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Adenokarzinome des Magens und gastroösophagealen Übergangs

Neoadjuvante und adjuvante Therapie

Adenocarcinoma of the stomach and gastroesophageal junction

Neoadjuvant and adjuvant therapy

  • Leitthema
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Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Es besteht weltweite Einigkeit, dass zur optimalen kurativen Behandlung von fortgeschrittenen Adenokarzinomen des Magens und des gastroösophagealen Übergangs eine multimodale Therapie notwendig ist.

Methode

Literaturrecherche und Analyse klinischer Studien.

Ergebnisse

In den USA ist bei Magenkarzinomen eine adjuvante Radiochemotherapie Standard. Asiatische Studien zeigen einen Überlebensvorteil durch eine adjuvante Therapie. In Europa leitet sich die Standardempfehlung für Adenokarzinome des Magens aus der britischen MAGIC-Studie und der französischen FNCLCC-Studie ab. In diesen Studien wurden Patienten mit Adenokarzinomen des Magens und gastroösophagealen Übergangs mit einer perioperativen Platin/5-Fluorouracil-basierten Chemotherapie behandelt. Dadurch konnte das Überleben signifikant verbessert werden. Für die Behandlung von Adenokarzinomen des gastroösophagealen Übergangs stellt die präoperative Radiochemotherapie einen gleichwertigen Behandlungsstandard dar. Auch hier ließ sich eine signifikante Verbesserung des Überlebens zeigen.

Schlussfolgerung

Für Magenkarzinome empfehlen die deutschen S3-Leitlinien daher ab Stadium uT3 eine perioperative Chemotherapie und für Adenokarzinome des gastroösophagealen Übergangs eine perioperative Chemotherapie oder eine präoperative Radiochemotherapie.

Abstract

Context

There is worldwide consensus that curative treatment of gastroesophageal adenocarcinoma can be optimized by a multidisciplinary approach.

Method

Literature research and analysis of clinical trials.

Results

In the USA adjuvant chemoradiotherapy is a standard of care for gastric cancer. Asian trials could show an improvement in survival by adjuvant chemotherapy. In Europe the recommendations are based on the British MAGIG trial and the French FNCLCC study. In these trials patients with adenocarcinoma of the stomach and gastroesophageal junction (GEJ) were treated with platinum 5-FU-based perioperative chemotherapy and overall survival could be significantly improved. For the treatment of adenocarcinoma of the GEJ preoperative radiochemotherapy is an equivalent standard. A significant improvement of survival could also be shown for this treatment.

Conclusion

The German S3 guidelines recommend perioperative chemotherapy for gastric tumors of at least stage uT3 and for GEJ adenocarcinoma either perioperative chemotherapy or preoperative radiochemotherapy.

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Authors and Affiliations

  1. Medizinische Klinik m. S. Hämatologie, Onkologie und Tumorimmunologie, Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland

    P. Thuss-Patience

  2. Klinik und Poliklinik für Allgemein-, Visceral- und Thoraxchirurgie, Universitätsklinikum Hamburg – Eppendorf, Hamburg, Deutschland

    A. Kutup

  3. Klinik für Radioonkologie und Strahlentherapie, Universitätsklinikum Aachen, Aachen, Deutschland

    M. Eble

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  1. P. Thuss-Patience
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Correspondence to P. Thuss-Patience.

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Thuss-Patience, P., Kutup, A. & Eble, M. Adenokarzinome des Magens und gastroösophagealen Übergangs. Onkologe 19, 371–379 (2013). https://doi.org/10.1007/s00761-012-2417-5

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