Stellenwert der radikalen Chirurgie bei der Behandlung des Ovarialkarzinoms

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Stellenwert des Tumormarkers CA 125 als prognostischer Parameter beim Rezidiv des Ovarialkarzinoms

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Stellenwert der Biometrie des fetalen Herzens im II und II Trimenon der Schwangerschaft

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Standards in der Therapie des Ovarialkarzinoms

Epithelial ovarian cancer is the gynecological tumor with the highest mortality rate. Recently, numerous new findings have emerged about status and extent of surgical therapy of this disease. Innovations regarding chemotherapy of primary and recurrent disease are also numerous. It is essential for the improvement of the patients’ situation to transfer these new developments already implemented in national and international standards and guidelines to clinical practice.     

Neue Entwicklungen in der operativen Therapie des Ovarialkarzinoms

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Fortschritte in der Diagnostik und Therapie des Ovarialkarzinoms

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Die pelvine Lymphonodektomie bei der operativen Behandlung des Ovarialkarzinoms

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Genetik des Ovarialkarzinoms

Characteristic genetic aberration can be identified in hereditary as well as in sporadic ovarian cancer (OC). Whole genome sequencing revolutionizes the discovery of gene mutations. Goals of such endeavors are personalized cancer risk assessment and therapy. Forty to 50 mutations or aberrations are found in an ovarian cancer; only 2 to eight are“driver mutations” conveying a selective growth advantage. Less aggressive type-1 OC contain mutations in KRAS, BRAF and PIK3CA, type-2 OC carry p53 and BRCA1/2 mutations with high frequency. Hereditary OC are associated with germ-line mutations in BRCA1/2 causing the hereditary breast and ovarian cancer syndrome, in mismatch repair genes in Lynch syndrome or in p53 in the Li-Fraumeni syndrome 1. For individual OC risk assessment, computer models can be used based on family history, germ-line mutations and DNA variations.     

Rezidivtherapie des Ovarialkarzinoms

Despite optimal primary oncologic management most patients with advanced ovarian cancer develop a recurrence with a subsequent shift from the therapeutic intention to a palliative approach. Symptom control and quality of life gain in importance as treatment goals and further management is primarily influenced by the response to the preceding platinum-based chemotherapy. Two main subgroups can be distinguished with platinum-resistant (recurrence less than 6 months after last platinum-based chemotherapy) and platinum-sensitive disease (recurrence more than 6 months after last platinum-based chemotherapy). In cases of platinum-resistant recurrence the initial concept of cytoreductive surgery in combination with platinum-based combination chemotherapy apparently failed and many patients still have to recover from persisting side effects of the previous therapy. Therefore, mono-chemotherapy was up till now the therapy of choice for this patient cohort. In contrast, patients with platinum-sensitive recurrence usually receive another platinum-based chemotherapy. According to recently published data some patients with recurrent disease might additionally benefit from antiangiogenic therapy by the addition of bevacizumab. In selected cases of platinum-sensitive recurrence secondary cytoreductive surgery appears to be an option although a prognostic impact of this procedure has not yet been proven through prospective randomized studies. In this review recent developments in the oncologic management of recurrent ovarian cancer are discussed and current evidence considering therapeutic approaches is highlighted to give a concise overview of clinically relevant therapeutic aspects.     

Metastasierungswege des Ovarialkarzinoms

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Der Stellenwert der Aromatasehemmer in der Behandlung des Mammakarzinoms

Mit Anastrozol, Letrozol und Exemestan stehen heute 3 hochselektive orale Aromatasehemmer zur Verfügung, die bislang beim metastasierten Mammakarzinom der postmenopausalen Frau nach Progression unter einem Anti?strogen zum Einsatz kommen. Etwa jede 3. Frau profitiert von diesen neuen Medikamenten entweder im Sinne einer objektiven Remission oder einer Krankheitsstabilisierung von >6 Monaten. Entgegen dem teilweise aus Marketinggründen bewusst erzeugten Eindruck einiger Presseberichte haben weder die chemische Struktur (steroidal- nichtsteroidal), noch die unterschiedliche Art der Hemmung des aktiven Zentrums der Aromatase, noch die Tatsache, ob es zu einer reversiblen oder irreversiblen Hemmung des Enzyms kommt, einen Einfluss auf die Wirkparameter wie Ansprechrate, Ansprechdauer oder “clinical benefit”.     

Ultraschallchirurgie des fortgeschrittenen Ovarialkarzinoms

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Operative Therapie des Ovarialkarzinoms

Ovarian carcinoma exhibits the highest rate of mortality among malignant genital tumors. This is usually the result of late diagnosis of the tumor in an advanced stage due to lack of early symptoms and inadequate facilities for early detection or screening. Frequently implantation metastases can be found early on in the peritoneum. Lymphatic invasion also occurs precociously, initially in the pelvic, then in the para-aortic lymph nodes. In contrast, formation of hematogenic metastases is rarely observed. Even in cases of early ovarian carcinoma in FIGO stages I and II, as a rule the necessary management includes hysterectomy and bilateral adnexectomy as well as extirpation of the two lymph node groups already mentioned. Treatment of advanced ovarian carcinoma (FIGO III and IV) is based on the most radical tumor resection possible followed by highly potent combination chemotherapy. The radicality of the surgical procedure is decisively important for the prognosis of patients with advanced ovarian carcinoma.     

Endokrine Therapie des Ovarialkarzinoms

Ovarian cancers express receptors for estrogens and gonadotropin-releasing hormone (GnRH) in 60% and 70% of cases, respectively. Therefore, they are candidates for endocrine treatment with tamoxifen, aromatase inhibitors (AI), and GNRH analogs. Tamoxifen and AI act by antagonizing tumoral estrogen receptors or by decreasing the estrogen plasma levels, respectively. GnRH analogs are very likely to act by binding to tumoral growth-promoting receptors for GnRH. Objective responses with endocrine treatment can be achieved in about 10% of the patients; disease stabilization occurs in 20% of cases. Major side effects have not been observed yet. All compounds have only been investigated in phase?II studies; however, it is unlikely that large phase?III studies will be performed for this indication. In heavily pretreated patients with advanced ovarian cancer-expressing receptors for estrogen or GnRH, endocrine treatment with tamoxifen, AI, and GnRH analogs is, therefore, a reasonable therapeutic strategy.     

Stellenwert des Gensondentests in der Routinediagnostik von Chlamydieninfektionen

Zusammenfassung Ein Gensondentest zum Nachweis von Chlamydia trachomatis (PACE^R 2, Genprobe, San Diege) wurde mit der Zellkultur als Standardmethode verglichen. Abstriche von 344 symtomatischen und asymptomatischen Patientinnen, 183 Abstriche von Cervix und Urethra und 161 Fimbrienabstriche, wurden untersucht Alle Abstrich, in denen in der Zellkultur Chlamydien nachgewiesen werden konnten, reagierten auch im Gensondentest positiv. Von den 20 Abstrichen, die im Gensondentest positiv reagierten, fiel die Zellkultur jedoch nur in 9 F?llen positiv aus. Bezogen auf die Zellkultur als Standardmethode ergab sich eine Sensitivit?t von 100% und eine Spezifit?t von 97,1%.