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Multimodale Therapiekonzepte von Keimzelltumoren

A multi-disciplinary approach to the treatment of germ cell tumors

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Zusammenfassung

Die Therapie von Keimzelltumoren erfolgt stadienspezifisch und risikoadaptiert. Seminome im Stadium I können mit aktiver Surveillance, adjuvanter Carboplatinmonotherapie oder einer adjuvanten Radiotherapie behandelt werden. Seminome im Stadium IIA werden bestrahlt, im Stadium IIB sind Radiotherapie oder primäre Chemotherapie gleichwertige Alternativen. Seminome im Stadium IIC bzw. III erhalten 3(–4) Zyklen PEB (Cisplatin, Etoposid, Bleomycin). Bei Nichtseminomen im Stadium I erhöht sich das Rezidivrisiko bei Nachweis einer Gefäßinvasion von 20% auf nahezu 50%. Ohne Gefäßinvasion wird eine aktive Surveillance, bei Gefäßinvasion eine adjuvante Chemotherapie mit 1(–2) Zyklen PEB empfohlen. Die Therapie metastasierter Nichtseminome erfordert je nach IGCCCG-Prognosegruppe die Applikation von 3 („good prognosis“) bis 4 („intermediate/poor prognosis“) Zyklen PEB. Eine schlechte Prognose weisen Patienten mit Nichtseminom und einem mediastinalen Primärtumor und/oder Leber-, ZNS- oder Knochenmetastasen oder inadäquatem Tumormarkerabfall auf. In diesen Fällen sollte eine Therapieintensivierung erwogen werden. Komplizierte Fälle müssen in Zentren von Experten interdisziplinär behandelt werden.

Abstract

The management of patients with germ cell tumors must be based upon complete staging and should be risk-adapted. Seminoma stage I can be managed by either active surveillance, adjuvant carboplatin therapy, or radiotherapy. Seminoma stage IIA should receive radiotherapy, stage IIB can be managed with either radiotherapy or chemotherapy. Seminoma stage IIC and III are treated with three (to four) cycles of PEB (cisplatin, etoposide, bleomycin). Nonseminoma stage I should be managed by either active surveillance or adjuvant chemotherapy with one (to two) cycles of PEB, based upon the risk factor vascular invasion. Treatment of advanced nonseminoma consists of either 3 or 4 cycles of PEB and must be guided by the IGCCCG prognostic subgroup. Prognosis is particularly poor in patients with either primary mediastinal nonseminoma, and/or metastases to liver, brain or bone, or inadequate tumor marker decline. In these cases, intensification of therapy with high dose chemotherapy can be justified. Complex cases with poor prognosis and all patients with relapsed disease should exclusively be treated by experts in a tertiary care setting to achieve highest possible cure rates in these young patients.

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Authors and Affiliations

  1. Onkologisches Zentrum, II. Medizinische Klinik und Poliklinik, Hubertus Wald Tumorzentrum, Universitäres Cancer Center Hamburg UCCH, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland

    F. Honecker & C. Bokemeyer

  2. Klinik für Radioonkologie/MVZ, Universitätsklinikum Tübingen, Tübingen, Deutschland

    R. Souchon

  3. Urologische Klinik, Krankenhaus Maria-Hilf, Krefeld, Deutschland

    S. Krege

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  1. F. Honecker
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  2. R. Souchon
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  3. S. Krege
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  4. C. Bokemeyer
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Correspondence to F. Honecker.

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Honecker, F., Souchon, R., Krege, S. et al. Multimodale Therapiekonzepte von Keimzelltumoren. Internist 51, 1382–1387 (2010). https://doi.org/10.1007/s00108-010-2675-5

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  • DOI: https://doi.org/10.1007/s00108-010-2675-5

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