Zusammenfassung
Das Peniskarzinom ist in Westeuropa mit einer Inzidenz von 0,1–0,9/100.000 Männer/Jahr ein seltener maligner Tumor des Urogenitaltrakts. Zum Zeitpunkt der Erstdiagnose weisen bis zu 45% der Patienten bereits Lymphknoten- und/oder systemische Metastasen auf, die einer weitergehenden systemischen Therapie bedürfen. Es ist Zielsetzung des Artikels die derzeitigen Konzepte der adjuvanten und neoadjuvanten Therapie zusammenzufassen. Ein kurativer Effekt durch die kombinierte operative und zytotoxische Therapie kann nur bei Patienten mit lokoregionärer Lymphknotenmetastasierung erreicht werden. Aufgrund der Rarität des Tumors liegen jedoch keine prospektiven Studien zur Beurteilung des bestmöglichen chemotherapeutischen Regimes vor.
In der Vergangenheit haben sich Cisplatin-haltige Behandlungsregime oder eine Kombinationstherapie von Bleomycin, Methotrexat und Vincristin durchgesetzt. Inwieweit sich eine Überlebensverbesserung durch die adjuvante Chemotherapie erzielen lässt, ist aufgrund der fehlenden Datenlage nicht abschließend beurteilbar. Bei Patienten mit fixierter inguinaler Lymphknotenmetastasierung oder „bulky disease“ ist ein multimodales Vorgehen unbedingt notwendig. Die neoadjuvante Chemotherapie ist mit einer Ansprechrate von 20–60% vergesellschaftet und erlaubt eine komplette Resektabilität des Befundes. Komplette Remissionen durch die alleinige Chemotherapie sind selten. Für die Zukunft sind neue Therapieansätze unter Verwendung Taxan-basierter Regime, analog den Plattenepithelkarzinomen anderen Ursprungs, zu erwarten.
Abstract
With an incidence of 0.1–0.9/100,000 men per year penile cancer is a rare cancer of the urogenital tract in Western Europe. At the time of initial diagnosis up to 45% of the patients already demonstrate metastatic disease and need some type of systemic treatment. It is the aim of this paper to review the current concepts of adjuvant and neoadjuvant chemotherapy for locally advanced penile cancer. A curative effect of combined surgical and cytotoxic management can only be achieved in patients with locoregional spread to the lymph nodes, but not with systemic spread.
Although there are prospective randomized trials available indicating the optimal cytotoxic regime, cisplatin-based protocols or combination therapies with bleomycin, vincristine, and methotrexate appear to be the most effective options. Finally, there are no data available with regard to the effect of adjuvant chemotherapy on progression-free survival. In patients with locoregional bulky disease or with fixed inguinal lymph nodes, neoadjuvant chemotherapy will result in a partial response in 20–60% of patients and enables complete resection of the mass. For the future, the use of taxane-based chemotherapy as described for squamous cell cancer of other origin might improve outcome.
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Heidenreich, A., Jakse, G. Neoadjuvante und adjuvante Chemotherapie bei Patienten mit fortgeschrittenem Peniskarzinom. Urologe 46, 1395–1399 (2007). https://doi.org/10.1007/s00120-007-1545-9
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DOI: https://doi.org/10.1007/s00120-007-1545-9