Lokoregionäre Hyperthermieverfahren in der Gynäkologie - Standortbestimmung und Perspektiven

Zusammenfassung

Unter dem Begriff lokoregionäre Hyperthermieverfahren fasst man die lokale Hyperthermie (Erwärmung von oberflächlichen Tumoren, z. B. Brustwandrezidiv eines Mammakarzinoms), die regionale Hyperthermie (Behandlung größerer Körperregionen, z. B. pelvine Tumoren) und die interstitielle Hyperthermie (Einbringen von Sonden in den Tumor mit anschließender Erwärmung) zusammen. Gegenwärtige Einsatzmöglichkeiten der wissenschaftlich begründeten Hyperthermie bestehen in Deutschland lediglich im Rahmen kontrollierter Studien bzw. in Kooperation mit den Niederlanden. Durch prospektiv randomisierte Studien untermauerte Anwendungsbereiche betreffen vorbestrahlte Patientinnen mit Lokalrezidiven von Mammakarzinomen (in Kombination mit einer erneuten Radiatio) und Patientinnen mit Zervixkarzinomen (ebenfalls in Kombination mit einer Strahlentherapie und bei Rezidiven in Kombination mit einer Chemotherapie). Auch Patientinnen mit ausgedehnten Vaginalkarzinomen (Stadium II > 4 cm und Stadium III) profitieren möglicherweise ersten Ergebnissen zufolge von einer Kombination der Strahlentherapie mit einer Hyperthermie. Für eine abschließende Bewertung dieser Therapiemethode ist einerseits das Abwarten von Studienergebnissen erforderlich, insbesondere hinsichtlich des Vergleichs der hyperthermen Radiotherapie mit einer Radiochemotherapie bei Patientinnen mit Zervixkarzinom FIGO-Stadium I B - IV A und der magnetischen Flüssigkeitshyperthermie in Kombination mit einer interstitiellen Strahlentherapie bei Patientinnen mit inoperablen lokal begrenzten Residualtumoren. Andererseits bleibt abzuwarten, welche Fortschritte experimentelle Targeting-Verfahren im Hinblick auf ihre klinischen Einsatzmöglichkeiten erzielen.

Abstract

Locoregional hyperthermia includes local hyperthermia (heat treatment of superficial tumours, e.g., recurrent breast cancer on the thoracic wall), regional hyperthermia (treatment of larger volumes like the pelvis for intrapelvic tumours) and interstitial hyperthermia (heating electrodes are introduced within the tumour tissue). At present, the application of scientifically verified hyperthermia in Germany is carried out within the scope of controlled studies, or in cooperation with the Netherlands. Evidence for a beneficial effect comes from randomised studies in patients with recurrent breast cancer in previously irradiated areas (in combination with re-irradiation) and in patients with cervical carcinoma (in combination with primary radiotherapy). Preliminary results in patients with advanced vaginal carcinoma (FIGO stage II > 4 cm and FIGO stage III) suggest that also in these patients the results are better when radiotherapy is combined with hyperthermia. Further evidence of the efficacy of hyperthermia has to come from ongoing studies. One study compares radiotherapy plus hyperthermia with radiotherapy plus cisplatin, another study compares radiotherapy plus cisplatin with trimodality treatment, both in patients with cervical cancer FIGO stages I B - IV A. A phase II study investigates the results of magnetic fluid hyperthermia combined with interstitial radiotherapy in patients with inoperable local tumour recurrence. Further progress will come from experimental studies on tumour targeting approaches.

Schlüsselwörter

Hyperthermie - Zervixkarzinom - Mammakarzinom - Vaginalkarzinom

Key words

hyperthermia - cervical cancer - breast cancer - vaginal cancer

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