Neoadjuvante Radiotherapie und Radiochemotherapie: Standards und Ausblick

Zusammenfassung

Das Rektumkarzinom ist ein Musterbeispiel für ein interdiziplinäres Vorgehen aller beteiligten onkologischen Disziplinen: der Chirurgie, Radiotherapie und internistischen Onkologie. In den letzten Jahren sind vor allem 4 Fragen in das Zentrum der klinischen Forschung und Praxis gerückt: Ist bei optimierter Chirurgie mit totaler Mesorektumexzision (TME) eine zusätzliche lokale Maßnahme wie die Radiotherapie überhaupt noch notwendig? Sollte die Radiotherapie präoperativ oder postoperativ angewandt werden? Soll die neoadjuvante Radiotherapie als Kurzzeitkonzept (5 × 5 Gy) oder als konventionell fraktionierte Bestrahlung in Kombination mit Chemotherapie erfolgen? Und: Wie kann die systemische Komponente der multimodalen Therapie so verbessert werden, dass die Fernmetastasierung gesenkt und damit das Überleben verbessert wird?

Abstract

Rectal cancer is one of the best examples in oncology for a multidisciplinary treatment approach requiring close cooperation of surgery, radiotherapy and chemotherapy. Recent clinical research as well as daily practice have focussed on 4 questions to be addressed: Is radiotherapy necessary at all if surgery is optimized by the adoption of total mesorectal excision (TME)? Should radiotherapy be applied preoperatively or postoperatively? Should we use the short-course radiotherapy concept of 5 × 5 Gy or rather conventionally fractionated radiotherapy with concomitant chemotherapy? And: How can we improve the systemic part of the multimodality concept in order to reduce distant metastases and improve survival?

Schlüsselwörter

Rektumkarzinom - neoadjuvant - Kombinationstherapie

Key words

rectal cancer - neoadjuvant - combined modality treatment

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