Zervixkarzinom

Kernaussagen

In den letzen Jahren hat sich das Spektrum der Therapie- und Präventionsmöglichkeiten beim Zervixkarzinom deutlich erweitert.

Seit Kurzem stehen für die primäre Prävention 2 Impfstoffe zur Verfügung. Die Impfung ist am effektivsten für junge Frauen ohne HPV-Infektion, d. h. vor dem ersten Sexualkontakt.

Die Stadieneinteilung des Zervixkarzinoms erfolgt bei den sichtbaren Läsionen entsprechend der FIGO bis heute rein klinisch, wobei der wichtigste Prognosefaktor, der Lymphknotenstatus, nicht abgebildet wird. CT und MRT haben eine unzureichende Aussagekraft in der Beurteilung pelviner und paraaortaler Lymphknoten.

Nur ein chirurgisches Staging, insbesondere als laparoskopischer Eingriff, erlaubt eine exakte Stadieneinteilung, auch wenn bisher keine valide randomisierte Studie den Überlebensvorteil einer Therapiemodifikation nach chirurgischer Stadieneinteilung bewiesen hat.

Die operative Therapie des primären Zervixkarzinoms umfasst, je nach Tumorstadium, die Konisation und einfache Hysterektomie, das chirurgische Staging, die Trachelektomie als fertilitätserhaltende Operation, die radikale Hysterektomie mit ihren verschiedenen Zugangswegen und Modifikationen sowie die exenterative Chirurgie. Bei fortgeschrittenem Tumor (ab FIGO II B) und bei Befall der pelvinen und / oder paraaortalen Lymphknoten ist die primäre Radiochemotherapie der Standard. Kombinationen aus radikaler Hysterektomie und Radiochemotherapie verdoppeln das Risiko höhergradiger Spättoxizität, ohne die onkologischen Ergebnisse zu verbessern, und sollten deshalb vermieden werden. Das operative Staging erlaubt eine sichere Patientenselektion für die operative Therapie oder die primäre Radiochemotherapie.

Einen Sonderfall stellt die Therapie im Stadium IV A. Es existiert keine Standardtherapie. Der Einsatz der exenterativen Chirurgie bzw. der Radiochemotherapie sollte interdisziplinär diskutiert und kritisch gegeneinander abgewogen werden. Insbesondere für Patientinnen ohne Fernmetastasen, bei denen eine R0-Resektion möglich erscheint, ist die Exenteration eine valide Alternative zur Radiochemotherapie.

In der metastasierten, rezidivierten Situation dient die systemische Therapie der Symptomverbesserung, der Verbesserung der Lebensqualität und der Verlängerung des Überlebens. Die aktuelle Phase-III-Studie der Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) vergleicht die Kombination aus Paclitaxel / Topotecan gegen Cisplatin / Topotecan beim rezidivierten oder persistierenden Zervixkarzinom.

Ein interdisziplinäres Team und eine vertrauensvolle Zusammenarbeit sind beste Voraussetzungen für die optimale Therapie der Patientinnen. Das Zervixzentrum der Charité bietet allen niedergelassenen und den in der Klinik tätigen Kolleginnen und Kollegen die Möglichkeit, Patientinnen in der interdisziplinären Konferenz via Internet vorzustellen, um therapeutische Konzepte abzustimmen bzw. Zweitmeinungen einzuholen.

Wir stehen unter der Website https://tumorzentrum-cbf-ssl.charite.de/ für die wöchentliche Konferenz bzw. über die Website des Zervixzentrums http://cervixcentrum.charite.de/ zur Verfügung.

Publication History

Publication Date:
07 October 2008 (online)

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