gynäkologie + geburtshilfe

, Volume 17, Issue 3, pp 21–27 | Cite as

Diagnostik und Therapie des Ovarialkarzinoms

State of the art
  • Florian Heitz
  • Philipp Harter
  • Andreas du Bois
Fortbildung
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Für die primäre Therapie des Ovarialkarzinoms gibt es gut evaluierte Therapiestrategien, welche von der Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) – Organkommission Ovar als Leitlinie publiziert werden. Eine hohe Leitlinienadhärenz führt bei Patientinnen mit Ovarialkarzinom zu längerer Rezidivfreiheit und verlängertem Überleben. Auch für die Second- und Third-Line-Therapie gibt es Evidenz, dass eine State-of-the-Art-Therapie den Krankheitsverlauf günstig beeinflusst. Die wichtigsten Aspekte der leitlinienbasierten Therapie und aktuelle Fragestellungen – wie Stellenwert der „neoadjuvanten“ Therapie oder Optimierung der First-Line-Therapie durch antiangiogene Substanzen – werden nachfolgend diskutiert.

Literatur

  1. 1.
    Robert-Koch Institut. Krebs in Deutschland 2005/2006-Häufigkeiten und Trends. 7. Ausgabe (2010).Google Scholar
  2. 2.
    Choi M, Fuller CD, Thomas CR, Jr., Wang SJ. Conditional survival in ovarian cancer: results from the SEER dataset 1988-2001. Gynecologic oncology, 109(2), 203–209 (2008).PubMedCrossRefGoogle Scholar
  3. 3.
    Kommission Ovar der AGO e.v. Empfehlungen für die Diagnostik und Therapie maligner Ovarialtumoren. (2011)Google Scholar
  4. 4.
    du Bois A, Rochon J, Lamparter C, Pfisterer J. [The Quality Assurance Program of the AGO Organkommission OVAR (QS-OVAR): Pattern of Care and Reality in Germany 2001]. Zentralblatt fur Gynakologie, 127(1), 9–17 (2005).PubMedCrossRefGoogle Scholar
  5. 5.
    Trimbos JB, Vergote I, Bolis G et al. Impact of adjuvant chemotherapy and surgical staging in early-stage ovarian carcinoma: European Organisation for Research and Treatment of Cancer-Adjuvant ChemoTherapy in Ovarian Neoplasm trial. Journal of the National Cancer Institute, 95(2), 113–125 (2003)PubMedCrossRefGoogle Scholar
  6. 6.
    Timmers PJ, Zwinderman AH, Coens C, Vergote I, Trimbos JB. Understanding the problem of inadequately staging early ovarian cancer. Eur J Cancer, 46(5), 880–884 (2010)PubMedCrossRefGoogle Scholar
  7. 7.
    Heitz F, Ognjenovic D, Harter P et al. Abdominal wall metastases in patients with ovarian cancer after laparoscopic surgery: incidence, risk factors, and complications. Int J Gynecol Cancer, 20(1), 41–46 (2010)PubMedCrossRefGoogle Scholar
  8. 8.
    Grabowski JP, Harter P, Buhrmann C et al. Re-operation outcome in patients referred to a gynecologic oncology center with presumed ovarian cancer FIGO I-IIIA after sub-standard initial surgery. Surgical oncology. Sep 27. [Epub ahead of print] (2010)Google Scholar
  9. 9.
    Trimbos JB, Schueler JA, van Lent M, Hermans J, Fleuren GJ. Reasons for incomplete surgical staging in early ovarian carcinoma. Gynecologic oncology, 37(3), 374–377 (1990)PubMedCrossRefGoogle Scholar
  10. 10.
    Trimbos B, Timmers P, Pecorelli S et al. Surgical staging and treatment of early ovarian cancer: long-term analysis from a randomized trial. Journal of the National Cancer Institute, 102(13), 982–987 (2010)PubMedCrossRefGoogle Scholar
  11. 11.
    Colombo N, Guthrie D, Chiari S et al. International Collaborative Ovarian Neoplasm trial 1: a randomized trial of adjuvant chemotherapy in women with early-stage ovarian cancer. Journal of the National Cancer Institute, 95(2), 125–132 (2003)PubMedCrossRefGoogle Scholar
