Aktuelle Aspekte der interdisziplinären lokalen Therapie des primären Mammakarzinoms

best practice onkologie - Die Therapie des Mammakarzinoms hat sich in den letzten Jahren rasant weiterentwickelt und zunehmend individualisiert. Im vorliegenden Artikel wird ein Überblick...     

Operative Therapie des Endometriumkarzinoms und seiner Präkanzerosen

Das Endometriumkarzinom des Korpus uteri ist mit einem Anteil von j?hrlich etwa 9.600 Neuerkrankungen und einem Anteil von 5–6% an allen b?sartigen Neubildungen, die z. Z. vierth?ufigste Krebserkrankung der Frau. Die Inzidenz der Erkrankung steigt mit dem Alter kontinuierlich an und erreicht ihren Gipfel zwischen dem 50. und 70. Lebensjahr [1]. Die operative Therapie des Endometriumkarzinoms ist die Standardtherapie. Neben der definitiven operativen Behandlung stellt die operative Therapie gleichzeitig auch die wichtigste Voraussetzung für das Staging der Erkrankung dar [11]. Die alte Klassifikation der FIGO ordnete das Endometriumkarzinom klinisch nur hinsichtlich seiner Ausbreitung innerhalb der Organgrenzen ein. Seit 1988 liegt eine neue Stadieneinteilung vor, welche die Tumorausbreitung innerhalb des Myometriums berücksichtigt, den Zervixbefall zwischen isoliertem Drüsenbefall und Stromainvasion unterscheidet und dem Stadium III alle F?lle mit Serosabefall, positiver Peritonealzytologie und Lymphknotenmetastasierung zuordnet [6, 7, 10, 18]. Diese Klassifizierung stellt das operative Staging in den Vordergrund und be- deutet für den Gro?teil der Patienten bereits die definitive Behandlung der Erkrankung.     

Diagnostik und Therapie des cholangiozellulären Karzinoms

Cholangiocellular carcinomas (CCC) are classified based on the anatomical location into intrahepatic (iCCC), perihilar (pCCC) and distal (dCCC) subgroups with different features and therapeutic options. Modern imaging techniques including magnetic resonance cholangiopancreatography (MRCP) offer excellent noninvasive diagnostic options. After major hepatectomy for iCCC a median survival of 36-57 months could be observed. Radical en bloc resection with portal vein resection for pCCC exhibits superior 5-year survival rates of 58?%. After pancreatoduodenectomy for dCCC, 5-year survival rates of 27-33?% can be achieved. Endoscopy plays a major role in palliative stenting which can be combined with photodynamic therapy. Palliative chemotherapy offers a median survival of up to 13 months but there is still little evidence in support of neoadjuvant or adjuvant therapy regimes.     

Diagnostik und Therapie des hepatozellulären Karzinoms

Aims

Hepatocellular carcinoma (HCC) is a frequent complication of liver cirrhosis. Worldwide HCC is one of the most common cancers with a rising incidence.

Content

Rapid recognition of HCC and the earliest possible treatment are decisive for the further course. Both treatment of the tumor and the underlying chronic liver disease, including preservation of liver function, are important for the management of patients with HCC.

Conclusion/recommendations

Standard stage-adapted treatments include liver resection, transplantation, and interventional treatment such as thermal ablation and transarterial therapy. In the advanced stage, treatment with the tyrosinekinase inhibitor sorafenib is the standard of care.     

Diagnostik und Therapie des hepatozellulären Karzinoms

Die Onkologie - Die Inzidenz des hepatozellulären Karzinoms (HCC) steigt seit einigen Jahren weltweit. Die Grundlage für die HCC-Entwicklung ist meist eine Leberzirrhose verschiedener...     

Was ist die optimale Therapie des primären Mammakarzinoms?

