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Hat die Systemtherapie von Lymphknotenmetastasen einen kurativen Wert?

Can systemic treatment for lymph node metastases be given with curative intent?

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Zusammenfassung

Hat die Systemtherapie von Lymphknotenmetastasen einen kurativen Wert? Die Antwort auf diese Frage ist abhängig von der Tumorentität. Daher wollen wir einen Überblick geben über die Rolle der systemischen Therapie in der kurativen Behandlung lokal fortgeschrittener urologischer Karzinome, wie dem Keimzelltumor, dem Urothel-, Nierenzell- und Prostatakarzinom. Bei Keimzelltumoren ist eine Heilung durch alleinige Cisplatin-basierte Polychemotherapie möglich. Dies gilt auch für Hochrisikokonstellationen, in denen komplette Remissionen und Langzeitüberleben nach Polychemotherapie zu beobachten sind. Im Gegensatz dazu ist der Einsatz der Chemotherapie bei lokal fortgeschrittenen Urothelkarzinomen bisher auf die (neo)adjuvante Behandlung vor oder nach einer Tumorresektion begrenzt. Weitere klinische Studien sind jedoch notwendig, um diese Strategie zu festigen und optimieren.

Das Nierenzellkarzinom ist bisher nur chirurgisch heilbar. Zytokine und neue zielgerichtete Therapien eröffnen therapeutische Optionen im fortgeschrittenen Stadium. Ihre Rolle in der adjuvanten Situation nach Resektion von Hochrisikostadien wird zzt. in randomisierten Studien geprüft. Das Gleiche trifft für die antihormonelle Therapie des lokal fortgeschrittenen Prostatakarzinoms zu.

Zusammenfassend ist heutzutage durch die Systemtherapie Heilung beim fortgeschrittenen Keimzelltumor realisierbar. Ihre Rolle in allen anderen urologischen Karzinomen ist auf die palliative Behandlung nicht resektabler Stadien begrenzt. Ein möglicher Beitrag in der (neo)adjuvanten Situation ist derzeit Gegenstand der klinischen Forschung.

Abstract

Can systemic treatment for lymph node metastasis be given with curative intention? The answer to this question depends on the tumor entity. Therefore we want to give an overview about the role of systemic therapy in the curative treatment of locally advanced urological cancers, such as germ cell tumors, urothelial, renal cell, and prostate cancer. In the case of germ cell tumors cure can be achieved by platinum-based polychemotherapy without any additional treatment modality. This is also true for high-risk germ cell tumors, in which complete remissions and long-term survival are observed following polychemotherapy. In contrast, the role for chemotherapy in locally advanced urothelial cancers so far seems to be confined to (neo-)adjuvant treatment in concert with surgery. Further clinical trials are warranted to standardize and optimize this strategy.

So far, renal cell cancer can only be cured by surgery. Cytokines and novel targeted therapies provide a therapeutic option in advanced renal cell cancers. A possible role of the latter modality in adjuvant treatment following resection of high-risk renal cell cancer is currently being tested in randomized trials. The same is true for hormone ablation therapy in locally advanced prostate cancer.

In summary, as of today medical therapy can provide cure in advanced germ cell cancers. Its role in all other urological cancers is confined to palliative treatment of non-resectable disease. A possible contribution in the (neo-)adjuvant setting is presently a matter of clinical research.

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  1. Innere Klinik (Tumorforschung), Universitätsklinikum , Hufelandstraße 55, 45122, Essen, Deutschland

    T. Gauler & M. Schuler

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  1. T. Gauler
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  2. M. Schuler
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Correspondence to T. Gauler.

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Gauler, T., Schuler, M. Hat die Systemtherapie von Lymphknotenmetastasen einen kurativen Wert?. Urologe 48, 62–65 (2009). https://doi.org/10.1007/s00120-008-1763-9

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