Die intraoperative hypertherme intraperitoneale Chemotherapie als Therapieoption beim Ovarialkarzinom - Entwicklungen der letzten Jahre

Zusammenfassung

Der peritoneale Befall ist eine der größten therapeutischen Herausforderungen beim Ovarialkarzinom. Die komplette chirurgische Resektion der Tumorreste spielt dabei eine entscheidende Rolle für die Prognose der Patientinnen. Der chirurgische Teil des Konzeptes beinhaltet die parietale und viszerale Peritonektomie, oft in Form einer multiviszeralen Resektion. Die Kombination der Chirurgie mit der hyperthermen intraperitonealen Chemotherapie (HIPEC) hat bei gastrointestinalen Malignomen mit Peritonealkarzinose für ausgewählte Patienten die Prognose erheblich verbessert. Analog dazu wurden beim Ovarialkarzinom mit Peritonealkarzinose Daten von über 300 Patientinnen, die multimodal behandelt wurden, über die letzten vier Jahre publiziert. Die Kollektive sind relativ klein und inhomogen, die Patientinnen zum Teil unterschiedlich behandelt worden. Es konnte jedoch die technische Durchführbarkeit mit einer niedrigen Letalität und vertretbaren Morbidität in Zentren nachgewiesen werden. Die intraoperative HIPEC ergänzt das therapeutische Konzept für ausgewählte Patientinnen, jedoch ersetzt sie nicht die adjuvante systemische Chemotherapie. Prospektiv randomisierte Phase-III-Studien sollen klären, welchen Stellenwert die HIPEC in dem vorgestellten Konzept einnimmt. Ein gemeinsames Studienprotokoll der Deutschen Gesellschaft für Viszeralchirurgie/Arbeitsgruppe Chirurgische Onkologie zusammen mit der Arbeitsgruppe Gynäkologische Onkologie/Ovar wäre daher hilfreich.

Abstract

Peritoneal metastases represent a therapeutic challenge in the treatment of ovarian cancer. Macroscopically complete surgical cytoreduction is decisive for the patient's prognosis. The surgical part of the treatment includes a parietal and visceral peritonectomy, often carried out as a multivisceral resection. Its combination with intraperitoneal hyperthermic chemotherapy (HIPEC) has been found to significantly improve the prognosis of selected patients with gastrointestinal malignancies and peritoneal carcinomatosis. In the last four years several reports have been published on the use of a similar treatment in women with ovarian cancer, and more than 300 patients with ovarian cancer and peritoneal carcinomatosis were treated using this multimodal combination. However, the patient collectives were rather small and inhomogeneous and not all of the patients were treated according to the same protocol. Nevertheless, the technical feasibility of this method with low mortality and acceptable morbidity rates was demonstrated for patients treated in different centers. Intraoperative HIPEC enriches the presented concept but does not replace systemic or long-term intraperitoneal chemotherapy. Prospective, randomized phase III trials need to be designed, in order to define the exact role of HIPEC for this treatment concept. A protocol, combining proposals of the German Society of Visceral Surgery/Surgical Oncology Group and the Gynecology Oncology Group, would be therefore helpful.

hypertherm - intraperitoneale Chemotherapie - Ovarialkarzinom

hyperthermic - intraperitoneal chemotherapy - ovarian cancer

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