Zusammenfassung
Dank vielfältiger supportiver Therapiemöglichkeiten kann die Chemotherapie heute trotz unterschiedlicher und teils hoher Toxizität meistens ambulant durchgeführt werden. Im Rahmen der supportiven Therapie kommen der antiemetischen Behandlung sowie der Prophylaxe und Therapie von Infektionen besondere Bedeutung zu.
Berechtigterweise befürchten Patienten in hohem Maße Übelkeit und Erbrechen. Diese Nebenwirkungen können mit großer Wahrscheinlichkeit durch die prophylaktische Gabe hochpotenter Antiemetika aus der Gruppe der 5-HT3-Rezeptorantagonisten in Kombination mit Kortikosteroiden reduziert bzw. vollständig aufgehoben werden. Am wirksamsten ist die antiemetische Therapie, wenn sie vor Einleitung der Chemotherapie erfolgt.
Ärzte fürchten dagegen eher Infektionen und Blutungskomplikationen. Die Granulozytopenie und das damit einhergehende erhöhte Infektionsrisiko sind eine der häufigsten Nebenwirkungen einer zytostatischen Chemotherapie. Kommt es zu einer Infektion, muss nach einer standardisierten Infektdiagnostik umgehend mit einer kalkulierten empirischen Antibiotikatherapie begonnen werden. Mithilfe granulozytenstimulierender Substanzen können die Granulozytopenie behandelt und die Chemotherapie fortgeführt werden.
Abstract
Due to a large variety of supportive treatment options, chemotherapy can be provided, in spite of diverse and partly high toxicity, on an outpatient base. Within the supportive therapy the antiemetic treatment as well as prophylaxis and therapy of infections are of paramount importance. Nausea and vometing, understandably are feared most by patients. These side effects can with high probability be reduced or even completely eliminated by prophylactic treatment with highly potent antiemetics of the group of the 5-HT3-receptorantagonists before chemotherapy in combination with corticosteroides.
On the other hand the physicians´ greatest concern are infections and bleeding complications as possible side effects of the cytostatics. The granulocytopeny and the higher risk of infection are one of the most frequent side effects of cytostatic chemotherapy. If an infection occurs it is necessary to immediately start a calculated empirical antibiotic therapy after standardised infection diagnostics. In case there is an infection after prior chemotherapy treatments with advanced granulocytopeny, the prescription of granulocyte stimulating substances allows the chemotherapy treatment to be continued.
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Hartlapp, J.H., Böhmer, S. Management der ambulanten Chemotherapie. Gynäkologe 36, 658–664 (2003). https://doi.org/10.1007/s00129-003-1402-x
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DOI: https://doi.org/10.1007/s00129-003-1402-x
Schlüsselwörter
- Ambulante Chemotherapie
- Übelkeit und Erbrechen
- Granulozytopenie
- Empirische Antibiotikatherapie
- Wachstumsfaktoren