Kolorektale Karzinome – personalisierte, stadienadaptierte Tumortherapie

 

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Zusammenfassung

Das kolorektale Karzinom (KRK) ist die zweithäufigste krebsbedingte Todesursache in Deutschland. Fast jeder zweite Patient stirbt an der Erkrankung. Beim Rektumkarzinom soll durch eine multimodale Therapie eine komplette Resektion des Tumors, eine sphinktererhaltende Operation und eine Reduktion von Lokalrezidiven und Fernmetastasen erreicht werden. In den UICC-Stadien II/III erfolgt eine neoadjuvante Radio- oder Radiochemotherapie, nach der Operation mittels totaler mesorektaler Exzision (TME) eine adjuvante Chemotherapie. Die medikamentöse Therapie des kolorektalen Karzinoms wurde durch neue Chemotherapeutika und biologische Substanzen im letzten Jahrzehnt entscheidend verbessert. Zielgerichtete Substanzen führten zu einer Verlängerung des Überlebens bei guter Lebensqualität. Die Mutationsanalyse des k-ras-Onkogens, des ersten prädiktiven molekularen Markers, führte zur Personalisierung der Therapie des KRK. Diese Übersicht stellt den aktuellen Stand der personalisierten und stadienadaptierten Therapie des metastasierten Kolon- und Rektumkarzinoms (KRK) dar.

Abstract

Colorectal cancer (CRC) is the second leading cause of cancer death in the western world. Every second patient dies of the disease. The introduction of new and effective chemotherapeutic substances and biologics during the past decade has significantly improved the systemic treatment of patients with CRC. In stage III colon cancer combination chemotherapy with oxaliplatin is the standard of care. Primary resection of metastases or resection after combination therapy and downsizing of lesions offers a chance for cure for some patients. In the treatment of rectal carcinoma, multimodality and neoadjuvant treatment concepts have replaced adjuvant chemoradio-therapy for locally advanced rectal cancer. In the palliative setting intensive combination treatment is indicated in colorectal cancer if tumor related symptoms or a rapid progress of the disease occur. The aim of palliative therapy is the prolongation of survival and the improvement of quality of life. The introduction of the mutational status of the KRAS oncogene as the first predictive marker into clinical care is an important step towards the personalization of treatment in CRC.

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