Adjuvante Radio-und Chemotherapie beim Zervixkarzinom

Zusammenfassung

Durch konsequentes Screening hat sich in den letzten Jahren in den Ländern der westlichen Welt sowohl die Inzidenz als auch die Mortalitätsrate für das invasive Zervixkarzinom verringert. Therapie der Wahl bei Zervixkarzinomen ist in den Stadien I B und II A die radikale Operation, in den höheren Stadien die primäre Strahlentherapie. Es bleibt aber die Feststellung, daß sich in den letzten Jahren die Behandlungsergebnisse nicht verbessert haben. Aus kleinen Studien ist bekannt, daß auch Zervixkarzinome auf eine Chemotherapie ansprechen. Die Resultate von fünf großen randomisierten Studien haben gezeigt, daß eine cisplatinhaltige Chemotherapie dann einen Überlebensvorteil für die Patientinnen mit invasivem Zervixkarzinom hatte, wenn diese simultan zur Strahlentherapie gegeben wurde.
Die Nebenwirkungen waren moderat und vorübergehend. Die Ergebnisse lassen die Schlußfolgerung zu, daß eine simultane Radiochemotherapie mit Cisplatin sowohl in der primären als auch in high-risk-Fällen in der adjuvanten Therapie eingesetzt werden sollte.

Adjuvant pelvic radiation and chemotherapy for cervical cancer

Summary

The screening for cervical cancer has been reduced both the incidence of and mortality from invasive cervical cancer in the western world. Radical pelvic surgery is an effective treatment for early invasive cervical cancer (FIGO-stage I B and II A), but for woman with more advanced disease radiotherapy is the standard treatment. However, the survival of the cervical cancer patients has not been inproved over the last decade. Previous studies have suggested that chemotherapy and radiotherapy are synergistic. The results of five large studies have shown that cisplatin-based chemotherapy when given at the same time a radiation therapy, prolongs survival in woman with cervical cancer. This was also observed in primary treatment schedule as in adjuvant situation. The side effects were temporary and manageable. The results suggest that chemoradiation is the favorable therapy for cervical cancer in advanced stage and in high-risk-situation.

