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Der Onkologe

, Volume 25, Issue 2, pp 171–184 | Cite as

Management des lokal fortgeschrittenen Zervixkarzinoms

  • Christof SchäferEmail author
  • Gabor Galli
  • Carsten Scholz
CME
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Zusammenfassung

Das lokal fortgeschrittene Zervixkarzinom erfordert eine besonders intensive interdisziplinäre Absprache. In der Definition des Stadiums spielen neben der klassischen FIGO-Einteilung (FIGO: „Fédération Internationale de Gynécologie et d’Obstétrique“) Risikofaktoren eine wichtige Rolle. Dabei ist der Lymphknotenstatus entscheidend. In frühen Stadien wird operativ vorgegangen, bei weiter fortgeschrittener Erkrankung bis hin zum Stadium IVA wird die Radiochemotherapie präferiert. In jedem Fall ist eine frühzeitige Besprechung innerhalb eines Tumorboards erforderlich. Kontroversen betreffen z. B. den Einsatz moderner bildgebender Verfahren, die Therapie bei befallenen paraaortalen Lymphknoten, den Stellenwert einer neoadjuvanten Chemotherapie und die Versuche, die klassische Radiochemotherapie mit Cisplatin zu intensivieren. Der Artikel gibt dazu einen Überblick, unter besonderer Berücksichtigung aktueller Studiendaten und unter Bezugnahme auf die derzeit gültigen Leitlinien.

Schlüsselwörter

Zervikale Neoplasmen Risikofaktoren Radiochemotherapie Operative Verfahren Neoadjuvante Therapie 

Management of locally advanced cervical cancer

Abstract

Locally advanced cervical cancer requires particularly intensive interdisciplinary consultation. In addition to the classical FIGO classification (FIGO: Fédération Internationale de Gynécologie et d’Obstétrique), risk factors play an important role in staging. The lymph node status is decisive here. In early stages, surgery is performed; in more advanced cases up to stage IVA, radiochemotherapy is preferred. In all cases, early consultation within a tumor board is necessary. Controversies concern, for example, use of modern imaging techniques, treatment of affected para-aortic lymph nodes, importance of neoadjuvant chemotherapy and attempts to intensify classical radiochemotherapy with cisplatin. The article provides an overview, taking into special consideration current study data and referring to the currently valid guidelines.

Keywords

Neoplasms, cervical Risk factors Chemoradiotherapy Surgical procedures, operative Neoadjuvant therapy 
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Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

