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Rektumkarzinom

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Strahlentherapie

Zusammenfassung

In Deutschland erkranken jährlich ungefähr 15-18000 Menschen an Rektumkarzinomen. Das Rektumkarzinom überwiegt leicht beim männlichen Geschlecht. Es wird ein Altersgipfel von etwa 68 Jahren beobachtet, 90 % der Patienten sind bei der Erstdiagnose älter als 50 Jahre. Das Lebenszeitrisiko, an einem kolorektalen Karzinom zu erkranken, liegt bei 6 %, daran zu versterben bei 2–3 %. Insgesamt stellt das kolorektale Karzinom derzeit sowohl für Männer als auch für Frauen die zweithäufigste Krebstodesursache dar. Im Kontrast zu der immer noch leicht zunehmenden Inzidenz der Erkrankung nehmen die Sterberaten beider Geschlechter seit Mitte der 70er-Jahren aber stetig ab. Maßgeblich dafür sind intensive Bemühungen um eine verbesserte Sekundärprävention; Risikogruppen konnten identifiziert werden und Vorsorgeuntersuchungen zur Früherkennung wurden vorangetrieben.

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Literatur

  • Alektiar K, Zelefsky M, Paty P et al. (2000) High-dose-rate intraoperative brachytherapy for recurrent colorectal cancer. Int J Radiat Oncol Biol Phys 48(1):219–226

    Article  PubMed  CAS  Google Scholar 

  • Aschele C, Cionini L, Lonardi S et al. (2011) Primary tumor response to preoperative chemoradiation with or without oxaliplatin in locally advanced rectal cancer: pathologic results of the STAR-01 randomized phase III trial. J Clin Oncol 29:2773–80

    Article  PubMed  CAS  Google Scholar 

  • Birgission H, Påhlman L, Gunnarsson U et al (2005a) Adverse effects of preoperative radiation therapy for rectal cancer: long-term follow-up of the Swedish Rectal Cancer Trial. J Clin Oncol 23:8697–8705

    Article  Google Scholar 

  • Birgission H, Påhlman L, Gunnarsson U et al (2005b) Occurrence of second cancers in Patients treated with radiotherapy for rectal cancer. J Clin Oncol 23: 6126–6126

    Article  Google Scholar 

  • Bosset JF, Collette L, Calais G et al. (2006) Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med. 355 1114–1123

    Article  PubMed  CAS  Google Scholar 

  • Bujko K, Nowacki MP, Nasierowska-Guttmejer A et al (2004) Sphincter preservation following preoperative radiotherapy for rectal cancer: report of a randomised trial comparing short-term radiotherapy cs. conventionally fractionated radiochemotherapy. Radiother Oncol 72:15–24

    Article  PubMed  CAS  Google Scholar 

  • Bujko K, Nowacki MP, Nasierowska-Guttmejer A et al (2006) Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. Br J Surg 93:1215–1223

    Article  PubMed  CAS  Google Scholar 

  • Camma C, Giunta M, Fiorica F et al (2000) Preoperative radiotherapy for resectable rectal cancer: a meta-analysis. JAMA 248:1008–1015

    Article  Google Scholar 

  • Classen J, Belka C, Paulsen F et al. (1998) Radiation-induced gastrointestinal toxicity. Pathophysiology, approaches to treatment and prophylaxis. Strahlenther Onkol. 174 Suppl 3:82–84

    PubMed  Google Scholar 

  • Collette L, Bosset JF, den Dulk M et al (2007) Patients with curative resection of cT3-4 rectal cancer after preoperative radiotherapy or radiochemotherapy: does anybody benefit from adjuvant fluorouracil-based chemotherapy? A trial of the European Organisation for Research and Treatment of Cancer Radiation Oncology Group. J Clin Oncol 25: 4339–4340

    Article  Google Scholar 

  • Colorectal Cancer Collaborative Group (2001) Adjuvant radiotherapy for rectal cancer: a systematic overview of 8507 patient from 22 randomised trials. Lancet 359:1291–1304

    Google Scholar 

  • Dunst J, Semlin S, Pigorsch S et al. (2000) Intermittent use of amifostine during postoperative radiochemotherapy and acute toxicity in rectal cancer patients. Strahlenther Onkol. 176(9):416–421

    Article  PubMed  CAS  Google Scholar 

  • Eble MJ, Lehnert T, Herfarth C et al. (1998) Intraoperative radiotherapy as adjuvant treatment for stage II/III rectal carcinoma. RecResCancerRes 1998;146:152–160

