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Diagnostisches und therapeutisches Vorgehen bei Morbus Hodgkin

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Zusammenfassung

Die Prognose des M.Hodgkin läßt sich durch ein besseres Verständnis der Erkrankung und durch die darauf basierenden neuen Behandlungsmethoden wesentlich günstiger gestalten. Die neuen Vorstellungen über die Pathogenese der Erkrankung beruhen insbesondere auf der histologischen Klassifizierung nachLukes sowie auf der Kenntnis des Ausbreitungsmusters der verschiedenen histologischen Formen, was wiederum nur durch den häufigen Einsatz der explorativen Laparotomie und Splenektomie ermöglicht wurde. Voraussetzung für eine optimale Behandlung des einzelnen Hodgkin-Kranken ist eine exakte Bestimmung des klinischen Ausbreitungsstadiums der Erkrankung, welches entsprechend den Vorschlägen von Rye oder Ann Arbor einem von vier Stadien zuzuordnen ist; dies hat in einigen Fällen eine Laparotomie und Splenektomie zur Voraussetzung. Ist das Krankheitsstadium auf Lymphknotenregionen und Milz beschränkt, so ist in der Regel eine ausgedehnte Megavolt-Bestrahlung indiziert, bei Organbefall Kombinationen verschiedener Zytostatika. Während die mittlere überlebenszeit unbehandelter Hodgkin-Patienten weniger als 2 Jahre beträgt, können heute über 50% der Kranken mehr als 5 Jahre ein weitgehend normales Leben führen, ohne ein Rezidiv ihrer Erkrankung erleben zu müssen. Wieviele dieser Patienten als endgültig geheilt zu betrachten sind, muß die Zukunft zeigen. Das Schicksal der Hodgkin-Patienten wird ganz wesentlich von der Qualität der Erstbehandlung bestimmt, welche deshalb in Zentren durchgeführt werden sollte, die sich intensiv mit den Problemen des M.Hodgkin auseinandersetzen.

Summary

Prognosis ofHodgkins disease can be improved essentially by the better understanding of the pathogenesis and by a treatment taking this into consideration. The new ideas about the pathogenesis ofHodgkins disease are based on the histological classification ofLukes and on the knowledge of the mode of spread of various histological forms made possible through the repeated use of explorative laparotomy and splenectomy.

The prerequisite for an optimal treatment of the individual stricken withHodgkins disease is an exact determination of the clinical propagation-stage of the disease, which, according to the suggestions of Rye or Ann Arbor, is to be classified in one of four stages; this has in some cases, a laparotomy and splenectomy as prerequisite. Is the extent of the disease limited to lymph node regions and the spleen, an extended megavolt irradiation is usually indicated; in the case of organic involvement, combinations of various cytostatic drugs are indicated. Whereas the average survival time of untreatedHodgkin patients is less than 2 years, today over 50% of the stricken can lead a nearly normal life for more than 5 years without suffering a relapse of their disease.

How many of these patients can be considered fully cured is still an open extent dependent on the quality of the initial treatment which, for this reason, should be carried out in centers dealing intensively with the problems of MorbusHodgkin.

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  1. Dieter Huhn

    Present address: Institut für Hämatologie der Gesellschaft für Strahlen- und Umweltforschung, Assoziation mit EURATOM, Ziemssenstraße 1 A, München

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  1. Lehrstuhl für Hämatologie, I. Medizinischen Klinik der Universität München, München

    Dieter Huhn & Christoph Steidle

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Studie im Rahmen der, Assoziation Hämatologie-EURATOM-GSF Nr. 031-64/I BIAD.

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Huhn, D., Steidle, C. Diagnostisches und therapeutisches Vorgehen bei Morbus Hodgkin. Blut 27, 105–130 (1973). https://doi.org/10.1007/BF01632001

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