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Therapie beim lokal fortgeschrittenen Rektumkarzinom

Ansätze zur Individualisierung

Individualizing treatment for locally advanced rectal cancer

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Zusammenfassung

Aufgrund der Ergebnisse der CAO/ARO/AIO-94-Studie hat sich die 5-FU-basierte Langzeitradiochemotherapie (RT/CTx) in der Therapie des lokal fortgeschrittenen Rektumkarzinoms (UICC-II/III-Stadium) der beiden unteren Rektumdrittel (0–12 cm ab Anokutanlinie) etabliert. Allerdings ist das Ansprechen des Tumors auf die RT/CTx sehr heterogen und reicht von der kompletten Remission bis zur totalen Therapieresistenz. Unter der klinischen Forderung, zeitnah eine an das „individuelle” Rezidivrisiko angepasste multimodale Therapiestrategie zu entwickeln, sind in den vergangenen Jahren zwar Fortschritte in der translationalen Forschung (Genprofiling etc.) erzielt worden. Dennoch ist eine tatsächliche „Individualisierung” der Therapie beim lokal fortgeschrittenen Rektumkarzinom bisher nicht realisiert. Sie kann sich nach dem bisherigen Kenntnisstand nur aus erfolgreich durchgeführten, randomisierten Multicenterstudien, wie z. B. der CAO/ARO/AIO-04-Studie und der GAST-05-Studie, in fachübergreifender Kooperation mit Grundlagenwissenschaftlern innerhalb eines Forschungsverbundes generieren.

Einen ersten, einfachen Schritt in Richtung „Individualisierung” ermöglicht derzeit die GAST-05-Studie. In dieser DFG-geförderten Investigator-Initiated-Phase-II-Studie (IIT) werden UICC-II/III-Rektumkarzinome des oberen Rektumdrittels (12–16 cm ab Anokutanlinie) unter Rücknahme der multimodalen RT/CTx allein nach chirurgischen Radikalitätsprinzipien (partielle vs. totale mesorektale Exzision) stratifiziert und postoperativ einer adjuvanten Chemotherapie zugeführt.

Abstract

Based on results of the German Rectal Cancer Study Group CAO/ARO/AIO-94 trial, long-term chemoradiotherapy (RT/CTx) is recommended as standard treatment for locally advanced rectal cancer (UICC stages II/III) in the lower two thirds of the rectum (0–12 cm from the anocutaneous verge). Tumor response to neoadjuvant therapy is very heterogeneous, ranging from complete remission to total resistance to RT/CTx. To fulfill the clinical requirement of individual and risk-adapted multimodal treatment, distinct progress in translational research has been achieved (e.g. gene profiling). However, in clinical reality “individualization” of the therapy of rectal cancer patients has not actually been realized. This can be achieved only on the basis of successful randomized clinical trials (e.g. the CAO/ARO/AIO-04 and GAST-05 trials) translationally combined with basic scientific approaches. One simple first step toward individualizing rectal cancer therapy is being made with the ongoing GAST-05 trial. This investigator initiated phase II trial funded by the German Research Foundation (Deutsche Forschungsgemeinschaft) excludes preoperative RT/CTx for patients with rectal cancer localized in the upper third of the rectum, using only quality controlled principles of radical surgery (partial vs total mesorectal excision) followed by adjuvant chemotherapy.

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Danksagung

Diese Arbeit wurde unterstützt durch die Deutsche Forschungsgemeinschaft (KF0179).

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Authors and Affiliations

  1. Abt. Allgemein- und Viszeralchirurgie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland

    T. Liersch, B.M. Ghadimi &  H. Becker

  2. Abt. Gastroenteropathologie, Universitätsmedizin Göttingen, Göttingen, Deutschland

    H. Rothe

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  1. T. Liersch
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  2. H. Rothe
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  3. B.M. Ghadimi
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  4. H. Becker
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Correspondence to H. Becker.

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Liersch, T., Rothe, H., Ghadimi, B. et al. Therapie beim lokal fortgeschrittenen Rektumkarzinom. Chirurg 80, 281–293 (2009). https://doi.org/10.1007/s00104-008-1617-4

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