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Nachsorge, Fertilität, Langzeittoxizität und Survivorship bei Keimzelltumoren

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best practice onkologie Aims and scope

Zusammenfassung

Hintergrund

Keimzelltumoren sind heute auch in metastasierten Stadien bei der Mehrheit der Patienten heilbar. Das frühzeitige Erkennen eines Rezidivs durch konsequente Nachsorge, die aber zusätzliche Toxizitäten durch unnötig häufige Bildgebungen hervorrufen können, ist dabei essenziell. Da die Patienten meist jung erkranken, sind die Prävention und Therapie von Spättoxizitäten entscheidend für ihre Lebensqualität.

Ziel der Arbeit

Ziel ist eine Übersicht über die aktuelle Studien- und Datenlage zur Nachsorge von Keimzelltumorpatienten zur frühzeitigen Diagnose eines Rezidivs, aber auch zur Prävention und Therapie möglicher physischer und psychosozialer Spättoxizitäten.

Ergebnisse

Es liegen evidenzbasierte Empfehlungen zur Nachsorge, abhängig von der Krankheitsausbreitung und der durchgeführten Therapie, vor. Diese fokussieren auf eine lebenslange Nachsorge hinsichtlich Fertilität sowie Erkrankungen im Rahmen eines metabolischen Syndroms. Außerdem besteht ein erhöhtes Risiko für Zweitmalignome, anhaltende pulmonale bzw. nephrologische Toxizitäten und Polyneuropathie. Patienten beklagen zudem häufig Fatigue und kognitive Einschränkungen. Studien zeigen auch vermehrte psychische Störungen wie Angststörungen, Depression oder posttraumatische Belastungsstörungen. Zunehmend werden auch die Zusammenhänge zwischen körperlichen Spättoxizitäten, psychischen Störungen und sozialen wie beruflichen Langzeitfolgen deutlich. Mit Survivorship-Programmen wird versucht, den komplexen Bedürfnissen der Patienten gerecht zu werden.

Schlussfolgerungen

Eine leitliniengerechte Nachsorge hat das Ziel, ein langfristiges Überleben bei guter Gesundheit nach Keimzelltumorerkrankung zu erreichen. Die Prävention und Therapie von körperlichen sowie psychosozialen Spätfolgen sind entscheidend, um eine möglichst hohe Lebensqualität zu erreichen.

Abstract

Background

High rates of long-term survival can be achieved in patients with germ cell tumors even in metastatic stages. Early detection of potential relapses by close surveillance but without causing further toxicity by unnecessarily frequent use of imaging is crucial. Patients are usually young when diagnosed with germ cell tumors; therefore, prophylaxis and treatment of long-term toxicity are important for the quality of life.

Objectives

We present an overview of the current literature and studies on follow-up and surveillance of germ cell tumor patients. We focus on a timely diagnosis of a potential relapse and especially on physical and psychosocial long-term toxicities.

Results

Evidence-based recommendations on follow-up depending on the stage of disease and therapy options are available for germ cell tumor patients. These recommendations include life-long follow-up concerning fertility issues and diseases assigned to a metabolic syndrome. Furthermore, the risk for second malignancies, pulmonary or nephrological toxicity as well as polyneuropathy is increased. Patients also frequently complain of fatigue and cognitive impairments. Studies have also demonstrated higher rates of psychological problems, e. g. anxiety, depression and posttraumatic stress disorder. The complex interactions between delayed physical toxicities, psychological problems and social as well as occupational long-term effects are also becoming clear. Survivorship programs aim to address the complex needs of germ cell tumor survivors in order to achieve the highest possible quality of life and health.

Conclusion

Evidence-based follow-up strategies aim to achieve a high rate of long-term survival with good health after germ cell tumors. Prevention and therapy of delayed physical as well as psychosocial toxicities are crucial to achieve the highest possible quality of life in long-term survival.

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Authors and Affiliations

  1. Klinik für Onkologie, Hämatologie und Knochenmarktransplantation mit Sektion Pneumologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

    Karin Oechsle

  2. Abteilung für Urologie, Kinderurologie und Urologische Onkologie, Klinikum Essen-Mitte, Essen, Deutschland

    Susanne Krege

  3. Tumor- und Brustzentrum ZeTuP St. Gallen, St. Gallen, Schweiz

    Friedemann Honecker

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  1. Karin Oechsle
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  2. Susanne Krege
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  3. Friedemann Honecker
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Correspondence to Karin Oechsle.

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Interessenkonflikt

K. Oechsle, S. Krege und F. Honecker geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Dieser Beitrag ist zuerst erschienen in Onkologe 2017 23:129–135; DOI 10.1007/s00761-016-0145-y Online publiziert: 17. November 2016 © Springer-Verlag Berlin Heidelberg 2016

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Oechsle, K., Krege, S. & Honecker, F. Nachsorge, Fertilität, Langzeittoxizität und Survivorship bei Keimzelltumoren. best practice onkologie 12, 144–152 (2017). https://doi.org/10.1007/s11654-017-0029-7

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  • DOI: https://doi.org/10.1007/s11654-017-0029-7

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