Ösophaguskarzinom Update

Das Ösophaguskarzinom weist trotz multimodaler Therapieansätze weiterhin nur geringe 5-Jahres-Überlebensraten von 15 – 25% auf. Angelehnt an die im Jahr 2015 publizierte S3-Leitlinie sowie die „ESMO Clinical Practice Guidelines“ stellen wir in diesem Artikel Diagnostik, Staging und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus dar.

Kernaussagen

• Die Diagnostik erfolgt durch Ösophagogastroduodenoskopie mit Biopsien.

• Für das Staging sind Endosonografie und Computertomografie notwendig.

• Bei Frühkarzinomen (T1a; ggf. T1b bei Adenokarzinomen) kann eine endoskopische Resektion versucht werden.

• Bei lokal fortgeschrittenen Karzinomen (T3–4 oder N+) ist eine multimodale Therapie indiziert.

• Die chirurgische Resektion erfolgt abhängig von der Lokalisation des Tumors:

  • Ivor Lewis,

  • McKeown,

  • zervikale Resektion oder

  • transhiatal erweiterte Gastrektomie.

• Eine chirurgische Resektion ist bei Oligometastasierung zurzeit nur im Rahmen von Studien indiziert (RENAISSANCE Trial)

Schlüsselwörter

oberer Gastrointestinaltrakt, Onkologie, Chemotherapie, Radiotherapie, maligne Erkrankung

