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DOI: 10.1055/s-0043-122057
Herausforderungen in der Therapie der Patientin mit Vulvakarzinom
Publication History
Publication Date:
28 June 2018 (online)
In den letzten Jahren ist die Inzidenz des Vulvakarzinoms deutlich angestiegen. Wegen der oft unspezifischen Frühsymptome, sollte bei jeder Vorsorgeuntersuchung die Vulva gründlich inspiziert werden – auch bei jungen Patientinnen. Liegt eine Krebserkrankung vor, kommt der Qualität der Primärtherapie eine besondere Bedeutung zu. Entscheidend für die Prognose ist zudem das Vorliegen von inguinofemoralen Lymphknoten.
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Der Primärtumor sollte im Gesunden reseziert werden. Ein evidenzbasierter Grenzwert für den optimalen Resektionsrand ist durch aktuelle Studien nicht belegt.
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Der zentrale Prognosefaktor beim Vulvakarzinom ist das Vorliegen von inguinofemoralen Lymphknotenmetastasen.
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Als Voraussetzungen für die SNB gelten derzeit klinisch unauffällige Leistenlymphknoten, Tumordurchmesser < 4 cm und ein unifokaler Primärtumor sowie die Möglichkeit des pathologischen Ultrastagings.
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Bei Metastasennachweis im SNL wird die komplette inguinofemorale LNE empfohlen. Eine alleinige Radiatio ist nach aktueller Wissenslage nicht ausreichend.
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Die Qualität der Primärtherapie hat eine besondere Wichtigkeit. Leistenrezidive verlaufen oft letal.
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Durch pelvines Lymphknotenstaging bei inguinalem Metastasennachweis kann eine pelvine Radiatio bei histologisch negativen Lymphknoten im Becken vermieden werden.
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