Das Medizinportal


Klassische und molekulare Diagnostik

Peter Bronsert, Lisa Lutz, Martin Werner, Department für Pathologie, Institut für Klinische Pathologie, Universitätsklinikum Freiburg (Seite 9-12)


  1. Yachida, S. et al. Distant metastasis occurs late during the genetic evolution of pancreatic cancer. Nature 467, 1114–1117 (2010).
  2. Bosman, F.T., Carneiro, F., Hruban, R.H., Theise, N. . WHO Classification of Tumours of the Digestive System, Fourth Edition - WHO. (2010).
  3. Wittekind C, Meyer, H.-J. TNM: Klassifikation maligner Tumoren. 7 vol. Weinheim: WILEY-VCH Verlag; 2010.
  4. Rüschoff, J. et al. HER2 diagnostics in gastric cancer-guideline validation and development of standardized immunohistochemical testing. Virchows Archiv?: an international journal of pathology 457, 299–307 (2010).
  5. Park, J. Y. & Zhang, P. J. HER2 testing in gastric and gastroesophageal junction adenocarcinomas. Diagnostic Histopathology 20, 247–256 (2014).
  6. Kasper, S. & Schuler, M. Targeted therapies in gastroesophageal cancer. European journal of cancer (Oxford, England?: 1990) 50, 1247–58 (2014).
  7. Lennerz, J. K. et al. MET amplification identifies a small and aggressive subgroup of esophagogastric adenocarcinoma with evidence of responsiveness to crizotinib. Journal of clinical oncology?: official journal of the American Society of Clinical Oncology 29, 4803–10 (2011).
  8. Xie, L. et al. FGFR2 gene amplification in gastric cancer predicts sensitivity to the selective FGFR inhibitor AZD4547. Clinical cancer research?: an official journal of the American Association for Cancer Research 19, 2572–83 (2013).
  9. Riediger, H. et al. The lymph node ratio is the strongest prognostic factor after resection of pancreatic cancer. Journal of gastrointestinal surgery?: official journal of the Society for Surgery of the Alimentary Tract 13, 1337–44 (2009).
  10. Ryan, D. P., Hong, T. S. & Bardeesy, N. Pancreatic Adenocarcinoma. The New England journal of medicine 371, 1039–1049 (2014).
  11. Sugiura, T. et al. Margin status, recurrence pattern, and prognosis after resection of pancreatic cancer. Surgery 154, 1078–86 (2013).
  12. Ferrone, C. R. et al. Pancreatic ductal adenocarcinoma: long-term survival does not equal cure. Surgery 152, S43–9 (2012).
  13. Bronsert, P. et al. Intestinal-type of differentiation predicts favourable overall survival: confirmatory clinicopathological analysis of 198 periampullary adenocarcinomas of pancreatic, biliary, ampullary and duodenal origin. BMC cancer 13, 428 (2013).
  14. Whatcott, C. J. et al. Desmoplasia in primary tumors and metastatic lesions of pancreatic cancer. Clinical cancer research?: an official journal of the American Association for Cancer Research (2015). doi:10.1158/1078-0432.CCR-14-1051
  15. Tanaka, K. et al. Significance of histopathological evaluation of pancreatic fibrosis to predict postoperative course after pancreatic surgery. Anticancer research 35, 1749–56 (2015).
  16. Lee, J. J. et al. Stromal response to Hedgehog signaling restrains pancreatic cancer progression. Proceedings of the National Academy of Sciences of the United States of America 111, E3091–100 (2014).
  17. Goodman, M. D. & Saif, M. W. Adjuvant Therapy for Pancreatic Cancer. JOP. Journal of the Pancreas 15, 87–90 (2014). 
  18. Kaufman B, et al. Olaparib monotherapy in patients with advanced cancer and a germ-line BRCA1/2 mutation: an open-label phase II study. ASCO Meet Abstr. 2013;31(15_suppl):11024.

