Radioonkologische Aspekte des Zervixkarzinoms

Chemoradiotherapy is an integral component of cervical cancer treatment in cases where surgery alone is not sufficient to achieve an optimal oncological outcome. The present German interdisciplinary guidelines on treatment of cervical cancer recommend performing either radical hysterectomy or primary chemoradiotherapy. The frequently used practice of trimodal therapy (i.e. radical hysterectomy, radiation and chemotherapy) doubles the risk for treatment-related delayed toxicity and should be avoided whenever possible. If risk factors are known prior to therapy, e.?g. lymph node metastases, parametrial infiltration or a combination of tumor size >4 cm, grade 3, lymphovascular space invasion (LVSI) or deep stromal infiltration, primary chemoradiotherapy should be recommended. The purely clinical FIGO classification does not consider lymph node involvement. This leads to a high rate of adjuvant chemoradiotherapy after radical surgery due to lymph node involvement. This could have been avoided in 90?% of patients, if surgical (laparoscopic) lymph node staging would have been used routinely. Whether this can result in advantages for patients with respect to the prognosis, was one of the aims of the Uterus-11 study of the working group for gynecological oncology (AGO) and the working group on radiological oncology (ARO).Mature data are expected to be available in 2018. For chemoradiotherapy sophisticated irradiation techniques should be used, which are available in all German treatment facilities. This is the only way to reduce acute and delayed side effects. Although ovarian preservation by ovarian transposition and organ sparing can be provided to premenopausal patients, a pregnancy after full-dose chemoradiotherapy is unlikely because of the resulting atrophy of the endometrium and fibrosis of the myometrium. Oncological results depend on treatment quality, full-dose external beam radiation, the use of brachytherapy and the administration of concomittant chemotherapy. The experience of the treatment facility is a predictor for patient outcome. The value of neoadjuvant chemotherapy in locally advanced cervical cancer is unclear and still under discussion.