  12. 12.
    Chan JK, Tian C, Teoh D et al. Survival after recurrence in early-stage high-risk epithelial ovarian cancer: a Gynecologic Oncology Group study. Gynecologic oncology, 116(3), 307–311 (2010)PubMedCrossRefGoogle Scholar
  13. 13.
    Axtell AE, Lee MH, Bristow RE et al. Multi-institutional reciprocal validation study of computed tomography predictors of suboptimal primary cytoreduction in patients with advanced ovarian cancer. J Clin Oncol, 25(4), 384–389 (2007).PubMedCrossRefGoogle Scholar
  14. 14.
    Qayyum A, Coakley FV, Westphalen AC, Hricak H, Okuno WT, Powell B. Role of CT and MR imaging in predicting optimal cytoreduction of newly diagnosed primary epithelial ovarian cancer. Gynecologic oncology, 96(2), 301–306 (2005).PubMedCrossRefGoogle Scholar
  15. 15.
    Risum S, Hogdall C, Loft A et al. Prediction of suboptimal primary cytoreduction in primary ovarian cancer with combined positron emission tomography/computed tomography—a prospective study. Gynecologic oncology, 108(2), 265–270 (2008).PubMedCrossRefGoogle Scholar
  16. 16.
    Fagotti A, Ferrandina G, Fanfani F et al. Prospective validation of a laparoscopic predictive model for optimal cytoreduction in advanced ovarian carcinoma. American journal of obstetrics and gynecology, 199(6), 642 e641–646 (2008).CrossRefGoogle Scholar
  17. 17.
    Vergote I, Trope CG, Amant F et al. Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. The New England journal of medicine, 363(10), 943–953 (2010).PubMedCrossRefGoogle Scholar
  18. 18.
    Sehouli J, Wagner U, Martin P, du Bois A. Neoadjuvante Chemotherapie kann nicht als Standardtherapie beim Ovarialkarzinom angesehen werden. AGO homepage, (2011).Google Scholar
  19. 19.
    du Bois A, Reuss A, Pujade-Lauraine E, Harter P, Ray-Coquard I, Pfisterer J. Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: a combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials: by the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR) and the Groupe d’Investigateurs Nationaux Pour les Etudes des Cancers de l’Ovaire (GINECO). Cancer, 115(6), 1234–1244 (2009).PubMedCrossRefGoogle Scholar
  20. 20.
    Eisenhauer EL, Abu-Rustum NR, Sonoda Y, Aghajanian C, Barakat RR, Chi DS. The effect of maximal surgical cytoreduction on sensitivity to platinum-taxane chemotherapy and subsequent survival in patients with advanced ovarian cancer. Gynecologic oncology, 108(2), 276–281 (2008).PubMedCrossRefGoogle Scholar
  21. 21.
    du Bois A, Harter P. Understanding and optimizing the potential role of surgical debulking in advanced epithelial ovarian cancer. J Clin Oncol, Ed book, e13–e17 (2010).Google Scholar
  22. 22.
    Harter P, Muallem ZM, Buhrmann C et al. Impact of a structured quality management program on surgical outcome in primary advanced ovarian cancer. Gynecologic oncology, [Epub ahead of print] (2011).Google Scholar
  23. 23.
    Kommoss S, Rochon J, Harter P et al. Prognostic impact of additional extended surgical procedures in advanced-stage primary ovarian cancer. Annals of surgical oncology, 17(1), 279–286 (2010).CrossRefGoogle Scholar
  24. 24.
    Wimberger P, Wehling M, Lehmann N et al. Influence of residual tumor on outcome in ovarian cancer patients with FIGO stage IV disease: an exploratory analysis of the AGO-OVAR (Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group). Annals of surgical oncology, 17(6), 1642–1648) (2010).CrossRefGoogle Scholar
  25. 25.