• Literatur

• 1 Robert Koch-Institut. Zentrum für Krebsregisterdaten (ZfKD). Im Internet: http://www.rki.de/DE/Content/Gesundheitsmonitoring/Krebsregisterdaten/krebs_node.html Stand: 22.06.2017
• 2 Pennathur A, Gibson MK, Jobe BA. et al. Oesophageal carcinoma. Lancet 2013; 381: 400-412
• 3 Bollschweiler E, Wolfgarten E, Gutschow C. et al. Demographic variations in the rising incidence of esophageal adenocarcinoma in white males. Cancer 2001; 92: 549-555
• 4 Steevens J, Botterweck AA, Dirx MJ. et al. Trends in incidence of oesophageal and stomach cancer subtypes in Europe. Eur J Gastroenterol Hepatol 2010; 22: 669-678
• 5 Siegel R, Naishadham D, Jemal A. Cancer Statistics 2013. CA Cancer J Clin 2013; 63: 11-30
• 6 Porschen R, Buck A, Fischbach W. et al. S3-Leitlinie Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des Oesophagus. Z Gastroenterol 2015; 53: 1288-1347
• 7 Lordick F, Mariette C, Haustermans K. et al. Oesophageal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2016; 27 (S5): v50-v57
• 8 Sharma P, Dent J, Armstrong D. et al. The development and validation of an endoscopic grading system for Barrettʼs esophagus: the Prague C & M criteria. Gastroenterology 2006; 131: 1392-1399
• 9 Kutup A, Link BC, Schurr G. et al. Quality control of endoscopic ultrasound in preoperative staging of esophageal cancer. Endoscopy 2007; 39: 715-719
• 10 Mönig SP, Zirbes TK, Schröder W. et al. Staging of gastric cancer: correlation of lymph node size and metastatic infiltration. Am J Roentgenol 1999; 173: 365-367
• 11 Alakus H, Batur M, Schmidt M. et al. Variable 18F-fluorodeoxyglucose uptake in gastric cancer is associated with different levels of GLUT-1 expression. Nucl Med Commun 2010; 31: 532-538
• 12 Brierley JD, Gospodarowicz MK, Wittekind C. eds. TNM Classification of malignant Tumours. 8th ed. UICC – Global Cancer Control. Oxford, UK, Hoboken, NJ: John Wiley & Sons, Inc.; 2016
• 13 Japan Esophageal Society. Japanese Classification of Esophageal Cancer, 11th edn, part II and III. Esophagus 2017; 14: 37-65
• 14 Siewert JR, Hölscher AH, Becker K. et al. [Cardia Cancer: attempt at a therapeutically relevant classification]. Chirurg 1987; 58: 25-32
• 15 Cao Y, Liao C, Tan A. et al. Meta-analysis of endoscopic submucosal dissection versus endoscopic mucosal resection for tumors of the gastrointestinal tract. Endoscopy 2009; 41: 751-757
• 16 Hodari A, Hammoud ZT, Borgi JF. et al. Assessment of morbidity and mortality after esophagectomy using a modified frailty index. Ann Thorac Surg 2013; 96: 1240-1245
• 17 Hölscher AH, Stahl M, Messmann H. et al. Die neue S3-Leitlinie zum Ösophaguskarzinom. Chirurg 2016; 87: 865-872
• 18 Omloo JM, Lagarde SM, Hulscher JB. 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
• 19 Kutup A, Nentwich MF, Bollschweiler E. et al. What should be the gold standard for the surgical component in the treatment of locally advanced esophageal cancer: transthoracic versus transhiatal esophagectomy. Ann Surg 2014; 260: 1016-1022
• 20 Sasako M, Sano T, Yamamoto S. et al. Left thoracoabdominal approach versus abdominal-transhiatal approach for gastric cancer of the cardia of subcardia: a randomised controlled trial. Lancet Oncol 2006; 7: 644-651
• 21 Fuchs H, Hölscher AH, Leers J. et al. Long-term quality of life after surgery for adenocarcinoma of the esophagogastric junction: extended gastrectomy or transthoracic esophagectomy?. Gastric Cancer 2016; 19: 312-317
• 22 Biere SS, Van Berge Henegouwen MI, Maas KW. et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet 2012; 379: 1887-1892
• 23 Reeh M, Mina S, Bockhorn M. et al. Staging and outcome depending on surgical treatment in adenocarcinomas of the oesophagogastric junction. Br J Surg 2012; 1406-1414
• 24 Siewert JR, Stein HJ, Böttcher K. Lymphadenektomie bei Tumoren des oberen Gastrointestinaltrakts. Chirurg 1996; 67: 877-888
• 25 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
• 26 Koenig AM, Prenzel KL, Bogoevski D. et al. Strong impact of micrometastatic tumor cell load in patients with esophageal carcinoma. Ann Surg Oncol 2009; 16: 454-462
• 27 Gaur P, Blackmon SH. Jejunal grafts conduits after esophagectomy. J Thorac Dis 2014; 6: 333-340
• 28 Luketich JD, Pennathur A, Awais O. et al. Outcomes after minimally invasive esophagectomy. Ann Surg 2012; 256: 95-103
• 29 Xiong WL, Li R, Lei HK. et al. Comparison of outcomes between minimally invasive oesophagectomy and open oesophagectomy for oesophageal cancer. ANZ J Surg 2017; 87: 165-170
• 30 Briez N, Piessen G, Bonnetain F. et al. Open versus laparoscopically-assisted oesophagectomy for cancer: a multicentre randomised controlled phase III trial – the MIRO trial. BMC Cancer 2011; 11: 310
• 31 Mariette C, Meunier B, Pezet D. et al. Hybrid minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicenter, openlabel, randomized phase III controlled trial, the MIRO trial. 2015 ASCO Gastrointestinal Cancers Symposium. J Clin Oncol 2015; 33 (Suppl. 03) 5
• 32 Gockel I, Lorenz D. Die onkologische Ösophagusresektion und -rekonstruktion: Offen, Hybrid, MIC oder Robotik?. Chirurg 2017;
