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01.02.2007 | Leitthema

Neck-Dissection nach Radiochemotherapie bei Kopf-Hals-Karzinomen

verfasst von: Prof. Dr. A.A. Duenne, P.J. Barth, V. Budach, J.A. Werner

Erschienen in: Die Onkologie | Ausgabe 2/2007

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Zusammenfassung

Bei Patienten mit Karzinomen der oberen Luft- und Speisewege ist der Nachweis manifester lymphogener Metastasen der wichtigste prognostische Faktor für das Gesamtüberleben. Das Überleben reduziert sich mit der Anzahl regionärer Lymphknotenmetastasen signifikant. Daher gehört die Behandlung des regionären Lymphabflusses (Neck-Dissection) bei einem primär chirurgischen Vorgehen zu den Therapieoptionen. Bei multimodalen Therapiekonzepten gilt dies auch für die primäre Radiochemotherapie. Diverse Probleme kommen durch die in der Literatur erläuterten Daten zutage: Alle Studien verwenden unterschiedliche Radiochemotherapieprotokolle und unterschiedliche Zeitspannen zwischen primärer Radiochemotherapie und Neck-Dissection. Die Indikation zur Neck-Dissection bleibt unklar. Ebenfalls unklar ist die Indikation zum Ausmaß der Neck-Dissection. Die publizierten Daten vermitteln unvollständige bis fehlende Angaben im Hinblick auf N-Status, Tumorlokalisation und Stadienverteilung etc. Ebenfalls unvollständig bis fehlend sind Angaben bezüglich der Korrelation zwischen prä- und postoperativem Halsstatus sowie der Bild gebenden Diagnostik und der postoperativ histologisch verifizierten Ergebnisse. Auch im Hinblick auf die histopathologische Begutachtung fehlen Standards. Die Frage, ab wann eine bestrahlte Zelle nicht apoptotisch oder nekrotisch, sondern noch zu weiterer Proliferation und Metastasierung fähig ist, wird nicht klar beantwortet.
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Metadaten
Titel
Neck-Dissection nach Radiochemotherapie bei Kopf-Hals-Karzinomen
verfasst von
Prof. Dr. A.A. Duenne
P.J. Barth
V. Budach
J.A. Werner
Publikationsdatum
01.02.2007
Verlag
Springer-Verlag
Erschienen in
Die Onkologie / Ausgabe 2/2007
Print ISSN: 2731-7226
Elektronische ISSN: 2731-7234
DOI
https://doi.org/10.1007/s00761-006-1168-6

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