    CAS  Google Scholar 

  • Folkesson J, Birgission H, Påhlman L et al (2005) Swedish rectal cancer trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol 23:5644–5650

    Article  PubMed  Google Scholar 

  • Fountzilas G, Zisiadis A, Dafni U et al. (1999). Postoperative radiation and concomitant bolus fluorouracil with or without additional chemotherapy with fluorouracil and high-dose leucovorin in patients with high-risk rectal cancer: a randomized phase III study conducted by the Hellenic Cooperative Oncology Group. Ann Oncol. 10(6):671–676

    Article  PubMed  CAS  Google Scholar 

  • Frykholm GJ, Påhlman L, Glimelius B (2001) Combined chemo- and radiotherapy vs. radiotherapy alone in the treatment of primary, nonresectable adenocarcinoma of the rectum. Int J Radiat Oncol Biol Phys ;50(2):427–434

    Article  PubMed  CAS  Google Scholar 

  • Gellermann J, Wlodarczyk W, Hildebrandt B et al. (2005) Noninvasive magnetic resonance thermography of recurrent rectal carcinoma in a 1.5 Tesla hybrid system. Cancer Res. 65(13):5872–5880

    Article  PubMed  CAS  Google Scholar 

  • Gerard JP, Azria D, Gourgou-Bourgade S et al (2010) Comparison of two neoadjuvant chemoradiotherapy regimens for locally advanced rectal cancer: results of the phase III trial ACCORD 12/0405-Prodige 2. J Clin Oncol 28:1638–1644

    Article  PubMed  CAS  Google Scholar 

  • Gerard JP, Conroy T, Bonnetain F et al. (2006) Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clin Oncol. 24 4620–4625

    Article  PubMed  Google Scholar 

  • van Gijn W, Marijnen CA, Nagtegaal ID, et al. (2011) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol 12:575–82

    Article  PubMed  Google Scholar 

  • Guerrero Urbano M, Henrys A, Adams E et al. (2006) Intensity-modulated radiotherapy in patients with locally advanced rectal cancer reduces volume of bowel treated to high dose levels. Int J Radiat Oncol Biol Phys. 65(3):907–916

    Article  PubMed  Google Scholar 

  • Gunderson LL, Nelson H, Martenson JA, et al. (1996) Intraoperative electron and external beam irradiation with or without 5-fluorouracil and maximum surgical resection for previously unirradiated, locally recurrent kolorektal cancer.DisColonRectum 39:1379–1395

    CAS  Google Scholar 

  • Hagmüller E, Hartung G, Sturm J et al. (1998) Adjuvant radiochemotherapy with 5-FU and folinic acid in Dukes stage B and C rectum carcinoma: an interim analysis] Langenbecks Arch Chir Suppl Kongressbd.15:1397–1399

    Google Scholar 

  • Heald RJ, Husband EM, Ryall RDH (1982) The mesorectum in rectal cancer surgery – the clue to pelvic recurrence? Br J Surg 69 613–616

    Article  PubMed  CAS  Google Scholar 

  • Henriksson R, Franzén L, Littbrand B (1992) Effects of sucralfate on acute and late bowel discomfort following radiotherapy of pelvic cancer. J Clin Oncol. 10(6):969–975

    PubMed  CAS  Google Scholar 

  • Hofheinz R, Wenz F, Post S et al. (2011) Capecitabine (Cape) versus 5-fluorouracil (5-FU)–based (neo)adjuvant chemoradiotherapy (CRT) for locally advanced rectal cancer (LARC): Long-term results of a randomized, phase III trial. J Clin Oncol 29: 2011 (suppl; abstr 3504)

    Article  Google Scholar 

  • Holm T, Cedermark B, Rutqvist LE et. al. (1994) Local recurrence of rectal adenocarcinoma after ‘curative’ surgery with and without preoperative radiotherapy. Br J Surg. 81(3):452–455

    Article  PubMed  CAS  Google Scholar 

  • Hombrink J, Fröhlich D, Glatzel M et al. (2000) Prevention of radiation-induced diarrhea by smectite. Results of a double-blind randomized, placebo-controlled multicenter study. Strahlenther Onkol. 2000;176(4):173–179

    Article  PubMed  CAS  Google Scholar 

  • van Kampen M, Wulf J, Eble MJ et al. (1995) Three-dimensional planned radiotherapy in rectal cancer. Feasibility study and preliminary clinical results. Strahlenther Onkol. 171(2):87–93

