Onkologisk behandling av endetarmskreft
- Onkologisk behandling av endetarmskreft
- Resektabel og potensielt resektabel endetarmskreft
- Primært ikke-resektabel endetarmskreft
- Behandling av pasienter med høy alder og/eller redusert funksjonsevne
- Synkrone metastaser
- Behandlingsopplegg og anbefalinger preoperativ strålebehandling og kjemoterapi
- Strålebehandling - praktisk inntegning av strålefelt
- Postoperativ (adjuvant) behandling
- Palliativ strålebehandling
- Protonbehandling
- Immunterapi
Onkologisk behandling av endetarmskreft
Sist oppdatert: 20.12.2023
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Utgiver: Helsedirektoratet
Versjon: 1.0
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Strålebehandling og cellegiftbehandling av endetarmskreft gis med flere ulike formål. Det viktigste er størrelsesreduksjon av svulsten for å øke muligheten for radikal kirurgi og redusere risiko for lokalt recidiv. Kjemoterapi vil også minske risiko for fjernmetastaser.
Alle pasienter med rektumcancer skal diskuteres i et tverrfaglig møte (MDT) etter at stadieinndeling og klinikk er kartlagt. Konsekvenser for funksjon, for eksempel LARS syndrom, og andre mulige seneffekter, er en viktig del av pasientinformasjon som grunnlag for informert samtykke.
Andelen pasienter som får neoadjuvant strålebehandling har de siste årene ligget mellom 30 % til 40 %. Andelen som får kort strålebehandling (5 Gy x 5) er økende og var i 2021 17 %, mens andelen som fikk lang strålebehandling (kjemoradioterapi) var 19 % (Nasjonalt kvalitetsregister for tykk- og endetarmskreft, 2021).
Preoperativ kjemoradioterapi (CRT) har bedre effekt og mindre bivirkninger enn postoperativ kjemoradioterapi (Sauer et al., 2012; Sebag-Montefiore et al., 2009). Årsakene kan være forskjeller i strålefølsomhet og ulikt tynntarmsvolum som bestråles. Etter rektumkirurgi er det vanligvis mere tynntarm i det lille bekken, spesielt etter rektumamputasjon, og tynntarmen er ofte fiksert.
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