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Strahlentherapie bei Rektumkarzinom

Wird zu viel bestrahlt?

Rectal cancer

How much radiotherapy do surgery patients need?

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Zusammenfassung

Allein durch die Einführung der totalen mesorektalen Exzision (TME) konnte die Lokalrezidivrate bei Patienten mit primärem Rektumkarzinom unter 10% gesenkt werden. Zuvor waren solche Ergebnisse nur in Kombination mit der multimodalen Therapie zu erreichen, so dass deren Bedeutung neu bewertet werden musste. Randomisiert kontrollierte Studien haben gezeigt, dass die Lokalrezidivrate ohne Einfluss auf das Überleben reduziert werden kann und die neoadjuvante Strahlentherapie einen Vorteil gegenüber der adjuvanten Strahlentherapie besitzt. Derzeit wird kontrovers diskutiert, ob die neoadjuvante Therapie mit dem Langzeit- oder Kurzzeitschema angeboten werden sollte. Kaum diskutiert wird dagegen die Frage der Notwendigkeit der Strahlentherapie an sich. Dies ist umso erstaunlicher, als sich in der letzten Zeit die Berichte über Nebenwirkungen der Strahlentherapie häufen.

Anhand der verfügbaren Literatur sollte untersucht werden, wie viel Strahlentherapie der chirurgische Patient tatsächlich braucht. Interessanterweise profitieren Patienten mit hohen Rektumtumoren nicht von der Bestrahlung. Weitere Studien sind dagegen indiziert, um deren Notwendigkeit bei Tumoren im Stadium UICC II/III mit negativem „circumferential margin“ zu untersuchen.

Abstract

With the introduction of total mesorectal excision in rectal cancer treatment, local recurrence rates could be reduced below 10%. Previously such results could be achieved only in combination with multimodal therapy. Therefore the role of multimodal therapy had to be redefined. Randomized controlled trials have shown that the local recurrence rate can be reduced with no effect on overall survival and that neoadjuvant radiotherapy is superior to adjuvant radiotherapy. Controversy exists however about the best way of application, as either short-course radiotherapy (5×5 Gy) or combined radiochemotherapy, but not about its necessity, especially considering recent reports about late side effects of radiotherapy. It was the aim of this paper to explore the literature for the amount of radiotherapy surgical patients for rectal cancer really need. Interestingly, those with high rectal tumors do not benefit from radiotherapy. Further randomized trials are however required to address the need of radiotherapy in UICC tumor stages II or III with negative circumferential margin.

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  1. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Ruprecht-Karls-Universität, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland

    A. Ulrich, J. Weitz &  M.W. Büchler

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  1. A. Ulrich
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  2. J. Weitz
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  3. M.W. Büchler
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Correspondence to M.W. Büchler.

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Ulrich, A., Weitz, J. & Büchler, M. Strahlentherapie bei Rektumkarzinom. Chirurg 80, 266–273 (2009). https://doi.org/10.1007/s00104-008-1618-3

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  • DOI: https://doi.org/10.1007/s00104-008-1618-3

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