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Die Rolle der Strahlentherapie bei der Behandlung des Pankreaskarzinoms aus der Sicht des Radioonkologen

The role of radiation therapy in treatment of pancreatic cancer from the viewpoint of radio-oncologists

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Zusammenfassung

Das Pankreaskarzinom ist, trotz intensiver Bemühungen der Forschung, weiterhin eine fast immer zum Tode des Patienten führende Krebserkrankung.

Durch eine neoadjuvante Radiochemotherapie können höhere R0-Resektionsraten erreicht oder primär inoperable, lokal fortgeschrittene Tumoren derartig verkleinert werden, dass eine sekundäre Resektion möglich ist. Patienten mit einer besonders aggressiven Tumorbiologie kann durch eine neoadjuvante Therapie die Morbidität der Resektion erspart werden. Auch in der adjuvanten Situation kann die kombinierte Radiochemotherapie im Vergleich zur alleinigen Chemotherapie das Lokalrezidivrisiko deutlich verringern. Durch den Fortschritt in der Bestrahlungstechnik konnte in den letzten Jahren die Toxizität kombinierter Radiochemotherapien gesenkt werden. Wenn eine lokale Problematik im Vordergrund der Erkrankung steht, sollten kombinierte Radiochemotherapien auch bei der Behandlung des metastasierten Pankreaskarzinoms eingesetzt werden.

Das Hinzufügen so genannter „biologicals“ zur bekannten Radiochemotherapie scheint ein sinnvoller Ansatz zum Verbesserung der Prognose dieser hochmalignen Erkrankung zu sein, die Studienergebnisse zur Klärung dieser Frage werden in den kommenden Jahren erwartet.

Bei allen Bemühungen zur Weiterentwicklung von Strahlen- und systemischer Therapie bei der Behandlung des Pankreaskarzinoms sollte man nicht die Wichtigkeit von Psychoonkologie und Ernährungsmedizin für diese Erkrankung vergessen.

Abstract

Despite great efforts in the field of preclinical and clinical research, pancreatic cancer is still one of the most devastating cancer diagnoses and nearly always results in death.

With neoadjuvant chemoradiotherapy higher R0 resection rates can be achieved in pancreatic cancer and may even lead to a secondary resection in primarily inoperable tumors. Patients who experience a disease progression due to aggressive tumor biology can be spared the unnecessary morbidity of resection by neoadjuvant therapy. Even in the adjuvant situation the rates of local relapse can be significantly reduced by combined chemoradiotherapy. Through progress in radiation techniques the toxicity of combined chemoradiotherapy could be lowered. If symptoms of the metastasized disease are caused by localized solitary or more widespread tumor manifestation, chemoradiotherapy should be considered for a rapid symptom relief.

The adjunct of various biologicals to chemoradiotherapy is a promising new way to improve the prognosis of pancreatic cancer. Results from initial trials to clarify this concept are expected soon.

Despite all progress in radiation techniques and in systemic therapy of pancreatic cancer, psychooncological care and good nutrition is of especially high importance in the care of this group of patients.

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Abbreviations

GITSG:

Gastrointestinal Tumor Study Group

EORTC:

European Organisation for Research and Treatment of Cancer

ESPAC:

European Study Group for Pancreatic Cancer

IMRT:

Intensitätsmodulierte Radiotherapie

IGRT:

Image-guided Radiotherapie

IORT:

Intraoperative Radiotherapie

EGFR:

Epidermal Growth Factor Receptor

TGF-alpha:

Transforming Growth Factor-alpha

RCHT:

Radiochemotherapie

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  1. Abteilung Radioonkologie und Strahlentherapie , Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland

    C. Timke & J.P. Debus

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  1. C. Timke
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  2. J.P. Debus
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Correspondence to C. Timke.

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Timke, C., Debus, J. Die Rolle der Strahlentherapie bei der Behandlung des Pankreaskarzinoms aus der Sicht des Radioonkologen. Radiologe 49, 149–153 (2009). https://doi.org/10.1007/s00117-008-1758-y

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