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Diagnostik und Therapie seminomatöser Hodentumoren

Diagnostics and treatment of seminomatous germ cell tumors

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Zusammenfassung

Gegenwärtig sind, mit zunehmender Tendenz, etwa 60% der neu diagnostizierten Hodentumoren in Deutschland Seminome. In den niedrigen Tumorstadien liegt das Augenmerk auf dem Vermeiden von Übertherapie. Für das Seminom betrifft diese Diskussion sowohl das Stadium I, wo die Therapievarianten Radiatio, Carboplatinmono und Surveillance zur Verfügung stehen, wie auch das Stadium IIA/B. Die Radiatio des Retroperitonealraums ist aufgrund der hohen Spättoxizität bei jungen Patienten im klinischen Stadium I nicht zu empfehlen und wird im klinischen Stadium IIA/B, in der gegenwärtig durchgeführten Form, kritisch hinterfragt. Ursache für diesen Paradigmenwechsel ist der hohe Prozentsatz von Zweitmalignomen nach Radiatio des Retroperitoneums. Zudem ist bei alleiniger Strahlentherapie im klinischen Stadium IIA/B in 10–25% der Fälle ein Rezidiv außerhalb des Bestrahlungsfelds zu erwarten. Aus diesem Grund wird gegenwärtig untersucht, ob durch die Kombination von neoadjuvanter Carboplatinmonotherapie plus Radiatio mit eingeschränktem Bestrahlungsfeld die Toxizität ohne Einschränkung der Heilungsrate reduziert werden kann. Bei Residualtumoren größer 3 cm im Querdurchmesser sollte mit einem Abstand von mehr als 6 Wochen zur vorangegangenen Chemotherapie ein FDG-PET-CT durchgeführt werden. Bei positivem Befund muss das weitere Vorgehen nach interdisziplinärer Diskussion des Falls individuell festgelegt werden.

Abstract

Currently, seminomas account for about 60% of newly diagnosed testicular cancers in Germany, with an increasing trend. In lower tumor stages the main focus is on the avoidance of over therapy. This is of special interest in stage I where radiotherapy, carboplatin monotherapy and surveillance are available therapies as well as in stage IIA/B. Due to high late toxicity, radiotherapy of the retroperitoneal space is obsolete for young patients with clinical stage I and, in its present form, discussed controversially for patients with clinical stage IIA/B. The cause for this paradigm shift is the high percentage of secondary malignancies resulting after radiotherapy of the retroperitoneal space. Furthermore, 10–25% of the patients receiving radiotherapy alone for clinical stage IIA/B seminoma suffer from a relapse of the disease due to tumor recurrence in extraregional lymph nodes. Therefore, an ongoing study is investigating if a combined treatment with neoadjuvant carboplatin and radiotherapy with a limited target volume can reduce toxicity without jeopardizing the cure rate. Patients with residual tumors >3 cm should undergo 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) computed tomography scanning after a minimum interval of 6 weeks after chemotherapy. In the case of a positive FDG-PET-CT result, the further therapeutic strategy should be the subject of interdisciplinary discussions.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. F. Zengerling, J. Müller, S. Krege und M. Schrader geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Prittwitzstr. 43, 89075, Ulm, Deutschland

    F. Zengerling, J. Müller &  M. Schrader

  2. Klinik für Urologie und Kinderurologie, Klinikum Maria Hilf, Krefeld, Deutschland

    S. Krege

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  1. F. Zengerling
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  2. J. Müller
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  3. S. Krege
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  4. M. Schrader
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Correspondence to M. Schrader.

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Zengerling, F., Müller, J., Krege, S. et al. Diagnostik und Therapie seminomatöser Hodentumoren. Urologe 53, 563–576 (2014). https://doi.org/10.1007/s00120-013-3378-z

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  • DOI: https://doi.org/10.1007/s00120-013-3378-z

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