografie

CTC

CT-Kolonografie

CU

Colitis Ulcerosa

DGE

Deutsche Gesellschaft für Ernährung

EMR

Endoskopische Mukosaresektion

ESD

Endoskopische Submukosadissektion

FAP

Familiäre Adenomatöse Polyposis

FICE

Fujinon Intelligent Colour Enhancement

FOBT

Fäkaler Okkulter Bluttest

FS

Folinsäure

HNPCC

Hereditäres kolorektales Karzinom ohne Polyposis

IEN

Intraepitheliale Neoplasie

iFOBT/FIT

Immunologischer FOBT

IHC

Immunhistochemische Untersuchung

KRK

Kolorektales Karzinom

LITT

Laserinduzierte interstitielle Thermotherapie

LL

Leitlinie

MAP

MUTYH-assoziierte Polyposis

MMR

Mismatch-repair Gen

MSA

Mikrosatellitenanalyse

MSCT

Mehrzeilen-CT

MSI

Mikrosatelliteninstabilität

MSI-H

Mikrosatelliteninstabilität hoch (high)

MSI-L

Mikrosatelliteninstabilität gering (low)

MSS

Mikrosatellitenstabilität

NBI

Narrow Band Imaging

ÖGD

Ösophagogastroduodenoskopie

OL

Leitstelle Onkologie der DKG

OR

Odds Ratio

ORR

Overall response rate

PCI

Peritoneal cancer index

PET

Positron Emission Tomography

PJS

Peutz-Jeghers-Syndrom

PSC

Primär sklerosierende Cholangitis

RCT

Randomisierte kontrollierte Studie

RFA

Radiofrequenzablation

RR

Relatives Risiko

RT

Radiotherapie

SIRT

Selective Internal Radiation Therapy

SR

Systematische Übersichtsarbeit

SSA

Sessiles serratiertes Adenom

TME

Totale Mesorektumexzision

TSA

Traditionelles serratiertes Adenom

WHO

Weltgesundheitsorganisation


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* Zusätzlich an der Aktualisierung dieser Leitlinie (Kapitel 6, 8, 9 und 11) beteiligt:
H. Ahmadzadehfar, H. Amthauer, D. Arnold, G. Baretton, H. Barlag, W. Budach, R. Caspari, J.-F. Chenot, M. Ebert, M.J. Eckart, G. Egidi, G. Folprecht, M. Geissler, C.T. Germer, A. Glitsch, M. Hass, S. Hegewisch-Becker, M. Höckel, R.-D. Hofheinz, W. Hohenberger, S. Holdenrieder, A. Jung, R. Kiesslich, T. Kirchner, C.-H. Köhne, F. Kolligs, J. Körber, M. Landenberger, H. Lang, H. Link, J. Menke, H. Neuhaus, M. Neumaier, P.L. Pereira, H.R. Raab, P. Schirmacher, H. Schmidberger, A.G. Schreyer, T. Seufferlein, S. Stintzing, C. Stroszczynski, A. Tannapfel, A. Theilmeier, J. Trojan, T.J. Vogl, H.A. Wolff


** an der vorangegangenen Aktualisierung der Leitlinie (Kapitel 3, 4, 5, 7 und 10) beteiligt:
L. Altenhofen, M. Anthuber, S. Aretz, G. Baretton, W. Bechstein, S.C. Bischoff, B. Bokemeyer, H.-J. Brambs, H. Brenner, P. Engeser, J. Epplen, M. Follmann, U. Graeven, M. Hass, M. Heike, P. Heußner, T. Höhler, W. Hohenberger, A. Holstege, J. Hübner, K.-W. Jauch, T. Kirchner, M. Klinkhammer-Schalke, J. Körber, F. Kolligs, I. Kopp, M. Kreis, M. Landenberger, H. Lang, K.-H. Link, S. Ludt, P. Lux, C. Maar, U. Melle, J. Ockenga, P.L. Pereira, R. Porschen, S. Post, C. Pox, H.-R. Raab, N. Rahner, A. Reinacher-Schick, J.F. Riemann, C. Rödel, M. Sailer, R. Sauer, A. Sieg, K. Scheidhauer, W. Scheppach, W. Schmiegel, W. Schmitt, H.-J. Schmoll, K. Schulmann, A. Tannapfel, A.Theilmeier, T. Vogl, C. Wagener, M. Walz, S. Wesselmann, J. Weitz, C. Witte, C. Wittekind


 
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