Zusammenfassung
Das Tubenkarzinom ist das seltenste aller gynäkologischen Malignome. Seine geringe
Inzidenz verhinderte bislang die Durchführung aussagekräftiger Untersuchungen, so
dass kein zulänglich definiertes Therapiekonzept für dieses Krankheitsbild existiert.
In Zeiten der evidenzbasierten Medizin stellt daher die Behandlung des Tubenkarzinoms
ein Dilemma für jeden Kliniker dar. Notgedrungen orientiert sich die Behandlung an
den Resultaten aus kleineren retrospektiven Untersuchungen mit langen Datenerhebungsperioden
und aus den Erkenntnissen aus größeren Untersuchungen beim Ovarialkarzinom. Beide
Entitäten weisen einige charakteristische Unterschiede auf, teilen aber auch viele
Gemeinsamkeiten. Das Tubenkarzinom weist im Vergleich zum Ovarialkarzinom eine frühere
klinische Symptomatik, eine höhere Prävalenz der Frühstadien und metastatische Beteiligung
retroperitonealer Lymphknoten auf. Bis heute ist nicht geklärt, ob spezifische tumorbiologische
Faktoren eine Rolle in diesem Zusammenhang spielen. Neuere Untersuchungen decken jedoch
zunehmend klinische und tumorbiologische Gemeinsamkeiten zwischen beiden Tumorentitäten
auf, die über den gemeinsamen Müller'schen Ursprung hinausgehen. So bestätigen jüngste
Ergebnisse aus retrospektiven Untersuchungen die Bedeutung der zytoreduktiven Chirurgie
und die hohe Chemosensibilität gegenüber Platinderivaten analog zum Therapiekonzept
beim Ovarialkarzinom. Zudem lassen neue Erkenntnisse über Häufigkeiten und Muster
genetischer Alterationen eine gemeinsame molekulargenetische Pathogenese vermuten.
Die Prävalenz von BRCA1- und BRCA2-Mutationen beim Tubenkarzinom gleicht den bisherigen
Ergebnissen zufolge der beim Ovarialkarzinom, und komparative Genomhybridisierungen
zeigen vergleichbare genomische Alterationen beider Tumorentitäten.
Vor dem Hintergrund fehlender evidenzbasierter Therapiekonzepte rechtfertigen daher
die bislang gesammelten Erkenntnisse, dass sich das therapeutische Management von
Tubenkarzinomen eng an dem von Ovarialkarzinomen orientiert.
Abstract
Fallopian tube carcinoma is the least common type of all gynecologic malignancies.
Its low incidence led to therapeutic concepts derived from smaller retrospective studies
with data collected over long time periods, resulting in a poorly defined management
of this disease. As a result, every clinician is forced to decide on the basis of
a low level of evidence. Alternatively, treatment of fallopian tube cancer today follows
concepts derived from large prospective randomised trials in ovarian cancer.
In comparison to ovarian cancer, fallopian tube carcinoma tends to be more often diagnosed
as being of low FIGO stage at time of primary diagnosis, probably due to earlier symptoms.
Together with increased retroperitoneal lymph node involvement, specific tumorbiological
factors may be reasonable for that. However, despite these differences both malignancies
share biological characteristics as well as clinical appearances. In keeping with
standard treatment of ovarian carcinoma, recent results from retrospective trials
with the largest collectives ever confirm the importance of cytoreductive surgery
and platinum sensitivity for the treatment of fallopian tube cancer. Furthermore,
strikingly similar frequencies of BRCA-1 and BRCA-2 mutations and patterns of genomic
alterations in these tumour entities have recently suggested a common molecular pathogenesis.
In summary of existing experiences, treatment of fallopian tube cancer may follow
concepts derived from large prospective randomised trials in ovarian cancer.
Schlüsselwörter
Tubenkarzinom - Ovarialkarzinom - Therapie
Key words
Fallopian tube cancer - ovarian cancer - therapy
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Dr. med. Felix Hilpert
Klinik für Gynäkologie und Geburtshilfe · Universitätsklinikum Kiel
Michaelisstraße 16
24105 Kiel
Email: fhilpert@email.uni-kiel.de