C. Schäfer, G. Galli und C. Scholz geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    AWMF (2014) Onkologie. S3-Leitlinie: Diagnostik, Therapie und Nachsorge der Patientin mit Zervixkarzinom, Langversion, 1.0, 2014. AWMF-Registernummer: 032/033OLGoogle Scholar
  2. 2.
    Eifel P, Klopp AH (2017) Gynecologic radiation oncology: a practical guide. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  3. 3.
  4. 4.
    Marth C, Landoni F, Mahner S, McCormack M, Gonzalez-Martin A, Colombo N, ESMO Guidelines Committee (2017) Cervical cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 28(suppl 4):iv72–iv83CrossRefGoogle Scholar
  5. 5.
    Verma J, Monk BJ, Wolfson AH (2016) New strategies for multimodality therapy in treating locally advanced cervix cancer. Semin Radiat Oncol 26(4):344–348CrossRefGoogle Scholar
  6. 6.
    Sofic A, Husic-Selimovic A, Beslic N, Rasic A, Begic D, Tomic-Cica A, Imsirevic N (2017) Effects of treatment of uterine cervical carcinoma monitored by magnetic resonance imaging-Sarajevo experience. Acta Inform Med 25(1):39CrossRefGoogle Scholar
  7. 7.
    Ferrari M, Travaini LL, Ciardo D, Garibaldi C, Gilardi L, Glynne-Jones R, Leonardi MC et al (2017) Interim 18FDG PET/CT during radiochemotherapy in the management of pelvic malignancies: a systematic review. Crit Rev Oncol Hematol 113:28–42CrossRefGoogle Scholar
  8. 8.
    de Boer P, Jürgenliemk-Schulz IM, Westerveld H, de Leeuw AA, Dávila-Fajardo R, Rasch CR, Stalpers LJ et al (2017) Patterns of care survey: radiotherapy for women with locally advanced cervical cancer. Radiother Oncol 123(2):306–311CrossRefGoogle Scholar
  9. 9.
    Papadia A, Gasparri ML, Genoud S, Bernd K, Mueller MD (2017) The combination of preoperative PET/CT and sentinel lymph node biopsy in the surgical management of early-stage cervical cancer. J Cancer Res Clin Oncol 143(11):2275–2281CrossRefGoogle Scholar
  10. 10.
    Rose PG, Java J, Whitney CW, Stehman FB, Lanciano R, Thomas GM, DiSilvestro PA (2015) Nomograms predicting progression-free survival, overall survival, and pelvic recurrence in locally advanced cervical cancer developed from an analysis of identifiable prognostic factors in patients from NRG oncology/gynecologic oncology group randomized trials of chemoradiotherapy. J Clin Oncol 33(19):2136–2142CrossRefGoogle Scholar
  11. 11.
    Chen JLY, Huang CY, Huang YS, Chen RJ, Wang CW, Chen YH, Kuo SH et al (2014) Differential clinical characteristics, treatment response and prognosis of locally advanced adenocarcinoma/adenosquamous carcinoma and squamous cell carcinoma of cervix treated with definitive radiotherapy. Acta Obstet Gynecol Scand 93(7):661–668CrossRefGoogle Scholar
  12. 12.
    Karageorgopoulou S, Kostakis ID, Gazouli M, Markaki S, Papadimitriou M, Bournakis E, Papadimitriou CA et al (2017) Prognostic and predictive factors in patients with metastatic or recurrent cervical cancer treated with platinum-based chemotherapy. BMC Cancer 17(1):451CrossRefGoogle Scholar
  13. 13.
    Stiasny A, Freier CP, Kuhn C, Schulze S, Mayr D, Alexiou C, Kost BP et al (2017) The involvement of E6, p53, p16, MDM2 and Gal-3 in the clinical outcome of patients with cervical cancer. Oncol Lett 14(4):4467–4476CrossRefGoogle Scholar
  14. 14.
    Moreno-Acosta P, Vallard A, Carrillo S, Gamboa O, Romero-Rojas A, Molano M, Mestre MC et al (2017) Biomarkers of resistance to radiation therapy: a prospective study in cervical carcinoma. Radiat Oncol 12(1):120CrossRefGoogle Scholar
  15. 15.
    Lucia F, Visvikis D, Desseroit MC, Miranda O, Malhaire JP, Robin P, Schick U et al (2017) Prediction of outcome using pretreatment 18 F-FDG PET/CT and MRI radiomics in locally advanced cervical cancer treated with chemoradiotherapy. Eur J Nucl Med Mol Imaging.  https://doi.org/10.1007/s00259-017-3898-7 CrossRefPubMedGoogle Scholar
