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Erschienen in:

14.09.2016 | Brachytherapie | Leitthema

Radioonkologische Aspekte des Zervixkarzinoms

verfasst von: Prof. Dr. Simone Marnitz

Erschienen in: Die Onkologie | Ausgabe 10/2016

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Zusammenfassung

Die Radiochemotherapie ist immer dann integraler Bestandteil der Therapie des Zervixkarzinoms, wenn die alleinige Operation nicht ausreicht, um ein optimales onkologisches Ergebnis zu erzielen. Nach der aktuellen deutschen Leitlinie zur Therapie des Zervixkarzinoms wird empfohlen, entweder eine radikale Hysterektomie oder eine primäre Radiochemotherapie durchzuführen. Die häufig geübte Praxis der trimodalen Therapie (radikale Hysterektomie plus Radiatio plus Chemotherapie) verdoppelt das Risiko für therapiebedingte Spättoxizität und sollte, wenn möglich, vermieden werden. Wenn bereits prätherapeutisch Risikofaktoren wie Lymphknotenbefall, Parametrienbefall oder eine Kombination aus z. B. Tumor >4 cm, Grading 3, Lymphgefäßinvasion oder Hämangioinvasion, tiefe Stromainfiltration etc. bekannt sind, sollte eine primäre Radiochemotherapie durchgeführt werden. Aufgrund der rein klinischen FIGO-Klassifikation ist z. B. der Lymphknotenbefall prätherapeutisch nicht abbildbar. Dies führt dazu, dass erst nach der radikalen Operation aufgrund der befallenen Lymphknoten doch eine adjuvante Radiochemotherapie durchgeführt wird. Das wäre bei 90 % der Patientinnen vermeidbar, würde zunächst ein operatives (laparoskopisches) Lymphknotenstaging durchgeführt werden. Ob dieses bzgl. der Prognose der Patientin einen Vorteil bietet, war Gegenstand der angeschlossenen Uterus-11-Studie der AGO und ARO. Mature Daten werden für 2018 erwartet. Die Radiochemotherapie sollte mit modernen Bestrahlungstechniken durchgeführt werden. Nur so lassen sich Akut- und Spätnebenwirkungen signifikant reduzieren. Diese Techniken sollte auch zum Erhalt der Ovarfunktion eingesetzt werden. Für prämenopausale Patientinnen kann nach einer suffizienten (hohen) Ovaripexie mittels modernster Strahlentherapietechniken die Dosis in den Ovarien reduziert werden, sodass die hormonelle Funktion erhalten werden kann. Eine Schwangerschaft nach Standardradiochemotherapie eines Zervixkarzinoms ist nicht möglich. Mitentscheidend für den Therapieerfolg ist die Gesamtdauer der Behandlung, die Vollständigkeit der Therapie aus perkutaner Strahlentherapie, Brachytherapie und Chemotherapie. Dies wird auch durch die Erfahrung und die Behandlungszahlen des jeweiligen Zentrums widergespiegelt. In Diskussion und weiterhin unklar ist der Stellenwert der neoadjuvanten Chemotherapie beim lokal fortgeschrittenen Zervixkarzinom.
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Metadaten
Titel
Radioonkologische Aspekte des Zervixkarzinoms
verfasst von
Prof. Dr. Simone Marnitz
Publikationsdatum
14.09.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
Die Onkologie / Ausgabe 10/2016
Print ISSN: 2731-7226
Elektronische ISSN: 2731-7234
DOI
https://doi.org/10.1007/s00761-016-0107-4

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