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Radiochemotherapie des Zervixkarzinoms

Chemoradiation in cervical cancer

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Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Die primäre kombinierte Radiochemotherapie (RCT) ist Standard bei lokal fortgeschrittenen und/oder nodal positiven Zervixkarzinomen. Die limitierte Genauigkeit bildgebender Verfahren bedingt zu hohe Raten an postoperativer adjuvanter RCT. Diese sog. trimodale Therapie führt zur Verdopplung chronischer therapiebedingter Nebenwirkungen im Vergleich zu RCT allein. Durch chirurgisches Staging vor Therapie kann eine Unter- wie Überbehandlung eher vermieden werden.

Material und Methoden

In einer Literaturrecherche wurden v. a. Publikationen mit Einfluss auf klinische Therapieentscheidungen berücksichtigt.

Ergebnisse

Für optimale Therapieergebnisse muss die RCT aus einer Kombination von perkutaner und Brachytherapie mit einer biologisch äquivalenten Dosis (EQD2Gy, „equivalent dose in 2 Gy“) tumorumschließend von 80–85 Gy bestehen. Die simultane Chemotherapie mit Cisplatin mono besteht aus 5–6 wöchentlichen Gaben von 40 mg/m2 Körperoberfläche (KOF). Eine Therapiedauer von <11, besser nicht mehr als 8 Wochen (56 Tage) hat Einfluss auf die lokale Kontrolle. Die Ergebnisse in erfahrenen Zentren mit mindestens 28 primären RCT/Jahr sind denen mit geringeren Patientenzahlen überlegen. Eine routinemäßige Hysterektomie nach einer lege artis durchgeführten RCT ist nicht indiziert. Dagegen profitieren Patientinnen mit nachgewiesenem positivem Restbefund von einer „Salvage‑/Rescue-Hysterektomie“.

Schlussfolgerung

Die cisplatinbasierte RCT ist die Standardtherapie für lokal fortgeschrittene Zervixkarzinome. Für bestmögliche onkologische Ergebnisse ist die perkutane Strahlentherapie plus Brachytherapie plus simultane Chemotherapie in einer Gesamttherapiedauer von <56 Tagen entscheidend. Diese Therapie sollte in Zentren mit entsprechender Erfahrung multidisziplinärer Teams erfolgen.

Abstract

Background

Primary chemoradiation therapy (CRT) remains the standard for locally advanced and/or lymph node-positive cervical cancer. Due to the limited accuracy of radiologic imaging, there is an unacceptably high rate of postoperative adjuvant CRT. This tri-modality treatment doubles chronic therapy-related toxicity compared to CRT alone. Surgical staging prior to treatment can avoid under- and overtreatment.

Materials and methods

In a literature review of publications mainly focusing on potentially practice-changing data was performed.

Results

For optimal results, CRT must comprise percutaneous and brachytherapy with a biologically effective dose (EQD2Gy) of 80–85 Gy to the tumor. Simultaneous chemotherapy consists of 5–6 weekly doses of cisplatin 40 mg/body surface area (BSA). Treatment duration should not exceed 8 weeks (56 days), and has an influence on local control. Outcomes in experienced centers with at least 28 CRT/year are superior to those with smaller numbers of patients. There is no indication for routine hysterectomy after state-of-the-art chemoradiation. In contrast, patients with histologically confirmed residual tumor might benefit from salvage (rescue) hysterectomy.

Conclusion

Cisplatin-based CRT is standard of care treatment for locally advanced cervical cancer. For the best possible oncologic results, external beam radiation plus brachytherapy plus simultaneous chemotherapy in an overall treatment time of <56 days is crucial. This therapy should be performed in high volume centers by an experienced, interdisciplinary team.

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Authors and Affiliations

  1. Klinik für Radioonkologie, CyberKnife und Strahlentherapie, Universität Köln, Med. Fakultät, Kerpener Str. 62, 50937, Köln, Deutschland

    Simone Marnitz, Till Waltar & Jan Herter

  2. CIO Centrum für Integrierte Onkologie Köln-Bonn, Köln-Bonn, Deutschland

    Simone Marnitz, Till Waltar & Jan Herter

  3. Zentrum für Molekulare Medizin Köln, Universität zu Köln, Köln, Deutschland

    Jan Herter

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  1. Simone Marnitz
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Correspondence to Simone Marnitz.

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Interessenkonflikt

S. Marnitz, T. Waltar und J. Herter geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Marnitz, S., Waltar, T. & Herter, J. Radiochemotherapie des Zervixkarzinoms. Onkologe 26, 606–615 (2020). https://doi.org/10.1007/s00761-020-00758-x

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