Zusammenfassung
Durch die Entwicklung der Bevölkerungsstruktur werden die urologischen Tumore als
typische Tumore des höheren Lebensalters an Bedeutung zunehmen. Die hauptsächlich
betroffene Patientengruppe weist häufig relevante Komorbiditäten und funktionelle
Beeinträchtigungen auf, die in der Therapieplanung berücksichtigt werden müssen. In
den letzten Jahrzehnten konnten im Bereich der operativen Versorgung urologischer
Tumore erhebliche Fortschritte in den perioperativen Komplikationsraten erzielt werden.
Dabei kommt vor allem einem interdisziplinärem perioperativem Management eine große
Bedeutung zu, da die Prognose-relevanten Komplikationen vor allem nicht-urologische
Probleme wie Infektionen, Verwirrtheitszustände, etc. betreffen. Gleichzeitig konnten
in der systemischen Therapie des Prostatakarzinoms mit der Einführung der Taxane erstmalig
Überlebensvorteile für eine palliative Chemotherapie erzielt werden. Mit Einführung
des Gemcitabins in die Therapie der Blasentumore scheinen den bisherigen MVAC-Protokoll
äquipotente, aber besser verträgliche Therapieprotokolle möglich. Die Rolle der Wachstumsfaktoren
muss in der Therapie der urologischen Tumore noch definiert werden, sei es in der
Intensivierung bisheriger Therapieschemata oder in der Verbesserung der Verträglichkeit
der Protokolle. Eine interdisziplinäre Zusammenarbeit zwischen Urologen, Internisten
und Geriatern ist zur adäquaten Individualisierung des Therapievorgehens sinnvoll
und sollte proaktiv erfolgen.
Abstract
Due to demographic developments malignancies of urogenital origin will gain increasing
importance. The urologist will face a growing group of patients with co-morbidities
and functional disabilities as these neoplasms increase with age. Optimisation of
peri-interventional management successfully reduces the risks of surgery. Integration
of taxane-based cytostatic regimes achieves a prolongation of survival in hormone-refractory
metastatic prostatic cancer. The introduction of gemcitabine in the management of
malignancies of the bladder seems to have reduced toxicity while maintaining anti-tumour
activity in comparison to MVAC. The role of haematopoetic growth factors remains to
be defined in urologic malignancies - increasing dose intensity for better activity
or reduction of toxicity. Individualisation of treatment requires early cooperation
of the urologist, the oncologist and the geriatrician for an optimal outcome.
Schlüsselwörter
geriatrische Onkologie - Komorbidität - peripoperatives Management - systemische Chemotherapie
Key words
Geriatric oncology - co-morbidities - perioperative management - systemic chemotherapy
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Dr. med. S. Krege
Urologische Universitätsklinik Essen
Hufelandstr. 55
45147 Essen ·
eMail: susanne.krege@uni-essen.de