• 33 Avery KN, Metcalfe C, Berrisford R. et al. The feasibility of a randomized controlled trial of esophagectomy for esophageal cancer – the ROMIO (Randomized Oesophagectomy : Minimally Invasive or Open) study : protocol for a randomized controlled trial. Trials 2014; 15: 200
• 34 Luketich JD, Pennathur A, Franchetti Y. et al. Minimally invasive Esophagectomy; Results of a prospective phase II multicenter trial – the Eastern Cooperative Oncology Group (E2202) study. Ann Surg 2015; 261: 702-707
• 35 Van Hillegersberg R, Seesing MFJ, Brenkman HFJ. et al. Roboterassistierte minimal-invasive Ösophagektomie. Chirurg 2016; 87: 635-642
• 36 Van der Sluis PC, Ruurda JP, Verhage RJ. et al. Oncologic long-term results of robot-assisted minimally invasive thoraco-laparoscopic esophagectomy with two-field lymphadenectomy for esophageal cancer. Ann Surg Oncol 2015; 22: S1350-S1356
• 37 Van der Sluis PC, Ruurda JP, van der Horst S. et al. Robot-assisted minimally invasive thoraco-laparoscopic esophagectomy versus open transthoracic esophagectomy for resectable esophageal cancer, a randomized controlled trial (ROBOT trial). Trials 2012; 13: 230
• 38 Park S, Hwang Y, Lee HJ. et al. Comparison of robot-assisted esophagectomy and thoracoscopic esophagectomy in esophageal squamous cell carcinoma. J Thorac Dis 2016; 8: 2853-2861
• 39 Mönig SP, Schiffmann LM. Resektion beim fortgeschrittenen Adenokarzinom des Magens und des Ösophagus. Chirurg 2016; 87: 398-405
• 40 Al-Batran SE, Homann N, Pauligk C. et al. Effect of neoadjuvant chemotherapy followed by surgical resection on survival in patients with limited metastatic gastric or gastroesophageal junction cancer: the AIO-FLOT3 Trial. JAMA Oncol 2017;
• 41 Cunningham D, Allum WH, Stenning SP. et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 2006; 355: 11-20
• 42 Al-Batran SE, Hofheinz RD, Pauligk C. et al. Histopathological regression after neoadjuvant docetaxel, oxaliplatin, fluorouracil, and leucovorin versus epirubicin, cisplatin, and fluorouracil or capecitabine in patients with resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4-AIO): results from the phase 2 part of a multicentre, open-label, randomised phase 2/3 trial. Lancet Oncol 2016; 17: 1697-1708
• 43 Al-Batran SE, Homann N, Schmalenberg H. et al. Perioperative chemotherapy with docetaxel, oxaliplatin, and fluorouracil/leucovorin (FLOT) versus epirubicin, cisplatin, and fluorouracil or capecitabine (ECF/ECX) for resectable gastric or gastroesophageal junction (GEJ) adenocarcinoma (FLOT4-AIO): a multicenter, randomized phase 3 trial. J Clin Oncol 2017; 35: abstr. 4004
• 44 Van Hagen P, Hulshof MC, van Lanschot JJ. et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 2012; 366: 2074-2084
• 45 Shapiro J, van Lanschot JJ, Hulshof MC. et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol 2015; 16: 1090-1098
• 46 Pöttgen C, Stuschke M. Radiotherapy versus surgery within multimodality protocols for esophageal cancer – a metaanalysis of the randomized trials. Cancer Treat Rev 2012; 38: 599-604
• 47 Hölscher AH, Bollschweiler E, Bogoevski D. et al. Prognostic impact of neoadjuvant chemoradiation in cT3 oesophageal cancer – a propensity score matched analysis. Eur J Cancer 2014; 50: 2950-2957
• 48 Chiu CH, Chao YK, Chang HK. et al. Interval between neoadjuvant chemoradiotherapy and surgery for esophageal squamous cell carcinoma: does delayed surgery impact outcome?. Ann Surg Oncol 2013; 30: 4245-4251
• 49 Markar S, Gronnier C, Duhamel A. et al. Salvage surgery after chemoradiotherapy in the management of esophageal cancer: Is it a viable therapeutic option?. J Clin Oncol 2015; 33: 3866-3873
• 50 Götze TO, Schiffman LM, Al-Batran SE. et al. Therapiekonzepte beim metastasierten Magenkarzinom. Allgemein- und Viszeralchirurgie up2date 2017; 11: 67-80
• 51 Webb A, Cunningham D, Scarffe JH. 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
• 52 Al-Batran SE, Hartmann JT, Hofheinz R. et al. Biweekly fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) for patients with metastatic adenocarcinoma of the stomach or esophagogastric junction: a phase II trial of the Arbeitsgemeinschaft Internistische Onkologie. Ann Oncol 2008; 19: 1882-1887
• 53 Bang YJ, Van Cutsem E, Feyereislova A. et al. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-esophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet 2010; 376: 687-697
• 54 Kachaamy T, Pannala R. Esophageal stents: when and how. Minerva Gastroenterol Dietol 2016; 62: 155-166
• 55 Kondrup J, Allison SP, Elia M. et al. ESPEN guidelines for nutrition screening 2002. Clin Nutr 2003; 22: 415-421
• 56 Hennessey DB, Burke JP, Ni-Dhonochu T. et al. Preoperative hypoalbuminemia is an independent risk factor for the development of surgical site infection following gastrointestinal surgery: a multi-institutional study. Ann Surg 2010; 252: 325-329
• 57 Baiocchi GL, DʼUgo D, Coit D. et al. Follow-up after gastrectomy for cancer. The Charter Scaligero Consensus Conference. Gastric Cancer 2016; 19: 15-20