Onkologie. Stellenwert der intraperitonealen Chemotherapie beim fortgeschrittenen Ovarialkarzinom

Patientinnen mit Ovarialkarzinom werden in etwa 70 % der Fälle im fortgeschrittenen Tumorstadium FIGO III oder IV diagnostiziert. Die 5-Jahres-Überlebensraten für diese Patientinnen sind hierbei mit etwa 32 % (FIGO IIIC) und 19 % (FIGO IV) begrenzt [1]. Die Standardtherapie besteht aus der primären Operation mit Entfernung beider Adnexe, Hysterektomie, infragastrischer Omentektomie und systematischer Lymphonodektomie im Bereich der großen Bauchgefäße bis zum Nierenstiel, der pelvinen Lymphonodektomie, Peritonektomie und Entfernung des sichtbaren Tumors. Ziel ist die makroskopische Tumorfreiheit am Ende der Operation, die in spezialisierten Zentren in etwa 65–74 % erreicht wird [2]. In der Regel erfolgt hiernach eine Chemotherapie mit 6 Zyklen Carboplatin und Paclitaxel oder, seltener, Docetaxel. Die Hinzunahme von Bevazicumab wird von der Organkommission Ovar der Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) seit Januar 2012 empfohlen, sie gehört in anderen Ländern, wie den USA, noch nicht zur Empfehlung der Fachgesellschaften. In Untergruppen kann die Sequenz zugunsten einer neoadjuvanten Chemotherapie von 2–3 Zyklen vor der Operation verändert werden [3], [4].

• Literatur

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