  16. 16.
    Frenel JS, Le Tourneau C, O’Neil B, Ott PA, Piha-Paul SA, Gomez-Roca C, Rangwala R et al (2017) Safety and efficacy of Pembrolizumab in advanced, programmed death ligand 1–positive cervical cancer: results from the phase Ib KEYNOTE-028 trial. J Clin Oncol 35(36):4035–4041CrossRefGoogle Scholar
  17. 17.
    Hollebecque A, Meyer T, Moore KN, Machiels JPH, De Greve J, López-Picazo JM, Kristeleit RS et al (2017) An open-label, multicohort, phase I/II study of nivolumab in patients with virus-associated tumors (CheckMate 358): efficacy and safety in recurrent or metastatic (R/M) cervical, vaginal, and vulvar cancers. J Clin Oncol.  https://doi.org/10.1200/jco.2017.35.15_suppl.5504 CrossRefGoogle Scholar
  18. 18.
    Marnitz S (2009) Treatment of locally advanced cervical cancer. New Armen Med J 3(3):35–37Google Scholar
  19. 19.
    Ward MC, Tendulkar RD, Videtic GM (Hrsg) (2017) Essentials of clinical radiation oncology. Springer, Heidelberg, Berlin, New YorkGoogle Scholar
  20. 20.
    Chéreau E, Feron JG, Ballester M, Coutant C, Bezu C, Rouzier R, Darai E et al (2012) Contribution of pelvic and para-aortic lymphadenectomy with sentinel node biopsy in patients with IB2–IIB cervical cancer. Br J Cancer 106(1):39CrossRefGoogle Scholar
  21. 21.
    Wu SG, Zhang WW, He ZY, Sun JY, Wang Y, Zhou J (2017) Comparison of survival outcomes between radical hysterectomy and definitive radiochemotherapy in stage IB1 and IIA1 cervical cancer. Cancer Manag Res 9:813CrossRefGoogle Scholar
  22. 22.
    National Comprehensive Cancer Network (2017) NCCN guidelines: cervical cancer, version 1.2017. NCCN, Fort WashingtonGoogle Scholar
  23. 23.
    Carlson JA, Rusthoven C, DeWitt PE, Davidson SA, Schefter TE, Fisher CM (2014) Are we appropriately selecting therapy for patients with cervical cancer? Longitudinal patterns-of-care analysis for stage IB–IIB cervical cancer. Int J Radiat Oncol Biol Phys 90(4):786–793CrossRefGoogle Scholar
  24. 24.
    Piver MS, Rutledge F, Smith JP (1974) Five classes of extended hysterectomy for women with cervical cancer. Obstet Gynecol 44(2):265–272PubMedGoogle Scholar
  25. 25.
    Höckel M, Dornhöfer N (2006) Pelvic exenteration for gynaecological tumours: achievements and unanswered questions. Lancet Oncol 7(10):837–847CrossRefGoogle Scholar
  26. 26.
    Höckel M (2008) Laterally extended endopelvic resection (LEER)—principles and practice. Gynecol Oncol 111(2):S13–S17CrossRefGoogle Scholar
  27. 27.
    ACS (2017) Survival rates for cervical cancer. https://www.cancer.org/cancer/cervical-cancer/detection-diagnosis-staging/survival.html (Erstellt: 4. Febr. 2018). Zugegriffen: 9.1.2019Google Scholar
  28. 28.
    Macdonald OK, Chen J, Dodson M, Lee CM, Gaffney DK (2009) Prognostic significance of histology and positive lymph node involvement following radical hysterectomy in carcinoma of the cervix. Am J Clin Oncol 32(4):411–416CrossRefGoogle Scholar
  29. 29.
    Schmidt AM, Imesch P, Fink D, Egger H (2012) Indications and long-term clinical outcomes in 282 patients with pelvic exenteration for advanced or recurrent cervical cancer. Gynecol Oncol 125(3):604–609CrossRefGoogle Scholar
  30. 30.
    Meng XY, Liao Y, Liu XP, Li S, Shi MJ, Zeng XT (2016) Concurrent cisplatin-based chemoradiotherapy versus exclusive radiotherapy in high-risk cervical cancer: a meta-analysis. OncoTargets Ther 9:1875CrossRefGoogle Scholar
  31. 31.
    Wang W, Hou X, Yan J, Shen J, Lian X, Sun S, Qiu J et al (2017) Outcome and toxicity of radical radiotherapy or concurrent chemoradiotherapy for elderly cervical cancer women. BMC Cancer 17(1):510CrossRefGoogle Scholar
  32. 32.