Fortschritte in der chirurgischen Therapie

Georg Lurje, Ulf Peter Neumann, Klinik fu?r Allgemein-, Viszeral-, und Transplantationschirurgie, Uniklinik RWTH Aachen (S. 14-16)


  1. Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin 2015; 65(2):87-108.
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  3. Nishida T. The Role of Endoscopy in the Diagnosis of Gastric Gastrointestinal Stromal Tumors. Ann Surg Oncol 2015.
  4. Sasako M, Sano T, Yamamoto S, et al. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med 2008; 359(5):453-462.
  5. Macdonald JS, Smalley SR, Benedetti J, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med 2001; 345(10):725-730.
  6. Santoro E. The history of gastric cancer: legends and chronicles. Gastric Cancer 2005; 8(2):71-74.
  7. Sayegh ME, Sano T, Dexter S, et al. TNM and Japanese staging systems for gastric cancer: how do they coexist? Gastric Cancer 2004; 7(3):140-148.
  8. Siewert JR. Gastric cancer: the dispute between East and West. Gastric Cancer 2005; 8(2):59-61.
  9. Katai H, Sano T. Early gastric cancer: concepts, diagnosis, and management. Int J Clin Oncol 2005; 10(6):375-383.
  10. Yasuda K, Shiraishi N, Suematsu T, et al. Rate of detection of lymph node metastasis is correlated with the depth of submucosal invasion in early stage gastric carcinoma. Cancer 1999; 85(10):2119-2123.
  11. Japanese Gastric Cancer A. Japanese Classification of Gastric Carcinoma - 2nd English Edition. Gastric Cancer 1998; 1(1):10-24.
  12. Miyata M, Yokoyama Y, Okoyama N, et al. What are the appropriate indications for endoscopic mucosal resection for early gastric cancer? Analysis of 256 endoscopically resected lesions. Endoscopy 2000; 32(10):773-778.
  13. Ono H, Kondo H, Gotoda T, et al. Endoscopic mucosal resection for treatment of early gastric cancer. Gut 2001; 48(2):225-229.
  14. Ohgami M, Otani Y, Kumai K, et al. Curative laparoscopic surgery for early gastric cancer: five years experience. World J Surg 1999; 23(2):187-192; discussion 192-183.
  15. Kitano S, Shiraishi N, Fujii K, et al. A randomized controlled trial comparing open vs laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery 2002; 131(1 Suppl):S306-311.
  16. Bozzetti F, Marubini E, Bonfanti G, et al. Subtotal versus total gastrectomy for gastric cancer: five-year survival rates in a multicenter randomized Italian trial. Italian Gastrointestinal Tumor Study Group. Ann Surg 1999; 230(2):170-178.
  17. Gouzi JL, Huguier M, Fagniez PL, et al. Total versus subtotal gastrectomy for adenocarcinoma of the gastric antrum. A French prospective controlled study. Ann Surg 1989; 209(2):162-166.
  18. Sasako M, Sano T, Yamamoto S, et al. Left thoracoabdominal approach versus abdominal-transhiatal approach for gastric cancer of the cardia or subcardia: a randomised controlled trial. Lancet Oncol 2006; 7(8):644-651.
  19. Yu W, Choi GS, Chung HY. Randomized clinical trial of splenectomy versus splenic preservation in patients with proximal gastric cancer. Br J Surg 2006; 93(5):559-563.
  20. Osugi H, Fukuhara K, Takada N, et al. Reconstructive procedure after distal gastrectomy to prevent remnant gastritis. Hepatogastroenterology 2004; 51(58):1215-1218.
  21. Bonenkamp JJ, Hermans J, Sasako M, et al. Extended lymph-node dissection for gastric cancer. N Engl J Med 1999; 340(12):908-914.
  22. Cuschieri A, Fayers P, Fielding J, et al. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group. Lancet 1996; 347(9007):995-999.
  23. Songun I, Putter H, Kranenbarg EM, et al. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol 2010; 11(5):439-449.
