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Deutsche Zeitschrift für Onkologie 2011; 43(1): 11-18
DOI: 10.1055/s-0030-1257603
Forschung
© Karl F. Haug Verlag in MVS Medizinverlage Stuttgart GmbH & Co. KG

Ein effektives, multimodales Therapiekonzept zur Behandlung des peritoneal metastasierten Ovarialkarzinom-Rezidivs

Herwart Müller
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Publication History

Publication Date:
06 April 2011 (online)

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Zusammenfassung

Bis zum heutigen Zeitpunkt konnte ein optimales therapeutisches Vorgehen für das Ovarialkarzinom-Rezidiv nicht definiert werden. Bisherige Veröffentlichungen legen nahe, dass mittels erneutem Debulking kombiniert mit einer hyperthermen Peritonealperfusion (HIPEC) die Überlebenszeit positiv beeinflusst werden kann. Methode: In einer retrospektiven monozentrischen Untersuchung an 70 Patientinnen mit peritonealem Rezidiv des Ovarialkarzinoms wurde die Durchführbarkeit dieses Verfahrens untersucht; gleichzeitig erfolgte die Analyse bezüglich prognostisch relevanter Faktoren. Die HIPEC erfolgte hierbei mit Mitomycin (20 mg/m2) plus Mitoxantron (20 mg/m2) bei einer Temperatur von 41,5 °C. Ergebnisse: Es erfolgten 78 Operationen bei 70 Patientinnen in der Zeit von 4/2002 bis 5/2006. Eine vollständige Resektion (CC-0- + -1-Resektion) konnte in 81 % erreicht werden. Die postoperative Morbidität betrug 20,5 %, wobei keine Todesfälle zu verzeichnen waren. Das 2-Jahresüberleben lag bei 72 %. Unanhängige Prognosefaktoren waren das Allgemeinbefinden, die Vollständigkeit der Resektion sowie die Ausdehnung der Peritonealkarzinose, wobei zwischen den beiden letztgenannten Faktoren eine inverse Beziehung bestand. Zusammenfassung: HIPEC ist ein standardisiertes Verfahren verbunden mit einer akzeptablen Morbidität und einer reproduzierbaren Effizienz hinsichtlich der Überlebenszeit der Patientinnen. Ausmaß der Erkrankung, Allgemeinbefinden und die Qualität der Resektion sind dabei prognostisch wichtige Faktoren. Das hier aufgezeigte multimodale Behandlungskonzept zeigt bei akzeptabler Belastung eine Möglichkeit, das Überleben der Patientinnen mit Ovarialkarzinom-Rezidiv zu verlängern.

Summary

Optimal treatment of chemoresistant and recurrent ovarian cancer is debating with second line chemotherapies. For peritoneal carcinomatosis new treatment combining cytoreductive surgery with heated intraperitoneal perioperative chemotherapy (HIPEC) may improve survival. Methods: Retrospective analysis of 70 patients with peritoneal carcinomatosis from ovarian cancer were performed to evaluate feasibility of second debulking plus hyperthermic peritoneal perfusion (HIPEC) and to identify prognostic factors. HIPEC is performed with Mitomycin (20 mg/m2) plus Mitoxantron (20 mg/m2) at 41.5 °C. Results: The study included 78 procedures in 70 patients from 4/2002 to 5/2006. Rate for complete resection (CC-0 + 1 resection) was 81 %. Procedure relates morbidity was 20.5 % without postoperative mortality. Two year survival rate was 72 %. Independent prognostic factors for survival were the extent of carcinomatosis, the completeness of cytoreduction and performance status. Conclusions: HIPEC is a standardized and reproducible feasible method. Less extensive disease and the quality of cytoreduction remain an independent factor of better outcome. Morbidity is acceptable. In selected patients HIPEC allows to reach the longest median time survival in recurrent peritoneal carcinomatosis from ovarian cancer.

Schlüsselwörter

Ovarialkarzinom - Rezidiv - Peritonealkarzinose - Hyperthermie - Peritonealperfusion - Peritonektomie

Keywords

Ovarian carcinoma - recurrence - peritoneal carcinosis - hyperthermia - peritoneal perfusion - peritonectomy

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Korrespondenzadresse

Dr. med. Herwart Müller

Facharzt für Allgemein- und Viszeralchirurgie
Spezialist für chirurgische Onkologie

Brücknerstraße 4

97080 Würzburg

Email: herwart.mueller@t-online.de

URL: http://www.surgicaloncology.de

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