Zusammenfassung
Die neoadjuvante Bestrahlung ist fester Bestandteil der multimodalen Therapie des lokal fortgeschrittenen Rektumkarzinoms mit nachgewiesenem Nutzen für die lokale Tumorkontrolle, nicht aber für das krankheitsfreie Überleben. Das Ausmaß des Einflusses der Bestrahlung auf die postoperative Darmfunktion und Lebensqualität bleibt jedoch umstritten. Es gibt zunehmende Hinweise darauf, dass neben der sphinktererhaltenden Resektion auch die präoperative Strahlentherapie isoliert die anorektale und urogenitale Funktion beeinträchtigen, zu anhaltenden dysfunktionellen Symptomen führten und die Lebensqualität erheblich beeinflussen kann. Neben den bedeutsamen Effekten der Strahlentherapie bei der Tumortherapie führt sie zu chronischen Zellschäden benachbarter Gewebe, die sich erst Wochen, Monate oder sogar Jahre nach Abschluss der Bestrahlung manifestieren. Fibrosierende Läsionen des Peritoneums sowie der Submukosa des Darms, und hier insbesondere von Arterien und Venen, sind die Folge und verursachen die langfristig für den Patienten funktionell relevanteren Störungen mit zum Teil erheblichen Auswirkungen auf die Lebensqualität. Die Strahlentherapie am Enddarm erhöht relevant das Risiko für die Ausbildung und Verstärkung anorektaler Funktionsstörungen und der erektilen Dysfunktion. Daher sollte die Indikation zur Bestrahlung wegen der Problematik des Overstagings und die daraus resultierende Überbehandlung mit dem unnötigen Risiko einer funktionellen Störung im Einzelfall kritisch geprüft werden. Bei gegebener Indikation ist die Aufklärung der Patienten über potenzielle postradiogene funktionelle Störungen und deren Behandlungsmöglichkeiten von zentraler Bedeutung.
Abstract
Neoadjuvant irradiation is an established component of the multimodal treatment of locally advanced rectal cancer with proven benefits in local tumor control but not in disease-free survival; however, the impact of irradiation on postoperative bowel function and quality of life remains controversial. There is increasing evidence that in addition to sphincter-preserving resections, preoperative radiotherapy alone also impairs anorectal and urogenital functions, leads to persistent dysfunctional symptoms and can significantly affect the quality of life. In addition to the significant effects of radiotherapy in tumor treatment, it leads to chronic cell damage of adjacent tissues, which manifests only weeks, months or even years after completion of the irradiation. This results in fibrosing lesions of the peritoneum as well as the submucosa of the intestines and especially here fibrosing lesions of arteries and veins. These changes are responsible for long-term bowel dysfunction that sometimes has a substantial negative effect on the quality of life. Radiotherapy of rectal cancer significantly increases the risk of developing and enhancing anorectal functional disorders and erectile dysfunction. Therefore, the indications for irradiation should be critically examined due to the problem of overstaging and the resulting overtreatment with the unnecessary risk of a functional disorder in individual cases. For a given indication, educating patients about potential postradiogenic functional disorders and the treatment options is of key importance.
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Gröne, J. Funktionelle Störungen am Enddarm nach Strahlentherapie. coloproctology 41, 262–266 (2019). https://doi.org/10.1007/s00053-019-0373-x
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DOI: https://doi.org/10.1007/s00053-019-0373-x