    Chan JK, Urban R, Hu JM et al. The potential therapeutic role of lymph node resection in epithelial ovarian cancer: a study of 13918 patients. British journal of cancer, 96(12), 1817–1822 (2007).CrossRefGoogle Scholar
  26. 26.
    du Bois A, Reuss A, Harter P, Pujade-Lauraine E, Ray-Coquard I, Pfisterer J. Potential role of lymphadenectomy in advanced ovarian cancer: a combined exploratory analysis of three prospectively randomized phase III multicenter trials. J Clin Oncol, 28(10), 1733–1739 (2010).CrossRefGoogle Scholar
  27. 27.
    Aletti GD, Dowdy S, Podratz KC, Cliby WA. Role of lymphadenectomy in the management of grossly apparent advanced stage epithelial ovarian cancer. American journal of obstetrics and gynecology, 195(6), 1862–1868 (2006).CrossRefGoogle Scholar
  28. 28.
    Panici PB, Maggioni A, Hacker N et al. Systematic aortic and pelvic lymphadenectomy versus resection of bulky nodes only in optimally debulked advanced ovarian cancer: a randomized clinical trial. Journal of the National Cancer Institute, 97(8), 560–566 (2005).CrossRefGoogle Scholar
  29. 29.
    du Bois A, Luck HJ, Meier W et al. A randomized clinical trial of cisplatin/paclitaxel versus carboplatin/paclitaxel as first-line treatment of ovarian cancer. Journal of the National Cancer Institute, 95(17), 1320–1329 (2003).CrossRefGoogle Scholar
  30. 30.
    Burger R, Bradley MF, Bookman MA et al. Incorporation of Bevacizumab in the Primary Treatment of Ovarian Cancer. The New England Journal of Medicine, 365:2473–83 (2011).PubMedCrossRefGoogle Scholar
  31. 31.
    Perren TJ, Swart AM, Pfisterer, J et al. A Phase 3 Trial of Bevacizumabin Ovarian Cancer The New England Journal of Medicine, 365:2484–96 (2011).Google Scholar
  32. 32.
    Heitz F, Harter P, Heitz J et al. Antiangiogene Ansätze in der Therapiedes Ovarialkarzinoms. Geburtsh Frauenheilk, 70: 791–797 (2010).CrossRefGoogle Scholar
  33. 33.
    Rustin GJ, van der Burg ME, Griffin CL et al. Early versus delayed treatment of relapsed ovarian cancer (MRC OV05/EORTC 55955): a randomised trial. Lancet, 376(9747), (1155–1163) (2011).CrossRefGoogle Scholar
  34. 34.
    Markman M. PET/CT scans in ovarian cancer: prognostic versus predictive utility? Minerva medica, 100(5), 415–420 (2009).PubMedGoogle Scholar
  35. 35.
    Harter P, du Bois A, Hahmann M et al. Surgery in recurrent ovarian cancer: the Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) DESKTOP OVAR trial. Annals of surgical oncology, 13(12), 1702–1710 (2006).PubMedCrossRefGoogle Scholar
  36. 36.
    Harter P, Sehouli J, Reuss A et al. Prospective validation study of a predictive score for operability of recurrent ovarian cancer: the Multicenter Intergroup Study DESKTOP II. A project of the AGO Kommission OVAR, AGO Study Group, NOGGO, AGO-Austria, and MITO. Int J Gynecol Cancer, 21(2), 289–295 (2011).PubMedCrossRefGoogle Scholar
  37. 37.
    Makrilia N, Syrigou E, Kaklamanos I, Manolopoulos L, Saif MW. Hypersensitivity reactions associated with platinum antineoplastic agents: a systematic review. Metal-based drugs, (2011).Google Scholar
  38. 38.
    Gomez R, Harter P, Luck HJ et al. Carboplatin hypersensitivity: does introduction of skin test and desensitization reliably predict and avoid the problem? A prospective single-center study. Int J Gynecol Cancer, 19(7), 1284–1287 (2009).PubMedCrossRefGoogle Scholar
  39. 39.
    Parmar MK, Ledermann JA, Colombo N et al. Paclitaxel plus platinum-based chemotherapy versus conventional platinum-based chemotherapy in women with relapsed ovarian cancer: the ICON4/AGO-OVAR-2.2 trial. Lancet, 361(9375), 2099–2106 (2003).PubMedCrossRefGoogle Scholar