Vom 12.–15.März 2003 fand in St. Gallen das 8. internationale Brustkrebs-Symposium zur Optimierung der interdiziplinären Primärtherapie des Mammakarzinoms statt. Ziel der mittlerweile alle zwei Jahre abgehaltenen Tagung ist eine Diskussion und Standortbestimmung über die neuesten wissenschaftlichen Erkenntnisse zur Biologie, Diagnostik und Primärtherapie des Mammakarzinoms im Austausch von internationalen Experten. Das traditionelle Live-Fazit der Tagung, die eigentliche Konsensuskonferenz, war in diesem Jahr zum Bedauern vieler Teilnehmer weitgehend auf die Formulierung der offenen Fragen reduziert. Die Publikation des Konsensus ist erst im Sommer zu erwarten. Es wurden neue Daten präsentiert, offene Fragen formuliert, ein Konsens aber vertagt.     

Lebertransplantation bei primären Non-HCC-Tumoren und sekundären Malignomen der Leber

Liver transplantation currently represents not only an effective but also a safe treatment for many patients with liver disease. Liver transplantation is also a crucial part of the treatment of hepatic malignancies and is the current treatment of choice in early stages of hepatocellular carcinoma (HCC) in cirrhosis. In other primary and secondary liver malignancies, liver transplantation can be a curative treatment option as well. However, these malignancies comprise a heterogeneous group of liver tumours that are considerably different in terms of tumour characteristics, treatment modalities, and prognosis. Therefore, the importance of liver transplantation in the treatment strategy varies among the different tumour entities. The current criteria for organ allocation influence and limit the use of this treatment modality in these heterogeneous settings. Supported by the advancing establishment of living donor liver transplantation, the importance of transplantation in the general oncological concept of some of these tumour entities is currently increasing again. This review gives an overview, based on the current literature, of the role of liver transplantation for treating primary non-HCC tumours and secondary malignancies of the liver.     

Therapie von prim?ren zerebralen Lymphomen

Primary central nervous system lymphomas (PCNSL) are a rare entity within the non-Hodgkins lymphomas. With a short history the clinical presentation frequently occurs with neurologic deficits and/or neuropsychiatric symptoms. Magnetic resonance imaging (MRI) and stereotactic biopsy are required for a definitive diagnosis. PCNSLs are chemosensitive and remission can occur with corticosteroids. The permeability of the blood-brain barrier must be taken into account in the choice of cytostatics. High-dose methotrexate (HD-MTX) is the most effective drug for PCNSL and the combination with high-dose AraC (HD-AraC) has been shown to be more effective than HD-MTX alone. In younger patients intensive treatment protocols as well as high-dose BCNU and thiotepa followed by autologous stem cell transplantation leads to a cure in a substantial proportion of patients. Combined immuno chemotherapy protocols lead to overall survival rates up to 30% in elderly patients. Due to the rarity of the disease patients should be treated according to clinical trial protocols.     

Früherkennung und Prävention des malignen Melanoms

Cutaneous melanoma is mainly caused by UV radiation. Mutations within the pigment cells are induced by UV radiation already in childhood and adolescence and they lead to the development of benign melanocytic neoplasms—the melanocytic nevi or moles. These can be regarded as indicators of the mutational status of the pigment cell system. The more moles and the larger they are in a person the higher the risk is for melanoma development. Therefore, persons at risk can be recognized by their pigmented moles. Thus, primary prevention consists of forceful UV protection, especially in childhood and adolescence. Abstention from UV radiation during the time of day when insolation is highest and wearing protective clothing are required. Use of sunscreens is not satisfactory; they protect insufficiently against mutations in the pigment cells. Secondary prevention means early recognition of cutaneous melanoma if possible already in the noninvasive growth phase as melanoma in situ. This kind of early recognition is possible today based on the application of dermoscopy. Diagnosis in the early growth phase of in situ melanoma is not associated with the risk of metastasis. Therefore, all suspicious lesions should be judged by specialists.     

Risikofaktoren und primäre Präventionsstrategien des Zervixkarzinoms

best practice onkologie - Hauptrisikofaktor für die Entstehung eines invasiven Zervixkarzinoms ist eine persistierende Infektion mit humanen Papillomviren (HPV). Die beiden High-Risk-Typen...     

