Der Urologe

, Volume 52, Issue 11, pp 1547–1555 | Cite as

Update Erstlinien- und Rezidivchemotherapie beim Hodentumor

Leitthema
First Online:

Zusammenfassung

Keimzelltumoren bleiben mit steigender Inzidenz auch aktuell die häufigste Tumorerkrankung des Mannes im Alter zwischen 20 und 45 Jahren. Die konsequente Anwendung stadiengerecht durchgeführter Therapiekonzepte hat dadurch zu einer Heilungsrate von etwa 88 % über alle Tumorstadien hinweg geführt. Dabei sind der Einsatz von Chirurgie, Strahlentherapie und Chemotherapie, die Auswahl der erforderlichen Medikamente sowie die Art und Dauer ihrer Anwendung durch internationale Konsensusempfehlungen genau festgelegt. Diese orientieren sich an der Histologie, am jeweiligen Tumorstadium und am Vorhandensein bekannter und gut untersuchter Risikofaktoren. Diese strikten Vorgaben sollen sicherstellen, dass für jeden Patienten die optimale Heilungschance mit der für ihn am wenigsten belastenden Therapie erzielt wird.

In der Primärtherapie früher und lokal begrenzter Tumorstadien bedeutet dies eine sorgfältige Abwägung zwischen den Nebenwirkungen einer oft nur adjuvanten Therapie und der zu erwartenden Rezidivgefahr gegenüber einer alleinigen Nachsorgestrategie. Für die weiter fortgeschrittenen metastasierten Tumorstadien bedeutet dies die Entscheidung für die optimale Sequenz von Chemotherapie, Operation oder Bestrahlung. Eine besondere Herausforderung stellen Therapieentscheidungen bei den seltenen Rezidiven nach primärer Chemotherapie dar. In diesem klinischen Kontext ist eine an Prognosefaktoren orientierte, risikoadaptierte Vorgehensweise von besonderer Bedeutung. Auch hier muss die höhere Rate an Therapieversagen gegenüber den meist toxischen Therapiekonzepten sorgfältig abgewogen werden.

Die Vernachlässigung anerkannter Therapiestandards in der Behandlung von Patienten mit Keimzelltumoren führt sowohl in der Primär- als auch in der Rezidivtherapie zu einer höheren Rate an Therapieversagen mit der Notwendigkeit von Folgetherapien oder oft sogar auch mit dem Tod eines Patienten. Noch immer sterben in Deutschland Patienten an Keimzelltumoren, ohne dass sie jemals eine Chance auf eine adäquat durchgeführte Therapie hatten.

Schlüsselwörter

Chemotherapie Rezidiv Salvagetherapie Residualtumorresektion Keimzelltumor 

Update on first-line and relapse chemotherapy for testicular cancer

Abstract

Germ-cell cancer (GCC) is still the most common cancer diagnosis in men between the ages of 20 and 45 years with an increasing incidence. Due to effective and standardized algorithms that have been developed to stratify patients into different risk groups, remarkable progress has been made in the medical treatment of testicular cancer with an overall cure rate of 88%. The application of surgery, radiotherapy and chemotherapy, the choice of chemotherapy agents as well as treatment duration is defined in international consensus guidelines. The guidelines are based on histology, tumor stages and presence or absence of already known and well-established risk factors. These stringent parameters guarantee the optimal curative treatment options for each GCC patient and can avoid overtreatment as well as undertreatment.

For patients with early stage disease, careful consideration between possible side effects due to an adjuvant therapy and the expected relapse rate must be made, whereas in advanced tumor stages the optimal sequence of chemotherapy, surgery and radiotherapy is the focus. In patients who progress or relapse after first-line therapy, the issue of optimal treatment represents a particular challenge and is far more complex. It needs to take into account the analysis of special prognostic variables for a further risk-tailored therapy. A careful weighting between the chosen regimen and the often higher rate of treatment failure in contrast to increased toxic side-effects is mandatory.

The disregard of accurate risk stratification and application of accepted treatment standards for patients with GCC at the time of initial diagnosis or at relapse is associated with developing more extensive disease and more intensive treatment. It also results in lower cure rates with the need for further therapy or leads to death of the patient without ever having had a chance for cure.

Keywords

Chemotherapy Recurrence Salvage therapy Residual tumor resection Germ-cell cancer 
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Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt. A. Lorch und P. Albers geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Bereich Konservative Urologische Onkologie, Klinik für UrologieUniversitätsklinikum DüsseldorfDüsseldorfDeutschland

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