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Therapieoptionen bei karzinomerkrankten Frauen mit Kinderwunsch

Therapy options for cancer patients wishing to become pregnant

  • Leitthema
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Der Gynäkologe Aims and scope

Zusammenfassung

Mit zunehmend erfolgreicheren onkologischen Therapien nimmt auch das Langzeitüberleben betroffener Patientinnen zu. Dies erfordert, die durch die Behandlung verursachten Langzeitkomplikationen verstärkt zu berücksichtigen. Hierzu zählt auch der Verlust der Ovarialfunktion beziehungsweise der Fertilität infolge zytostatikainduzierter Gonadotoxizität. Heute können mehrere, teilweise jedoch noch als experimentell einzustufende Möglichkeiten des Fertilitätserhalts Anwendung finden. Die Zahl der Therapieoptionen zum Fertilitätserhalt hat gerade in jüngster Zeit zugenommen. Vor einer isolierten Strahlentherapie können die Ovarien beispielsweise aus dem Bestrahlungsfeld transpositioniert werden. Oozyten, fertilisierte Eizellen und Embryonen sowie Ovarialgewebe können heute kryokonserviert werden. Auch GnRH-Analoga schützen möglicherweise die weiblichen Gonaden. Einige der verfügbaren Optionen, wie die Kryokonservierung von Embryonen, sind in Deutschland rechtlich nicht zulässig. Ungeklärt ist neben zahlreichen technischen Details auch die Kostenerstattung. Dennoch hat die Perspektive einer Erfüllung des Kinderwunsches trotz tumorspezifischer Therapie große Bedeutung erlangt. Dies wird auch in der Gründung eines bundesweiten Netzwerkes „FertiPROTEKT“ deutlich, das überregional Methoden des Fertilitätserhalts anbietet.

Abstract

As oncologic treatment grows more successful, the longevity of affected patients also increases. This in turn demands increased attention to long-term complications resulting from that treatment, including loss of ovary function and fertility resulting from cytostatically-induced gonadotoxicity. Many new options for retaining fertility are available, some of them still best classified as experimental; their number has especially increased of late. One example is transposition of the ovaries out of the radiation field before isolated radiotherapy. Oocytes, fertilized ova, embryos, and ovarial tissue can now be conserved cryogenically. Also, GnRH analogs can protect the gonads. Some of the options, including cryoconservation of embryos, are not legal in Germany. Many technical questions still require clarification, as do details of reimbursement. Nonetheless the ability to become pregnant despite tumor-specific therapy has come to assume great importance. This is reflected by the new German network called FertiPROTEKT which makes available on a national basis methods for preserving fertility.

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  1. Klinik für Frauenheilkunde und Geburtshilfe, Bereich für Reproduktionsmedizin und gynäkologische Endokrinologie, Universität Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    S. von Otte, K. Diedrich & M. Thill

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  1. S. von Otte
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von Otte, S., Diedrich, K. & Thill, M. Therapieoptionen bei karzinomerkrankten Frauen mit Kinderwunsch. Gynäkologe 41, 523–532 (2008). https://doi.org/10.1007/s00129-008-2193-x

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