  24. Diagnostik und Therapie der Adenokarzinome des Magens und o?sophagogastralen U?bergangs. S3-Leitlinie 2012.
  25. Shinohara T, Maeda Y, Hamada T, et al. Survival Benefit of Surgical Treatment for Liver Metastases from Gastric Cancer. J Gastrointest Surg 2015.
  26. Kerkar SP, Kemp CD, Avital I. Liver resections in metastatic gastric cancer. HPB (Oxford) 2010; 12(9):589-596.
  27. Gill RS, Al-Adra DP, Nagendran J, et al. Treatment of gastric cancer with peritoneal carcinomatosis by cytoreductive surgery and HIPEC: a systematic review of survival, mortality, and morbidity. J Surg Oncol 2011; 104(6):692-698.
  28. Zentrum für Krebsregisterdaten, Robert Koch Institut; www.rki.de/Krebs/DE/Content/Krebsarten/Bauchspeicheldruesenkrebs/bauchspeicheldruesenkrebs_node.html 2012. 
  29. Li D, Xie K, Wolff R, et al. Pancreatic cancer. Lancet 2004; 363(9414):1049-1057.
  30. Trede M, Schwall G, Saeger HD. Survival after pancreatoduodenectomy. 118 consecutive resections without an operative mortality. Ann Surg 1990; 211(4):447-458.
  31. DeOliveira ML, Winter JM, Schafer M, et al. Assessment of complications after pancreatic surgery: A novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg 2006; 244(6):931-937; discussion 937-939.
  32. Birkmeyer JD, Stukel TA, Siewers AE, et al. Surgeon volume and operative mortality in the United States. N Engl J Med 2003; 349(22):2117-2127.
  33. Traverso LW, Longmire WP, Jr. Preservation of the pylorus in pancreaticoduodenectomy. Surg Gynecol Obstet 1978; 146(6):959-962.
  34. Diener MK, Fitzmaurice C, Schwarzer G, et al. Pylorus-preserving pancreaticoduodenectomy (pp Whipple) versus pancreaticoduodenectomy (classic Whipple) for surgical treatment of periampullary and pancreatic carcinoma. Cochrane Database Syst Rev 2014; 11:CD006053.
  35. Limani P, Samaras P, Lesurtel M, et al. [Pancreatic cancer- a curable disease]. Praxis (Bern 1994) 2015; 104(9):453-460.
  36. Kooby DA, Gillespie T, Bentrem D, et al. Left-sided pancreatectomy: a multicenter comparison of laparoscopic and open approaches. Ann Surg 2008; 248(3):438-446.
  37. Kendrick ML, Cusati D. Total laparoscopic pancreaticoduodenectomy: feasibility and outcome in an early experience. Arch Surg 2010; 145(1):19-23.
  38. Wellner UF, Kusters S, Sick O, et al. Hybrid laparoscopic versus open pylorus-preserving pancreatoduodenectomy: retrospective matched case comparison in 80 patients. Langenbecks Arch Surg 2014; 399(7):849-856.
  39. Boggi U, Amorese G, Vistoli F, et al. Laparoscopic pancreaticoduodenectomy: a systematic literature review. Surg Endosc 2015; 29(1):9-23.
  40. Ramacciato G, Mercantini P, Petrucciani N, et al. Does portal-superior mesenteric vein invasion still indicate irresectability for pancreatic carcinoma? Ann Surg Oncol 2009; 16(4):817-825.
  41. S3-Leitlinie zum exokrinen Pankreaskarzinom. Leitlinienprogramm Onkologie 2013.
  42. Yeo CJ, Cameron JL, Lillemoe KD, et al. Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2: randomized controlled trial evaluating survival, morbidity, and mortality. Ann Surg 2002; 236(3):355-366; discussion 366-358.
  43. Pedrazzoli S, DiCarlo V, Dionigi R, et al. Standard versus extended lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas: a multicenter, prospective, randomized study. Lymphadenectomy Study Group. Ann Surg 1998; 228(4):508-517.
  44. Nimura Y, Nagino M, Takao S, et al. Standard versus extended lymphadenectomy in radical pancreatoduodenectomy for ductal adenocarcinoma of the head of the pancreas: long-term results of a Japanese multicenter randomized controlled trial. J Hepatobiliary Pancreat Sci 2012; 19(3):230-241.

