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Anschrift für die Verfasser Prof. Dr. med. Wolff Schmiegel
Medizinische Klinik, Ruhr-Universität Bochum, Knappschaftskrankenhaus In der Schornau 23–25, 44892 Bochum
E-Mail: meduni-kkh@rub.de, Internet: www.medunikkh.de
SUMMARY
Clinical Practice Guideline:
Colorectal Carcinoma—The Management of Polyps, (Neo)Adjuvant Therapy, and the Treatment of Metastases
Background: Colorectal carcinoma (CRC) is the second most common type of cancer in Germany. In view of recent major changes in the diag- nosis and treatment of CRC, the S3 guideline for CRC published in its full version in 2004 was partially updated in 2008 and again in 2009.
Method: The literature was systematically searched for all articles pub - lished from 2004 onward concerning polyp management, (neo-)adju- vant treatment, and treatment of metastatic disease. Evidence-based recommendations were developed in a consensus conference.
Results: For some patients who have undergone polypectomy, the time to follow-up with colonoscopy can be lengthened. In UICC stage III colon cancer, adjuvant chemotherapy with an oxaliplatin-based regimen is recommended. In stage II colon cancer, adjuvant chemotherapy should be considered mainly when risk factors are present. In stages II and III, neo-adjuvant therapy should be given before resection in rectal cancer.
In patients with metastatic disease, the use of all possible treatment options results in an average overall survival time of 24 months. In some patients with primarily non-resectable liver metastases, systemic treatment may enable a secondary, potentially curative resection. Ther - apeutic agents are chosen individually on the basis of clinical factors including the goal of treatment, the patient’s general condition, and tu- mor molecular markers.
Conclusion: The S3 guideline contains evidence-based recommenda- tions for the diagnosis and treatment of colorectal carcinoma. Broad implementation of the guideline will be essential for improved patient care.
Key words: colorectal carcinoma, polyps, adjuvant therapy, cancer treat- ment, palliative treatment
Zitierweise: Dtsch Arztebl Int 2009; 106(51–52): 843–8 DOI: 10.3238/arztebl.2009.0843
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