  40. 40.
    Pfisterer J, Plante M, Vergote I et al. Gemcitabine plus carboplatin compared with carboplatin in patients with platinum-sensitive recurrent ovarian cancer: an intergroup trial of the AGO-OVAR, the NCIC CTG, and the EORTC GCG. J Clin Oncol, 24(29), 4699–707 (2006).PubMedCrossRefGoogle Scholar
  41. 41.
    Pujade-Lauraine E, Wagner U, Aavall-Lundqvist E et al. Pegylated liposomal Doxorubicin and Carboplatin compared with Paclitaxel and Carboplatin for patients with platinum-sensitive ovarian cancer in late relapse. J Clin Oncol, 28(20), 3323–3329 (2010).PubMedCrossRefGoogle Scholar
  42. 42.
    Marth C, Alexandre J, Hanker L et al. Pegylated liposomal doxorubicin and carboplatin versus paclitaxel and carboplatin in platinum-sensitive ovarian cancer patients: Treatment at recurrence and overall survival final analysis from CALYPSO phase III GCIG trial. J Clin Oncol, 29 (supp.) (2011).Google Scholar
  43. 43.
    Aghajanian C, Blank SV, Goff BA, Judson PL, Teneriello MG, Husain A, Sovak MA, Yi J, Nycum LR. OCEANS: A randomized, double-blinded, placebo-controlled phase III trial of chemotherapy with or without bevacizumab (BEV) in patients with platinum-sensitive recurrent epithelial ovarian (EOC), primary peritoneal (PPC), or follopian tube cancer (FTC). J Clin Oncol 2012 Apr 23 (Epub ahead of print)Google Scholar
  44. 44.
    Meier W, du Bois A, Reuss A et al. Topotecan versus treosulfan, an alkylating agent, in patients with epithelial ovarian cancer and relapse within 12 months following 1st-line platinum/paclitaxel chemotherapy. A prospectively randomized phase III trial by the Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group (AGO-OVAR). Gynecologic oncology, 114(2), 199–205 (2009).Google Scholar
  45. 45.
    ten Bokkel HW, Gore M, Carmichael J et al. Topotecan versus paclitaxel for the treatment of recurrent epithelial ovarian cancer. J Clin Oncol, 15(6):2183–93 (1997).Google Scholar
  46. 46.
    Gordon AN, Fleagle JT, Guthrie D, Parkin DE, Gore ME, Lacave AJ. Recurrent epithelial ovarian carcinoma: a randomized phase III study of pegylated liposomal doxorubicin versus topotecan. J Clin Oncol, 19(14), 3312–3322 (2001).PubMedGoogle Scholar
  47. 47.
    Burger RA, Sill MW, Monk BJ, Greer BE, Sorosky JI. Phase II trial of bevacizumab in persistent or recurrent epithelial ovarian cancer or primary peritoneal cancer: a Gynecologic Oncology Group Study. J Clin Oncol, 25(33), 5165–5171 (2007).PubMedCrossRefGoogle Scholar
  48. 48.
    Cannistra SA, Matulonis UA, Penson RT et al. Phase II study of bevacizumab in patients with platinum-resistant ovarian cancer or peritoneal serous cancer. J Clin Oncol, 25(33), 5180–5186 (2007).PubMedCrossRefGoogle Scholar
  49. 49.
    Garcia AA, Hirte H, Fleming G et al. Phase II clinical trial of bevacizumab and low-dose metronomic oral cyclophosphamide in recurrent ovarian cancer: a trial of the California, Chicago, and Princess Margaret Hospital phase II consortia. J Clin Oncol, 26(1), 76–82 (2008).PubMedCrossRefGoogle Scholar

Copyright information

© Urban & Vogel 2012

Authors and Affiliations

  • Florian Heitz
    • 1
  • Philipp Harter
  • Andreas du Bois
  1. 1.Klinik für Gynäkologie und gynäkologische OnkologieKliniken Essen-Mitte, evangel. Huyssens-Stiftung/Knappschaft GmbHEssenDeutschland

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