Zusammenfassung
Die Kombination aus operativer Tumorentfernung und systemischer Chemotherapie ist die einzige potenziell kurative Therapieoption beim Pankreaskarzinom, das als systemische Erkrankung betrachtet werden muss. Durch Resektion und adjuvante Chemotherapie lassen sich heute mediane Überlebenszeiten von 25–30 Monaten erreichen. Die Hälfte der Patienten hat allerdings innerhalb der ersten 15 Monate nach Resektion einen systemischen Progress und verstirbt innerhalb der ersten beiden Jahre. Langzeitüberleben über 5 Jahre wird bei etwa 20 %, über 10 Jahre bei etwa 10 % der Patienten nach potenziell kurativer Resektion beobachtet, wobei hier fundierte Daten zum Effekt der systemischen Therapie noch ausstehen. Die Überlebenszeiten und die hohe Frequenz der systemischen Progression unterstreichen die dringende Notwendigkeit der Evaluation neuer systemischer Therapien.
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Literatur
Adler G, Seufferlein T, Bischoff SC, Brambs HJ, Feuerbach S, Grabenbauer G, Hahn S, Heinemann V, Hohenberger W, Langrehr JM, Lutz MP, Micke O, Neuhaus H, Neuhaus P, Oettle H, Schlag PM, Schmid R, Schmiegel W, Schlottmann K, Werner J, Wiedenmann B, Kopp I (2007) S3-Leitlinie „Exokrines Pankreaskarzinom“ 2007. Z Gastroenterol 45: 487–523
Collisson EA, Sadanandam A, Olson P, Gibb WJ, Truitt M, Gu S, Cooc J, Weinkle J, Kim GE, Jakkula L, Feiler HS, Ko AH, Olshen AB, Danenberg KL, Tempero MA, Spellman PT, Hanahan D, Gray JW (2011) Subtypes of pancreatic ductal adenocarcinoma and their differing responses to therapy. Nat Med 17: 500–503
Ferrone CR, Brennan MF, Gonen M, Coit DG, Fong Y, Chung S, Tang L, Klimstra D, Allen PJ (2008) Pancreatic adenocarcinoma: the actual 5-year survivors. J Gastrointest Surg 12: 701–706
Ferrone CR, Pieretti-Vanmarcke R, Bloom JP, Zheng H, Szymonifka J, Wargo JA, Thayer SP, Lauwers GY, Deshpande V, Mino-Kenudson M, Fernandez-del Castillo C, Lillemoe KD, Warshaw AL (2012) Pancreatic ductal adenocarcinoma: long-term survival does not equal cure. Surgery 152: S43–S49
Gillen S, Schuster T, Meyer zum Buschenfelde C, Friess H, Kleeff J (2010) Preoperative/neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of response and resection percentages. PLoS Med 7: e1000267
Hartwig W, Hackert T, Hinz U, Gluth A, Bergmann F, Strobel O, Buchler MW, Werner J (2011) Pancreatic cancer surgery in the new millennium: better prediction of outcome. Ann Surg 254: 311–319
Hartwig W, Strobel O, Hinz U, Fritz S, Hackert T, Roth C, Buchler MW, Werner J (2013) CA19-9 in potentially resectable pancreatic cancer: perspective to adjust surgical and perioperative therapy. Ann Surg Oncol 20: 2188–
Neoptolemos JP, Stocken DD, Bassi C, Ghaneh P, Cunningham D, Goldstein D, Padbury R, Moore MJ, Gallinger S, Mariette C, Wente MN, Izbicki JR, Friess H, Lerch MM, Dervenis C, Olah A, Butturini G, Doi R, Lind PA, Smith D, Valle JW, Palmer DH, Buckels JA, Thompson J, McKay CJ, Rawcliffe CL, Buchler MW (2010) Adjuvant chemotherapy with fluorouracil plus folinic acid vs gemcitabine following pancreatic cancer resection: a randomized controlled trial. JAMA 304: 1073–1081
Neoptolemos JP, Stocken DD, Friess H, Bassi C, Dunn JA, Hickey H, Beger H, Fernandez-Cruz L, Dervenis C, Lacaine F, Falconi M, Pederzoli P, Pap A, Spooner D, Kerr DJ, Buchler MW (2004). A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 350: 1200–1210
