Summary
The following case report is about a 55 year old male patient with CUP-syndrome. After developing a malignant bowel obstruction he received five cycles of a palliative chemotherapy with oxaliplatin and irinoetcan. The focus is on medical intentions and goals concerning palliative chemotherapy and on discussing patients attitudes towards chemotherapy. Communication is identified as fundamental skill in shared decision making. On the one hand it improves Patients satisfaction and palliative care and on the other hand it reduces psychological and existential suffering. In tumors of unknown primary site regimens with different combinations of Platin, Taxol, Etoposide, Irinotecan and Gemcitabine showed responses up to 46 % and a survival benefit with a overall median survival up o 12 months and even long term survival.
Zusammenfassung
Anhand eines Fallbeispiels eines 55-jährigen männlichen Patienten mit CUP, welcher nach Entwicklung eines tumorassoziierten mechanischen Ileus fünf Zyklen einer Chemotherapie mit Oxaliplatin und Irinotecan erhalten hat, wird unter Verweis auf rezente Literatur vor allem auf die medizinischen Intentionen und Ziele von palliativen Zytostatikabehandlungen eingegangen sowie die Haltung von Patienten dazu diskutiert. Kommunikation wird als wichtigstes Mittel im Prozess der therapeutischen Entscheidungsfindung betont, um den Bedürfnissen des Patienten besser gerecht werden zu können. Hinsichtlich Chemotherapie bei CUP wird festgehalten, dass für verschiedenste Mehrfachkombinationen aus Platinen, Taxanen, Etoposid, Irinotecan und Gemcitabine Ansprechraten bis 46 % und Überlebensvorteile mit medianem Survival bis zu 12 Monaten und vereinzelt sogar Langzeitüberlebende dokumentiert sind.
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Iglseder, S. Palliative Chemotherapie bei CUP: Ärztliche Intentionen versus Patientenhaltung in der Entscheidungsfindung – ein Fallbeispiel. Wien Med Wochenschr 156, 283–287 (2006). https://doi.org/10.1007/s10354-006-0290-9
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DOI: https://doi.org/10.1007/s10354-006-0290-9