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Individualisierung von Leitlinien

Vorgehen beim Rektumkarzinom im Stadium UICC II und III

Individualization of guidelines

Approach for rectal cancer in UICC stages II and III

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Zusammenfassung

Hintergrund

Die Leitlinien zur Therapie des Rektumkarzinoms im UICC-Stadium II und III werfen die Frage einer Übertherapie auf. Deshalb haben wir die Therapie in günstigen Einzelfällen individualisiert (oberes Rektumdrittel, weiter Sicherheitsabstand bei kleinem T3).

Material und Methoden

Alle in einem Zeitraum von 4 Jahren operierten 131 Patienten mit einem Rektumkarzinom im Stadium II und III wurden retrospektiv eingeschlossen. In 30 günstigen Fällen wurde bewusst auf eine Strahlentherapie verzichtet, bei 15 davon auch auf eine Chemotherapie. Nach durchschnittlich 57 Monaten konnte der Krankheitsverlauf bei 95 % der Patienten geklärt werden.

Ergebnisse

Das 5-Jahres-Überleben der Gesamtgruppe lag bei 81,5 % mit einer Lokalrezidivrate von 8 %. Insgesamt 30 Patienten ohne ergänzende Therapie (oder lediglich adjuvante Chemotherapie) hatten eine 5-Jahres-Überlebensrate von 100 % (86,7 %) und eine Lokalrezidivrate von 6,7 % (6,7 %).

Schlussfolgerung

In dieser Studie konnte gezeigt werden, dass eine Individualisierung der Leitlinien in besonderen Fällen nicht zu einer Verschlechterung des Überlebens oder einer Zunahme der Lokalrezidive führt. So kann einigen Patienten eine Strahlen- und Chemotherapie mit allen ihren Konsequenzen erspart werden.

Abstract

Background

The German guidelines for the therapy of rectal carcinoma in Union Internationale Contre le Cancer (UICC) stages II and III raise questions of overtherapy. This is why we have individualized the therapy in suitable isolated cases (localization in the upper third of the rectum and wider safety margins in cases of small T3).

Material and methods

All 131 patients with rectal cancer stages II and III, who were operated on within a time period of 4 years were retrospectively included in the study. In 30 favorable cases no radiotherapy was given and in 15 of these no chemotherapy. After an average of 57 months follow-up the course of the disease could be clarified in 95 % of the patients.

Results

The 5-year survival rate in the whole group was 81.5 % with a local recurrence rate of 8 %. Of the patients with no additional therapy (or only adjuvant chemotherapy), 30 had a 5-year survival rate of 100 % (86.7 %) and a local recurrence rate of 6.7 % (6.7 %).

Conclusions

In this study it could be shown that an individualization of guidelines in special cases does not lead to a higher mortality rate or to a higher rate of local recurrence. The study highlights that chemotherapy and radiotherapy with all the negative consequences could be avoided for several patients.

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Authors and Affiliations

  1. Israelitisches Krankenhaus Hamburg, Orchideenstieg 14, 22297, Hamburg, Deutschland

    N. Eismann, A. Emmermann & C. Zornig

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  1. N. Eismann
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  2. A. Emmermann
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  3. C. Zornig
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Correspondence to N. Eismann.

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Eismann, N., Emmermann, A. & Zornig, C. Individualisierung von Leitlinien. Chirurg 85, 125–130 (2014). https://doi.org/10.1007/s00104-013-2551-7

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