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11.07.2019 | Zervixkarzinom | Leitthema

Radiochemotherapie oder operative Therapie bei Zervixkarzinom – was und zu welcher Zeit?

verfasst von: Prof. Dr. Simone Marnitz, Dennis Akuoma-Boateng, Jan Herter

Erschienen in: Die Gynäkologie | Ausgabe 8/2019

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Zusammenfassung

Hintergrund

Auch wenn die Inzidenz des Zervixkarzinoms trotz mangelhafter Vakzinierungsrate in Deutschland langfristig weiter sinken wird, ist das Zervixkarzinom mit weltweit über 500.000 Neuerkrankungen pro Jahr nach wie vor ein globales Gesundheitsproblem.

Fragestellung

Darstellung des stadienabhängigen Stellenwertes der primären und adjuvanten Radiochemotherapie bei Zervixkarzinomen.

Material und Methode

Es erfolgte eine ausführliche Literaturrecherche zu Therapieoptionen bei Zervixkarzinomen in verschiedenen Stadien. Insbesondere die Wahl der Therapieoptionen primäre Hysterektomie (HE) gefolgt von Radiochemotherapie, primäre kombinierte Radiochemotherapie und neoadjuvante Chemotherapie gefolgt von der HE vs. Radiochemotherapie wird vor dem Hintergrund der onkologischen Ergebnisse, der therapiebedingten Toxizität und der Lebensqualität analysiert.

Ergebnisse

Die radikale HE sollte nach geeigneter Selektion erfolgen, eine adjuvante Radiochemotherapie sollte vermieden werden. Die sog. trimodale Therapie trägt zu einer Verdopplung der therapieassoziierten Langzeitnebenwirkungen bei. Die neoadjuvante Chemotherapie bei lokal fortgeschrittenen Tumoren sollte im Rahmen der ARO(Arbeitsgemeinschaft Radiologische Onkologie)-AGO(Arbeitsgemeinschaft Gynäkologische Onkologie)-NOGGO(Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie)-Studie durchgeführt werden. Im Sinne der Lebensqualität junger Patientinnen sollte an eine Ovariopexie vor Radiochemotherapie gedacht werden. Patientinnen mit histologisch gesicherten paraaortalen Metastasen profitieren möglicherweise von einer systematischen Lymphonodektomie vor einer EFRT („extended field radiation therapy“).

Schlussfolgerung

Vernetzung, Aufklärung und Therapie durch ein erfahrenes, interdisziplinäres Team sollten selbstverständlich werden.

S3-Leitlinie Diagnostik, T.u.N.d.P.m.Z., www.awmf.de. AWMF-Registernummer 032/033OL, Gültig bis 31. Okt. 2019

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Titel: Radiochemotherapie oder operative Therapie bei Zervixkarzinom – was und zu welcher Zeit?
verfasst von: Prof. Dr. Simone Marnitz
Dennis Akuoma-Boateng
Jan Herter
Publikationsdatum: 11.07.2019
Verlag: Springer Medizin
Schlagwörter: Zervixkarzinom
Zytostatische Therapie
Zervixkarzinom
Hysterektomie
Erschienen in: Die Gynäkologie / Ausgabe 8/2019
Print ISSN: 2731-7102
Elektronische ISSN: 2731-7110
DOI: https://doi.org/10.1007/s00129-019-4463-1

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Radiochemotherapie oder operative Therapie bei Zervixkarzinom – was und zu welcher Zeit?

Zusammenfassung

Hintergrund

Fragestellung

Material und Methode

Ergebnisse

Schlussfolgerung

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Update Gynäkologie

Springer Medizin

Zusammenfassung

Hintergrund

Fragestellung

Material und Methode

Ergebnisse

Schlussfolgerung

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