Schlüsselwörter

Zervixkarzinom - Strahlentherapie - Chemotherapie

Key words

Cervix cancer - radiotherapy - chemotherapy

Literatur

• 1 Baltzer J, Zander J. Adjuvant radiotherapy in the surgical treatment of the carcinoma of the cervix.  Biomed Pharmacother. 1985;  39 422-426
• 2 Chang T C, Lai C H, Hong J H, Hsueh S. et al . Randomized trial of neoadjuvant cisplatin, vincristine, bleomycin, and radical hysterectomy versus radiation therapy for bulky stage I B and II A cervical cancer.  J Clin Oncol. 2000;  18 1740-1747
• 3 Chatani M, Nose T, Masaki N, Inoue T. Adjuvant radiotherapy after radical hysterectomy of the cervical cancer. Prognostic factors and complications.  Strahlenther Onkol. 1998;  174 504-509
• 4 Delgado G. Lymphovascular space involvement in cervical cancer: an independent risk.  Gynecol Oncol. 1998;  68 219
• 5 Delgado G, Bundy B, Zaino R, Sevin B U, Creasman W T, Major F. Prospective surgical-pathological study of disease-free interval in patients with stage I B squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study.  Gynecol Oncol. 1990;  38 352-357
• 6 Dunst J, Haensgen G, Krause U, Fuechsel G, Koehler U, Becker A. A 2-week pretreatment with 13-Cis-Retinoic Acid + Interferon-alpha 2a prior to definitive radiation improves tumor tissue oxygenation in cervical cancers.  Strahlentherapie Oncol. 1998;  174 571-574
• 7 Frigerio L, Mariani A, Gandini L, Origoni M, Galli L, Rabaiotti E, Aletti G, Ferrari A. Prognostic factors in patients with with locally advanced cervical cancer treated with radical hysterectomy and adjuvant radiotherapy.  Int Surg. 1998;  83 265-270
• 8 Grogan M, Thomas G M, Melamed I, Wong F L, Pearcey R G, Joseph P K, Portelance L, Crook J, Jones K D. The importance of hemoglobin levels during radiotherapy for carcinoma of the cervix.  Cancer. 1999;  86 1528-1536
• 9 Kenter G G, Hellebrekers B W, Zwinderman K H, van de Vijver M, Peters L A, Trimbos J B. The case for completing the lymphadenectomy when positive lymph nodes are found during radical hysterectomy for cervical carcinoma.  Acta Obstet Gynecol Scand. 2000;  79 72-76
• 10 Keys H M, Bundy B N, Stehman F B, Muderspach L I, Chafe W E, Suggs C L, Walker J L, Gersell D. Cisplatin, radiation, and adjuvant hysterectomy compared with radiationand adjuvant hysterectomy for bulky stage I B cervical carcinoma.  N Engl J Med. 1999;  340 1154-1161
• 11 Komaki R, Brickner T J, Hanlon A L, Owen J B, Hanks G E. Long-term results of treatment of cervical carcinoma in the United States in 1973, 1978, and 1983: Patterns of Care Study (PCS).  Int J Radiat Oncol Biol Phys. 1995;  31 973-982
• 12 Lai C H, Hong J H, Hsueh S, Ng K K, Chang T C, Tseng C J, Chou H H, Huang K G. Preoperative prognostic variables and the impact of postoperative adjuvant therapy on the outcomes of Stage I B or II cervical carcinoma patients with or without pelvic lymph node metastases: an analysis of 891 cases.  Cancer. 1999;  85 1537-1546
• 13 Lippman S M, Kavanagh J J, Paredes M. et al . al.13-cis-retinoic acid (13cRA), interferon (IFN-a2a) and radiotherapy for locally advanced cancer of the cervix.  ASCO Proc J Clin Oncol. 1993;  (Suppl) 816
• 14 Morris M, Eifel P J, Lu J. et al . Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer.  N Engl J Med. 1999;  340 1137-1143
• 15 Pearcey R G, Brundage M D, Drouin P. et al . A clinical trial comparing concurrent cisplatin and radiation therapy versus radiation alone for locally advanced squamous cell carcinoma of the cervix carried out by the National Cancer Institute of Canada Clinical Trials Group.  ASCO Proc J Clin Oncol. 2000;  (Suppl) 1497
• 16 Peters W A, Liu P Y, Barrett R J. Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix.  J Clin Oncol. 2000;  18 1606-1613
• 17 Piver M S, Chung W S. Prognostic significance of cervical lesion size and pelvic node metastases in cervical carcinoma.  Obstet Gynecol. 1975;  46 507-510
• 18 Rose P G, Bundy B N, Watkins E B. et al . Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer.  N Engl J Med. 1999;  340 1144-1153
• 19 Sardi J E, Giaroli A, Sananes C. et al . Long-term follow-up of the first randomized trial using neoadjuvant chemotherapy in stage I b squamous carcinoma of the cervix: the final results.  Gynecol Oncol. 1997;  67 61-69
• 20 Sedlis A, Bundy B N, Rotman M Z, Lentz S S, Muderspach L I, Zaino R J. A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage I B carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: A Gynecologic Oncology Group Study.  Gynecol Oncol. 1999;  73 177-1783
• 21 Shueng P W, Hsu W L, Jen Y M, Wu C J, Liu H S. Neoadjuvant chemotherapy followed by radiotherapy should not be a standard approach for locally advanced cervical cancer.  Int J Radiat Oncol Biol Phys. 1998;  40 889-896
• 22 Snijders-Keilholz A, Hellebrekers B W, Zwinderman A H, van de Vijver M J, Trimbos J B. Adjuvant radiotherapy following radical hysterectomy for patients with early-stage cervical carcinoma (1984-1996).  Radiother Oncol. 1999;  51 161-167
• 23 Tattersall M H, Lorvidhaya V, Vootiprux V. et al . Randomized trial of epirubicin and cisplatin chemotherapy followed by pelvic radiation in locally advanced cervical cancer. Cervical Cancer Study Group of the Asian Oceanian Clinical Oncology Association.  J Clin Oncol. 1995;  13 444-451
• 24 Thomas G M. Improved treatment for cervical cancer-concurrent chemotherapy and radiotherapy.  N Engl J Med. 1999;  340 1198-2000
• 25 Whitney C W, Sause W, Bundy B N. et al . Randomized comparison of fluorouracil plus cisplatin versus Hydroxyurea as an adjunct to radiation therapy in stage II B-IV A carcinoma of the cervix with negative para-aortic lymph nodes: a Gynecologic Oncology Group and Southwest Oncology Group study.  J Clin Oncol. 1999;  17 1339-1348