Strahlentherapeutische Behandlungsstrategien

Thomas B. Brunner, Klinik für Strahlenheilkunde, Universität Freiburg


  1. Macdonald JS, Smalley SR, Benedetti J, et al: Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med 345:725-30, 2001.
  2. Smalley SR, Benedetti JK, Haller DG, et al: Updated analysis of SWOG-directed intergroup study 0116: a phase III trial of adjuvant radiochemotherapy versus observation after curative gastric cancer resection. J Clin Oncol 30:2327-33, 2012.
  3. Moehler M, Al-Batran SE, Andus T, et al: [German S3-guideline "Diagnosis and treatment of esophagogastric cancer"]. Z Gastroenterol 49:461-531, 2011.
  4. Kim S, Lim DH, Lee J, et al: An observational study suggesting clinical benefit for adjuvant postoperative chemoradiation in a population of over 500 cases after gastric resection with D2 nodal dissection for adenocarcinoma of the stomach. Int J Radiat Oncol Biol Phys 63:1279-85, 2005.
  5. Cunningham D, Allum WH, Stenning SP, et al: Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 355:11-20, 2006.
  6. Sjoquist KM, Burmeister BH, Smithers BM, et al: Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: an updated meta-analysis. Lancet Oncol 12:681-92, 2011.
  7. van Hagen P, Hulshof MC, van Lanschot JJ, et al: Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 366:2074-84, 2012
  8. Oppedijk V, van der Gaast A, van Lanschot JJ, et al: Patterns of recurrence after surgery alone versus preoperative chemoradiotherapy and surgery in the CROSS trials. J Clin Oncol 32:385-91, 2014.
  9. Schulz C, Kullmann F, Kunzmann V, et al: NeoFLOT: Multicenter phase II study of perioperative chemotherapy in resectable adenocarcinoma of the gastroesophageal junction or gastric adenocarcinoma-Very good response predominantly in patients with intestinal type tumors. Int J Cancer 137:678-85, 2015.
  10. Treatment of locally unresectable carcinoma of the pancreas: comparison of combined-modality therapy (chemotherapy plus radiotherapy) to chemotherapy alone. Gastrointestinal Tumor Study Group. J Natl Cancer Inst 80:751-5, 1988.
  11. Bittner MI, Grosu AL, Brunner TB: Comparison of toxicity after IMRT and 3D-conformal radiotherapy for patients with pancreatic cancer - a systematic review. Radiother Oncol 114:117-21, 2015.
  12. Mukherjee S, Hurt CN, Bridgewater J, et al: Gemcitabine-based or capecitabine-based chemoradiotherapy for locally advanced pancreatic cancer (SCALOP): a multicentre, randomised, phase 2 trial. Lancet Oncol 14:317-26, 2013.
  13. Gillen S, Schuster T, Meyer Zum Buschenfelde C, et al: Preoperative/neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of response and resection percentages. PLoS Med 7:e1000267, 2010.
  14. Golcher H, Brunner TB, Witzigmann H, et al: Neoadjuvant chemoradiation therapy with gemcitabine/cisplatin and surgery versus immediate surgery in resectable pancreatic cancer: results of the first prospective randomized phase II trial. Strahlenther Onkol 191:7-16, 2015.
  15. Seufferlein T, Porzner M, Becker T, et al: [S3-guideline exocrine pancreatic cancer]. Z Gastroenterol 51:1395-440, 2013.
  16. Brunner TB, Nestle U, Grosu AL, et al: SBRT in pancreatic cancer: what is the therapeutic window? Radiother Oncol 114:109-16, 2015.

Moderne Pharmakologische Therapiekonzepte

Florian Lordick1, Maren Knödler1, Gertraud Stocker1, Ivonne Haffner1, Ulrich Hacker1, Albrecht Hoffmeister2, Joachim Mössner2 , 1Universitäres Krebszentrum Leipzig, Universitätsklinikum Leipzig, 2Klinik und Poliklinik für Gastroenterologie und Rheumatologie, Universitätsklinikum Leipzig