    PubMed  Google Scholar 

  • Kapiteijn E, Marijnen CAM, Nagtegaal ID et al (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345: 638–646

    Article  PubMed  CAS  Google Scholar 

  • Kölbl O, Richter S, Flentje M (2000) Influence of treatment technique on dose-volume histogram and normal tissue complication probability for small bowel and bladder. A prospective study using a 3-D planning system and a radiobiological model in patients receiving postoperative pelvic irradiation.Strahlenther Onkol. 176(3):105–111

    Article  PubMed  Google Scholar 

  • Lee J, Lee J, Ahn J, et al. (2002) Randomized trial of postoperative adjuvant therapy in stage II and III rectal cancer to define the optimal sequence of chemotherapy and radiotherapy: a preliminary report. J Clin Oncol. ;20(7):1751–1758

    Article  PubMed  CAS  Google Scholar 

  • Lingareddy V, Ahmad NR, Mohiuddin M. (1997) Palliative reirradiation for recurrent rectal cancer. Int J Radiat Oncol Biol Phys. 38(4):785–790

    Article  PubMed  CAS  Google Scholar 

  • Mak A, Rich T, Schultheiss T et al. (1994) Late complications of postoperative radiation therapy for cancer of the rectum and rectosigmoid. Int J Radiat Oncol Biol Phys. 28(3):597–603

    Article  PubMed  CAS  Google Scholar 

  • Mannaerts G, Martijn H, Crommelin M et al.(2000) Feasibility and first results of multimodality treatment, combining EBRT, extensive surgery, and IOERT in locally advanced primary rectal cancer. Int J Radiat Oncol Biol Phys. 47(2):425–433

    Article  PubMed  CAS  Google Scholar 

  • Marijnen CA, van de Velde CJ, Putter H et al (2005) Impact of short-term preoperative radiotherapy on health-related quality of life and sexual functioning in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol 23:1847–1858

    Article  PubMed  Google Scholar 

  • Marijnen CAM, Nagtegaal ID, Klein Kranenbarg E et al. (2001) No downstaging after short-term preoperative radiotherapy in rectal cancer patients. J Clin Oncol 19:1976–1984

    PubMed  CAS  Google Scholar 

  • Ngan S, Fisher R, Goldstein D, et al. (2010) A randomized trial comparing local recurrence rates between short-course and long-course preoperative radiotherapy for clinical T3 rectal cancer: An intergroup trial (TROG, AGITG, CSSANZ, RACS). J Clin Oncol 28:152 (suppl.abstr. 3509)

    Google Scholar 

  • O´Connell MJ, Martenson JA, Wieand HS et al. (1994) Improving adjuvant therapy for rectal cancer by combining protracted-infusion fluorouracil with radiation therapy after curative surgery. NEnglJMed 331:502–507

    Article  Google Scholar 

  • Påhlman L, Glimelius B (1990): Pre- or postoperative radiotherapy in rectal and rectosigmoid carcinoma. Ann Surg 211:187–195

    Article  PubMed  Google Scholar 

  • Peeters KC, Marijnen CAM, Nagtegaal ID et al. (2007) The TME trial after a median follow-up of 6 years. Ann Surg 264:693–701

    Article  Google Scholar 

  • Rau B, Wust P, Hohenberger P et al. Preoperative hyperthermia combined with radiochemotherapy in locally advanced rectal cancer: a phase II clinical trial. Ann Surg. 1998;227(3):380-389. Review.

    Article  PubMed  CAS  Google Scholar 

  • Robert Koch Institut (2012) „Krebs in Deutschland 2007/2008“, 8. Ausgabe

    Google Scholar 

  • Rödel C, Becker H, Fietkau R, et al. (2011) Preoperative chemoradiotherapy and postoperative chemotherapy with 5-fluorouracil and oxaliplatin versus 5-fluorouracil alone in locally advanced rectal cancer: First results of the German CAO/ARO/AIO-04 randomized phase III trial. J Clin Oncol 29: (suppl; abstr LBA3505

    Google Scholar 

  • Rödel C, Grabenbauer G, Matzel K, et al. (2000) Extensive surgery after high-dose preoperative chemoradiotherapy for locally advanced recurrent rectal cancer. Dis Colon Rectum. 43(3):312–319

    Article  PubMed  Google Scholar 

  • Rödel C, Grabenbauer GG, Schick C et al. (2000) Preoperative radiation with concurrent 5-fluorouracil for locally advanced T4-primary rectal cancer. Strahlkenther Onkol;176(4):161–167