Oettle H, Post S, Neuhaus P, Gellert K, Langrehr J, Ridwelski K, Schramm H, Fahlke J, Zuelke C, Burkart C, Gutberlet K, Kettner E, Schmalenberg H, Weigang-Koehler K, Bechstein WO, Niedergethmann M, Schmidt-Wolf I, Roll L, Doerken B, Riess H (2007) Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA 297: 267–277
Regine WF, Winter KA, Abrams RA, Safran H, Hoffman JP, Konski A, Benson AB, Macdonald JS, Kudrimoti MR, Fromm ML, Haddock MG, Schaefer P, Willett CG, Rich TA (2008) Fluorouracil vs gemcitabine chemotherapy before and after fluorouracil-based chemoradiation following resection of pancreatic adenocarcinoma: a randomized controlled trial. JAMA 299: 1019–1026
Schmidt J, Abel U, Debus J, Harig S, Hoffmann K, Herrmann T, Bartsch D, Klein J, Mansmann U, Jager D, Capussotti L, Kunz R, Buchler MW (2012) Open-label, multicenter, randomized phase III trial of adjuvant chemoradiation plus interferon alfa-2b versus fluorouracil and folinic acid for patients with resected pancreatic adenocarcinoma. J Clin Oncol 30: 4077–4083
Schnelldorfer T, Ware AL, Sarr MG, Smyrk TC, Zhang L, Qin R, Gullerud RE, Donohue JH, Nagorney DM, Farnell MB (2008) Long-term survival after pancreatoduodenectomy for pancreatic adenocarcinoma: is cure possible? Ann Surg 247: 456–462
Smeenk HG, van Eijck CH, Hop WC, Erdmann J, Tran KC, Debois M, van Cutsem E, van Dekken H, Klinkenbijl JH, Jeekel J (2007) Long-term survival and metastatic pattern of pancreatic and periampullary cancer after adjuvant chemoradiation or observation: long-term results of EORTC trial 40891. Ann Surg 246: 734–740
Smith RA, Tang J, Tudur-Smith C, Neoptolemos JP, Ghaneh P (2011) Meta-analysis of immunohistochemical prognostic markers in resected pancreatic cancer. Br J Cancer 104: 1440–1451
Strobel O, Berens V, Hinz U, Hartwig W, Hackert T, Bergmann F, Debus J, Jager D, Buchler MW, Werner J (2012) Resection after neoadjuvant therapy for locally advanced, „unresectable“ pancreatic cancer. Surgery 152: S33–S42
Ueno H, Kosuge T, Matsuyama Y, Yamamoto J, Nakao A, Egawa S, Doi R, Monden M, Hatori T, Tanaka M, Shimada M, Kanemitsu K (2009) A randomised phase III trial comparing gemcitabine with surgery-only in patients with resected pancreatic cancer: Japanese Study Group of Adjuvant Therapy for Pancreatic Cancer. Br J Cancer 101: 908–915
Van Laethem JL, Hammel P, Mornex F, Azria D, Van Tienhoven G, Vergauwe P, Peeters M, Polus M, Praet M, Mauer M, Collette L, Budach V, Lutz M, van Cutsem E, Haustermans K (2010) Adjuvant gemcitabine alone versus gemcitabine-based chemoradiotherapy after curative resection for pancreatic cancer: a randomized EORTC-40013-22012/FFCD-9203/GERCOR phase II study. J Clin Oncol 28: 4450–4456
Verbeke CS, Menon KV (2009) Redefining resection margin status in pancreatic cancer. HPB (Oxford) 11: 282–289
Yachida S, White CM, Naito Y, Zhong Y, Brosnan JA, Macgregor-Das AM, Morgan RA, Saunders T, Laheru DA, Herman JM, Hruban RH, Klein AP, Jones S, Velculescu V, Wolfgang CL, Iacobuzio-Donahue CA (2012) Clinical significance of the genetic landscape of pancreatic cancer and implications for identification of potential long-term survivors. Clin Cancer Res 18: 6339–6347
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Strobel, O., Werner, J. (2013). Langzeitverlauf nach operativer Tumorentfernung und Chemotherapie des duktalen Pankreaskarzinoms. In: Beger, H., et al. Erkrankungen des Pankreas. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-37964-2_79
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