  1. De Angelis R, Sant M, Coleman MP, et al. Cancer survival in Europe 1999–2007 by country and age: results of EUROCARE-5—a population-based study. Lancet Oncol 2014; 15: 23-34.
  2. Moehler M, Al-Batran SE, Andus T, et al. German S3-Guideline "Diagnosis and Treatment of Esophagogastric Cancer". Z Gastroenterol 2011; 49: 461-531
  3. Seufferlein T, Porzner M, Becker T, Budach V, Ceyhan G, Esposito I, Fietkau R, Follmann M, Friess H, Galle P, Geissler M, Glanemann M, Gress T, Heinemann V, Hohenberger W, Hopt U, Izbicki J, Klar E, Kleeff J, Kopp I, Kullmann F, Langer T, Langrehr J, Lerch M, Löhr M, Lüttges J, Lutz M, Mayerle J, Michl P, Möller P, Molls M, Münter M, Nothacker M, Oettle H, Post S, Reinacher-Schick A, Röcken C, Roeb E, Saeger H, Schmid R, Schmiegel W, Schoenberg M, Siveke J, Stuschke M, Tannapfel A, Uhl W, Unverzagt S, van Oorschot B, Vashist Y, Werner J, Yekebas E; Guidelines Programme Oncology AWMF; German Cancer Society eV; German Cancer Aid. [S3-guideline exocrine pancreatic cancer]. Z Gastroenterol 2013; 51: 1395-440
  4. Lordick F, Lorenzen S, Yamada Y, Ilson D. Optimal chemotherapy for advanced gastric cancer: is there a global consensus? Gastric Cancer 2014; 17: 213-25
  5. Bang YJ, Van Cutsem E, Feyereislova A, et al. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet 2010; 376: 687-97
  6. Lordick F. Gastrointestinal cancer: Salvage chemotherapy in gastric cancer--more than a straw? Nat Rev Clin Oncol 2012; 9: 312-3
  7. Fuchs CS, Tomasek J, Yong CJ, et al. Ramucirumab monotherapy for previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (REGARD): an international, randomised, multicentre, placebo-controlled, phase 3 trial. Lancet 2014; 383: 31-9
  8. Wilke H, Muro K, Van Cutsem E, et al. Ramucirumab plus paclitaxel versus placebo plus paclitaxel in patients with previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (RAINBOW): a double-blind, randomised phase 3 trial. Lancet Oncol 2014; 15: 1224-35
  9. Lordick F. Gastrointestinal cancer. Over the RAINBOW--renaissance in antiangiogenesis. Nat Rev Clin Oncol 2015; 12: 7-8
  10. Lordick F, Kang YK, Chung HC, et al. Capecitabine and cisplatin with or without cetuximab for patients with previously untreated advanced gastric cancer (EXPAND): a randomised, open-label phase 3 trial. Lancet Oncol 2013; 14: 490-9
  11. Waddell T, Chau I, Cunningham D, et al. Epirubicin, oxaliplatin, and capecitabine with or without panitumumab for patients with previously untreated advanced oesophagogastric cancer (REAL3): a randomised, open-label phase 3 trial. Lancet Oncol 2013; 14: 481-9
  12. Lordick F. Targeting the HGF/MET pathway in gastric cancer. Lancet Oncol 2014; 15: 914-6
  13. Muro K, Bang Y, Shankaran V, et al. A phase 1b study of pembrolizumab (Pembro; MK-3475) in patients (Pts) with advanced gastric cancer.  Program and abstracts of the European Society for Medical Oncology 2014 Congress; September 26-30, 2014; Madrid, Spain. Abstract LBA15.
  14. Li Y, Rogoff HA, Keates S, Gao Y, Murikipudi S, Mikule K, Leggett D, Li W, Pardee AB, Li CJ. Suppression of cancer relapse and metastasis by inhibiting cancer stemness. Proc Natl Acad Sci U S A 2015; 112: 1839-44
  15. Burris HA 3rd, Moore MJ, Andersen J, et al. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol 1997; 15: 2403-13
  16. Conroy T, Desseigne F, Ychou M, et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 2011; 364: 1817-25
  17. Gourgou-Bourgade S, Bascoul-Mollevi C, Desseigne F, et al. Impact of FOLFIRINOX compared with gemcitabine on quality of life in patients with metastatic pancreatic cancer: results from the PRODIGE 4/ACCORD 11 randomized trial. J Clin Oncol 2013; 31: 23-9
  18. Von Hoff DD, Ervin T, Arena FP, et al. Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med 2013; 369: 1691-703
  19. Rahma OE, Duffy A, Liewehr DJ, Steinberg SM, Greten TF. Second-line treatment in advanced pancreatic cancer: a comprehensive analysis of published clinical trials. Ann Oncol 2013; 24: 1972-9
  20. Oettle H, Riess H, Stieler JM, et al. Second-line oxaliplatin, folinic acid, and fluorouracil versus folinic acid and fluorouracil alone for gemcitabine-refractory pancreatic cancer: outcomes from the CONKO-003 trial. J Clin Oncol 2014; 32: 2423-9