    Article  Google Scholar 

  • Rödel C, Martus P, Papadopoulos T et al. (2005) Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol 24(8)3120–321

    Google Scholar 

  • Rödel C, Sauer R (2007): Integration of novel agents into combined-modality treatment for rectal cancer patients. Strahlenther Onkol 183:227–235

    Article  PubMed  Google Scholar 

  • Rödel C, Sauer R. (2001) Perioperative radiotherapy and concurrent radiochemotherapy in rectal cancer Sem Surg Oncol 20:3–12

    Google Scholar 

  • Roeder F, Treiber M, Oertel S et al. (2007) Patterns of failure and local control after intraoperative electron boost radiotherapy to the presacral space in combination with total mesorectal excision in patients with locally advanced rectal cancer. Int J Radiat Oncol Biol Phys. 67(5):1381–1388

    Article  PubMed  Google Scholar 

  • Roh MS, Yothers GA, O’Connell MJ et al. (2011) The impact of capecitabine and oxaliplatin in the preoperative multimodality treatment in patients with carcinoma of the rectum: NSABP R-04. ASCO Meeting Abstracts 29:3503

    Google Scholar 

  • S3-Leitlinienkonferenz „Kolorektales Karzinom“ (2004) Z Gastroenterol 42:1129–1177

    Google Scholar 

  • Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C, Fietkau R, Martus P, Tschmelitsch J, Hager E, Hess CF, Karstens JH, Liersch T, Schmidberger H, Raab R (2004) German Rectal Cancer Study Group Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 351:1731–40

    Article  PubMed  CAS  Google Scholar 

  • Schmiegel W, Pox C, Adler G et al. (2004) S3-Leitlinienkonferenz „Kolorektales Karzinom“ Z Gastroenterol 42 (2004) 1129–1177

    Google Scholar 

  • Sebag-Montefiore D, Steele R, Quirke P et al. (2006): Routine short course radiotherapy or selective post-op chemoradiotherapy for resectable rectal cancer? Preliminary results of the MRC CR07 randomised trial. J Clin Oncol ASCO Annual Meeting Proceedings Part I 24:3511

    Google Scholar 

  • Smalley SR, Benedetti J, Williamson SK, et al. (2006) Phase III trial of fluorouracil-based chemotherapy regimens plus radiotherapy in postoperative adjuvant rectal cancer: GI INT 0144. J Clin Oncol.24(22):3542–3547

    Article  PubMed  CAS  Google Scholar 

  • Swedish Rectal Cancer Trial (1997) Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med 336: 980–987

    Article  Google Scholar 

  • Tepper JE, O´Connell MJ, Petroni GR et al. (1997) Adjuvant postoperative fluorouracil-modulated chemotherapy combined with pelvic radiation therapy for rectal cancer: initial results of intergroup 0114. J Clin Oncol;15:2030–2039

    PubMed  CAS  Google Scholar 

  • Valentini V, Morganti A, Gambacorta M, et al. (2006) Study Group for Therapies of Rectal Malignancies (STORM).Preoperative hyperfractionated chemoradiation for locally recurrent rectal cancer in patients previously irradiated to the pelvis: A multicentric phase II study.Int J Radiat Oncol Biol Phys. 64(4):1129–1139 Epub 2006 Jan 18

    Article  PubMed  Google Scholar 

  • Willett CG, Shellito PC, Tepper JE, et al. (1991) Intraoperative electron beam radiation therapy for recurrent locally advanced rectal or rectosigmoid carcinoma. Cancer 67:1504–1508

    Article  PubMed  CAS  Google Scholar 

  • Wolmark N, Wieand HS, Hyams DM, et al. (2000) Randomized trial of postoperative adjuvant chemotherapy wirh or without radiotherapy for carcinoma of the rectum: National Surgical Adjuvant Breast and Bowel Project Protocol R-02. J Natl Cancer Inst ;92:388–396

    Article  PubMed  CAS  Google Scholar 

  • You Q, Wang R, Suen G, et al. (1993) Combination preoperative radiation and endocavitary hyperthermia for rectal cancer: long-term results of 44 patients. Int J Hyperthermia 9(1):19–24

    Article  PubMed  CAS  Google Scholar 

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Kraus-Tiefenbacher, U., Rödel, C. (2013). Rektumkarzinom. In: Wannenmacher, M., Wenz, F., Debus, J. (eds) Strahlentherapie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-88305-0_24

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