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01.01.2009 | Leitthema

Definitive Radiotherapie und Radiochemotherapie der Vulva und Vagina

verfasst von: J. Dimopoulos, E. Fidarova, Prof. Dr. R. Pötter

Erschienen in: Die Onkologie | Ausgabe 1/2009

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Zusammenfassung

Bei der Mehrzahl der lokal inoperablen Tumoren der Vulva kann durch den Einsatz der präoperativen Radiotherapie (RT) bzw. der Radiochemotherapie (RCHT) eine funktions- bzw. organerhaltende Operabilität erzielt werden. Der Einsatz dieser kombinierten Therapieform ist allerdings mit erheblichen Morbiditätsraten verbunden. Cisplatin, 5-Fluorouracil und Mitomycin C zählen zu den am häufigsten simultan zur RT verwendeten Substanzen, wobei die vorliegende Datenlage keine Empfehlung einer Standardchemotherapie erlaubt. In einigen Serien wurde über sehr niedrige Lokalrezidivraten nach definitiver RCHT berichtet. Besonders für medizinisch inoperable Patientinnen oder Patientinnen mit lokal weit fortgeschrittenen Tumoren stellt daher die definitive Radiochemotherapie eine Alternative zur Operation dar. Bei kleinen Tumoren mit Infiltration der distalen Urethra, der Vagina und/oder des Anus, die grundsätzlich operabel sind, eine Operation jedoch zu unvermeidbaren Funktionseinschränkungen führen würde, ist die definitive RCHT ebenfalls eine therapeutische Option. Die therapeutische Methode der Wahl für die Mehrzahl der Patientinnen mit lokal fortgeschrittenem Vaginalkarzinom ist die definitive Radiotherapie bzw. die Radiochemotherapie. Eine analoge Vorgehensweise wie beim Zervixkarzinom scheint hierbei sinnvoll zu sein, sowohl bezüglich der Radiotherapie wie auch der Radiochemotherapie (Cisplatin). Lokal fortgeschrittene Tumoren werden durch eine kombinierte Teletherapie (simultan Cisplatin) und Brachytherapie mit hohen Gesamtdosen behandelt (ca. 80–90 Gy), heute vorzugsweise unter Einsatz der MRT-gestützten Brachytherapie. Bei sehr kleinen oberflächlichen Tumoren (oft multilokulär) erfolgt eine alleinige intravaginale Brachytherapie.
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Metadaten
Titel
Definitive Radiotherapie und Radiochemotherapie der Vulva und Vagina
verfasst von
J. Dimopoulos
E. Fidarova
Prof. Dr. R. Pötter
Publikationsdatum
01.01.2009
Verlag
Springer-Verlag
Erschienen in
Die Onkologie / Ausgabe 1/2009
Print ISSN: 2731-7226
Elektronische ISSN: 2731-7234
DOI
https://doi.org/10.1007/s00761-008-1541-8

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