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Laryngorhinootologie 2016; 95(10): 674-683
DOI: 10.1055/s-0042-114987
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Kopf-Hals-Krebs in der Schwangerschaft – Empfehlungen zu Diagnostik und Therapie mit Fallbericht

Head and Neck Cancer in Pregnancy – Recommendations for Diagnosis and Therapy With Case Report
C. Mozet
1   ENT, Schwarzwald-Baar-Klinikum Villingen-Schwenningen, Villingen-Schwenningen
,
T. Kuhnt
2   Bildgebung und Strahlenmedizin, Universitätsklinikum Leipzig, Leipzig
,
B. Sattler
3   Medizinphysik, Klinik und Poliklinik für Nuklearmedizin Leipzig, Leipzig
,
J. Remmele
4   Klinik für Strahlentherapie und Radioonklogie, Universitatsklinikum Leipzig, Leipzig
,
U. Thome
5   Neonatologie, Universität Leipzig, Leipzig
,
H. Stepan
6   Geburtsmedizin, Universitatsklinikum Leipzig, Leipzig
,
R. Kluge
7   Nuklearmedizin, Universitatsklinikum Leipzig, Leipzig
,
A. Dietz
8   Plastische Operationen, Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universität Leipzig, Leipzig
,
M. Knoedler
9   Krebszentrm (UCCL),Universitatsklinikum Leipzig, Leipzig
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
20. Oktober 2016 (online)

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Zusammenfassung

Hintergrund: Die Diagnose einer Krebserkrankung in der Schwangerschaft ist selten, aufgrund einer Verschiebung des Alters der Erstgebärenden hin zum letzten Drittel des reproduzierfähigen Alters aber auch für Kopf-Hals-Tumorpatientinnen möglicherweise zunehmend relevant. Dabei besteht eine große Unsicherheit bezüglich des Nutzens und Risikos von diagnostischen oder therapeutischen Tumortherapiemodalitäten für das Ungeborene, sodass eine fundierte Empfehlung in diesen Fällen besonders schwer fällt. Nach neuen Literaturdaten scheint aber sogar eine multimodale Tumortherapie (Operation, Bestrahlung, Chemotherapie) trotz Schwangerschaft möglich und sollte streng gegen das Risiko einer Frühgeburtlichkeit abgewogen werden.

Material und Methoden: Die Arbeit gibt eine Literaturübersicht über aktuelle Erkenntnisse zu diagnostischen Verfahren in der Schwangerschaft und zu dem Risiko von tumortherapeutischen Maßnahmen wie Bestrahlung und Chemotherapie für das Ungeborene. Die Erkenntnisse werden anhand eines konkreten Falls einer Schwangeren mit einem ausgedehnten Gehörgangskarzinom diskutiert und es werden Empfehlungen formuliert.

Ergebnisse: Suffizient durchgeführte diagnostische Modalitäten erreichen die gefährdenden Uterusdosen praktisch nicht. Eine Reihe von Fallberichten und Beobachtungsstudien zeigen auch keinen Entwicklungsnachteil für die Kinder pränatal exponierter tumorkranker Mütter durch Bestrahlung oder Chemotherapie, wohingegen der langfristige Entwicklungsnachteil durch die Frühgeburtlichkeit nachgewiesen ist.

Schlussfolgerung: Wenn während einer Schwangerschaft eine Tumorneuerkrankung im Kopf-Hals-Bereich festgestellt wird, erscheint auch die Durchführung einer etablierten Therapie mittels Operation und/oder Cisplatin-basierter Radiochemotherapie mit vertretbarem Risiko für das ungeborene Kind möglich.

Abstract

Objective: The diagnosis of cancer in pregnancy is rare, but might become more relevant even for head and neck cancer patients due to a shift of age of primipara towards the last third of reproductive years. Unsureness exists about the risk and benefit of diagnostic and therapeutic cancer modalities for the unborn and established recommendations are still missing. But, according to recent data, even multimodal therapeutic approaches (e. g. surgery, radiation, chemotherapy) seem possible in face of pregnancy and should be traded against the risk of prematurity.

Material and Methods: Our findings are discussed on the basis of a case report of a pregnant woman with advanced carcinoma of the outer ear canal and therapy options are formulated.

Results: Sufficient performed diagnostic modalities do not reach imperilling uterus dosages. A growing number of case reports und studies did not detect any developmental disadvantage of children of prenatal exposed mothers by radiation or chemotherapy, whereas long-term impairments of premature infants are proven.

Conclusion: In cancer in pregnancy, an immediate start of well-established therapy modalities like surgery and/or cisplatin-based chemoradiation seems to be possible without unjustifiable risks for the unborn.

Schlüsselwörter

Schwangerschaft - Chemotherapie - Bestrahlung - Kopf-Hals-Tumoren - Risiko

Key words

pregnancy - chemotherapy - radiation - head and neck cancer - risk
 

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