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DOI: 10.1055/s-2005-872560
© Georg Thieme Verlag Stuttgart · New York
Einsatzmöglichkeiten der lokoregionären Hyperthermie in der gynäkologischen Onkologie
Clinical Impact of Locoregional Hyperthermia in Gynacological OncologyPublication History
Publication Date:
26 September 2006 (online)
Zusammenfassung
Fortschritte auf dem Gebiet der gynäkologischen Onkologie waren in den letzten Jahren vor allem durch eine Weiterentwicklung der Chemo- und Strahlentherapie zu verzeichnen. Beispielsweise ist eine Optimierung der Primärtherapie des Ovarialkarzinoms durch Implementierung der Taxane, beim inoperablen Zervixkarzinom durch die Kombination von Cisplatintherapie und Bestrahlung gelungen. Dennoch ist die Prognose dieser Erkrankungen in fortgeschrittenen Stadien unverändert infaust. Aufgrund des Ausmaßes der Tumordissemination ist eine weitere Verbesserung der therapeutischen Effizienz in diesen Fällen wiederum von Seiten der konservativen Therapien zu erwarten. Eine der Optionen ist der Einsatz der Hyperthermie. Sie ist in der Lage, sowohl die Strahlen- als auch die Chemotherapie in ihrer Wirkung zu verstärken. Für die Thermo-Radiotherapie ist der klinische Nutzen bereits ausreichend validiert. So wurde bei verschiedenen Tumorentitäten in 11 prospektiv-randomisierten Studien an mehr als 1 000 Patientinnen eine verbesserte lokale Tumorkontrolle nachgewiesen, unter anderem beim Thoraxwandrezidiv von Mammakarzinomen. In der Primärbehandlung des fortgeschrittenenen Zervixkarzinoms konnte darüber hinaus ein Überlebensvorteil im Vergleich zur alleinigen Radiotherapie gezeigt werden. Zahlreiche Phase-II-Studien weisen außerdem auf einen Synergismus zwischen Hyperthermie und Chemotherapie hin. Entsprechende Daten liegen für die hypertherme Chemotherapie beim rezidivierenden Zervixkarzinom und mit liposomalen Anthrazyklinen beim Mammakarzinom und Ovarialkarzinom vor. Je nach Tumorlokalisation kommen die lokale Oberflächen- oder regionale Tiefenhyperthermie zur Anwendung. Der genauere Stellenwert der Hyperthermie im Allgemeinen und in der gynäkologischen Onkologie im Speziellen bleibt durch weitere wissenschaftliche Untersuchungen zu klären. Derzeit ist der Einsatz des Verfahrens in der klinischen Routine auf wenige Indikationsgebiete begrenzt.
Abstract
In the last decade progress in gynecological oncology has been achieved mainly by new cytotoxic drugs and advances in radiation technology. For example, the use of taxanes in the primary therapy of ovarian cancers and of combined radio-chemotherapy in cervical cancer has led to significant prolongations of survival. However, in case of relapse most gynaecological malignancies are associated with very poor prognosis. Efficacy of local and systemic therapy can be increased by combining radiotherapy and/or chemotherapy with locoregional hyperthermia (LRH). Increasing the temperature of the target tissue up to 41-43 °C leads to local hyperaemia and the tumor tissue becomes more responsive to cytotoxic interventions. In several prospective randomized studies the combination between LRH and radiotherapy was superior to radiotherapy alone in terms of local control (e. g. chest wall recurrence in breast cancer) and has led to longer overall survival in advanced cervical cancer. Platinum derivatives and other cytotoxic drugs have shown synergistic effects with LRH and the combination of both has elicited high response rates in recurrent cervical cancer. In phase-II-clinical trials the newly developed liposomal anthracyclines demonstrated synergistic effects with LRH in patients with refractory ovarian cancer. Our own experience has shown that adding LRH to radio- and/or chemotherapy is well tolerated by the patients. Despite of the fact, that the available data are still preliminary, the inclusion of LRH into multimodal cancer therapy concepts appears to be very promising. Well-designed comparative studies are still needed to evaluate the role of hyperthermia as an adjunct to conventional cancer therapy.
Schlüsselwörter
regionale Tiefenhyperthermie - Lokale Oberflächenhyperthermie - Mammakarzinom - Zervixkarzinom - Ovarialkarzinom
Key words
Regional hyperthermia - local hyperthermia - breast cancer - cervical cancer - ovarian cancer
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Dr. med. J. Bischoff
Universitätsfrauenklinik der Medizinischen Fakultät · Otto-von-Guericke-Universität
Gerhart-Hauptmann-Straße 35
39108 Magdeburg
Email: joachim.bischoff@medizin.uni-magdeburg.de