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Management von Borderlinetumoren des Ovars (BOT)

Management of borderline ovarian tumours

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Zusammenfassung

Borderlinetumoren des Ovars (BOT) sind definiert als Geschwülste, die einige, aber nicht alle Charakteristika maligner Ovarialtumoren aufweisen. Das wesentliche Kennzeichen ist das Fehlen einer destruktiven Stromainvasion. Das Ovarialkarzinom wird meist im Stadium III/IV, BOT meist im Stadium I/II diagnostiziert. Die 15-Jahre-Gesamtüberlebensrate liegt im Stadium I bei 99% und fällt im Stadium III auf 30–50%. Häufig werden bei BOT so genannte Peritonealimplantate beschrieben, die in 70–80% mit primären Proliferaten an der äußeren Oberfläche auftreten. Bei Implantaten ist relevant, um welchen Typ es sich handelt. Meist werden nichtinvasive Implantate beobachtet. Bei 6–10% der Patientinnen treten jedoch invasive Implantate auf, die mit einer erheblich schlechteren Überlebensrate assoziiert sind. Die Therapie ist eng am klinischen Management des Ovarialkarzinoms orientiert und verfolgt das definitive „Staging“, die vollständige bzw. maximale Tumorreduktion. Da häufig junge Frauen betroffen sind, ist dem Kinderwunsch beim operativen Vorgehen Rechnung zu tragen. Eine systematische Lymphonodektomie bei unauffälligen Lymphknoten kann nicht empfohlen werden. Eine Indikation zur adjuvanten Therapie besteht in der Regel nicht. Von einigen Autoren wird bei postoperativem Tumorrest oder Rezidiv eine platinhaltige Chemotherapie empfohlen. Die Nachsorge sollte lebenslang erfolgen.

Abstract

Borderline ovarian tumours (BOT) are defined as growths that have some, but not all, characteristics of malignant ovarian tumours. The decisive characteristic is the lack of a destructive invasion of the stroma. In most cases, ovarian carcinoma is in stage III/IV when diagnosed, while most BOT are diagnosed in stage I/II. The overall 15-year survival rate is around 99% for BOT diagnosed in stage I/II, falling to 30–50% for those diagnosed in stage III. In the presence of BOT, so-called peritoneal implants are frequently described, which are found at the outer surface with primary proliferations in 70–80% of cases. When implants are found it is important to determine their nature. Most implants are noninvasive, but in 6–10% of patients they are invasive, substantially lowering the survival rate. The therapy leans heavily on the clinical management of ovarian carcinoma and is directed at definitive staging, i.e. complete or maximum debulking. As the women affected are often young, it is essential to take account of any desire for children when surgery is planned and carried out. Routine performance of lymphadenectomy even when the lymph nodes are unremarkable cannot be recommended. As a rule no adjuvant therapy is indicated. Some authors recommend platinum-containing chemotherapy if residual tumour persists after surgery or in the case of recurrence. After-care should continue to the end of each patient’s life.

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  1. Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Charité, Campus Virchow-Klinikum, Berlin

    J. Sehouli & W. Lichtenegger

  2. Klinik für Pathologie, Universitätsklinikum Charité, Campus Mitte, Berlin

    C. Denkert & M. Dietel

  3. Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 , Berlin

    J. Sehouli

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  1. J. Sehouli
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Sehouli, J., Denkert, C., Dietel, M. et al. Management von Borderlinetumoren des Ovars (BOT). Onkologe 11, 1127–1138 (2005). https://doi.org/10.1007/s00761-005-0955-9

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