Chirurgische Therapie von prim?ren Lebertumoren bei Erwachsenen

Surgical removal is currently the main approach in the curative treatment of primary liver tumors. The current article summarizes principle strategies of liver surgery as well as aspects in the treatment of hepatocellular carcinoma and cholangiocarcinoma. In this aspect liver resection is particularly important and in selected cases liver transplantation can be an alternative therapy.     

Perspektiven für die Therapie des kastrationsrefraktären Prostatakarzinoms

best practice onkologie -     

Neues zur systemischen Therapie des medullären Schilddrüsenkarzinoms

Context

Medullary thyroid cancer (MTC) is a rare form of cancer with an annual incidence of only 2–5 per million inhabitants and has a very variable, often a relatively indolent course of the disease. In recent years substantial new data have been collected on novel therapy options for this neoplasm.

Objective

The aim of this review is to present and evaluate the current therapeutic options for advanced MTC.

Methods

Selective review of the literature, analysis of clinical trials.

Results

As the natural course of disease even with known distant metastases is frequently relatively slow a watchful waiting strategy is justified in many patients. Surgery or local ablative therapy should be considered. If a significant tumor progression is observed systemic treatment options should be discussed with the patient. Based on the observation of a mutated RET protooncogene and increased neoangiogenesis in MTC, many tyrosine kinase inhibitors have been evaluated with very promising results. Vandetanib has been approved in 2012 as the first drug for the treatment of aggressive and symptomatic MTC. Data on cytotoxic chemotherapy regimens are limited; therefore, these drugs should only be used in individual therapeutic concepts.

Conclusion

In order to further improve therapeutic options in this rare cancer all patients should preferentially be treated within clinical trials.     

Operative Behandlung von sekundären Knochentumoren

Die operative Behandlung von Knochenmetastasen extraskelett?rer Prim?rtumoren weist eine stetig zunehmende Frequenz im interdisziplin?ren onkologischen Behandlungskonzept auf. Die Ursache dafür ist in der suffizienten Therapie der Prim?rtumoren, des tumorspezifisch orientierten Nachsorgesystems mit der Erkennung von Frühmetastasen und in der Tatsache zu sehen, dass Knochenmetastasen der verschiedenen Prim?rtumoren eine extrem unterschiedliche Prognose aufweisen. Diese Erfahrungen pl?dieren für ein rechtzeitiges risikoadaptiertes operatives Vorgehen bei der Behandlung von Knochenmetastasen und wenden sich gegen die ausschlie?liche Stabilisierung der pathologischen Fraktur. Die vorliegende Arbeit zeigt die Grunds?tze der risikoadaptierten, operativen Knochenmetastasentherapie auf und demonstriert die verschiedenen Techniken unter Berücksichtigung des Prim?rtumors und der daraus resultierenden Prognose.     

Medikamentöse Therapie des metastasierten oder rezidivierten mutationsnegativen NSCLC

Background

The introduction of immune checkpoint inhibitors (ICI) has led to rapid changes in the treatment of metastatic non-small cell lung cancer (NSCLC) without treatable driver mutations over the last few years.

Objective

A brief historical outline of treatment before and a summary of changes after the arrival of ICI is given.

Material and methods

A selective Pubmed search was performed employing the keywords NSCLC stage IV, checkpoint inhibitors and chemotherapy.

Conclusion

The ICIs were initially introduced as second line treatment of metastatic NSCLC as several large phase III trials were able to show a clinically significant improvement compared to the standard docetaxel treatment. Meanwhile, pembrolizumab is the standard first-line treatment of NSCLC with high PD-L1 expression (TPS?>?50%). Recently, several phase III trials could show superior efficacy of the combination of an ICI with standard platinum-based doublet chemotherapy compared to chemotherapy alone. Some of the investigated combinations have already been approved for nonsquamous NSCLC and further approvals can be expected. Since the introduction of ICI long-term survival of 3 or more years has been achieved in some patients with metastatic NSCLC.