    Song S, Rudra S, Hasselle MD, Dorn PL, Mell LK, Mundt AJ, Hasan Y et al (2013) The effect of treatment time in locally advanced cervical cancer in the era of concurrent chemoradiotherapy. Cancer 119(2):325–331CrossRefGoogle Scholar
  33. 33.
    Gandhi AK, Sharma DN, Rath GK, Julka PK, Subramani V, Sharma S, Thulkar S et al (2013) Early clinical outcomes and toxicity of intensity modulated versus conventional pelvic radiation therapy for locally advanced cervix carcinoma: a prospective randomized study. Int J Radiat Oncol Biol Phys 87(3):542–548CrossRefGoogle Scholar
  34. 34.
    Cheng JY, Huang EY, Hsu SN, Wang CJ (2016) Simultaneous integrated boost (SIB) of the parametrium and cervix in radiotherapy for uterine cervical carcinoma: a dosimetric study using a new alternative approach. Br J Radiol 89(1068):20160526CrossRefGoogle Scholar
  35. 35.
    Naik A, Gurjar OP, Gupta KL, Singh K, Nag P, Bhandari V (2016) Comparison of dosimetric parameters and acute toxicity of intensity-modulated and three-dimensional radiotherapy in patients with cervix carcinoma: a randomized prospective study. Cancer Radiother 20(5):370–376CrossRefGoogle Scholar
  36. 36.
    Poorvu PD, Sadow CA, Townamchai K, Damato AL, Viswanathan AN (2013) Duodenal and other gastrointestinal toxicity in cervical and endometrial cancer treated with extended-field intensity modulated radiation therapy to paraaortic lymph nodes. Int J Radiat Oncol Biol Phys 85(5):1262–1268CrossRefGoogle Scholar
  37. 37.
    Duenas-González A, Zarbá JJ, Patel F, Alcedo JC, Beslija S, Casanova L, Orlando M et al (2011) Phase III, open-label, randomized study comparing concurrent gemcitabine plus cisplatin and radiation followed by adjuvant gemcitabine and cisplatin versus concurrent cisplatin and radiation in patients with stage IIB to IVA carcinoma of the cervix. J Clin Oncol 29(13):1678–1685CrossRefGoogle Scholar
  38. 38.
    Cihoric N, Tsikkinis A, Badra EV, Glatzer M, Novak U, Scherz A, Lössl K et al (2017) Highly conformal combined radiotherapy with cisplatin and gemcitabine for treatment of loco-regionally advanced cervical cancer—a retrospective study. Radiat Oncol 12(1):202CrossRefGoogle Scholar
  39. 39.
    Niibe Y, Onda T, Matsuo K, Inoue Y, Hayakawa K (2017) Phase II study of concurrent chemoradiotheapy using nedaplatin for locally advanced uterine cervical carcinoma (KGROG0501): final results. Anticancer Res 37(12):6983–6988PubMedGoogle Scholar
  40. 40.
    Nam EJ, Lee M, Yim GW, Kim JH, Kim S, Kim SW, Kim YT et al (2013) Comparison of carboplatin-and cisplatin-based concurrent chemoradiotherapy in locally advanced cervical cancer patients with morbidity risks. Oncologist 18(7):843–849CrossRefGoogle Scholar
  41. 41.
    Cetina L, Rivera L, Candelaria M, de la Garza J, Dueñas-González A (2004) Chemoradiation with gemcitabine for cervical cancer in patients with renal failure. Anticancer Drugs 15(8):761–766CrossRefGoogle Scholar
  42. 42.
    Roberts KB, Urdaneta N, Vera R, Vera A, Gutierrez E, Aguilar Y, Sartorelli AC et al (2000) Interim results of a randomized trial of mitomycin C as an adjunct to radical radiotherapy in the treatment of locally advanced squamous-cell carcinoma of the cervix. Int J Cancer 90(4):206–223CrossRefGoogle Scholar
  43. 43.
    Kumar L, Gupta S (2016) Integrating chemotherapy in the management of cervical cancer: a critical appraisal. Oncology 91(Suppl. 1):8–17CrossRefGoogle Scholar
  44. 44.
    Gandhi AK (2016) Novel agents and treatment techniques to enhance radiotherapeutic outcomes in carcinoma of the uterine cervix. Ann Transl Med 4(3):49PubMedPubMedCentralGoogle Scholar
  45. 45.
    Osman M (2014) The role of neoadjuvant chemotherapy in the management of locally advanced cervix cancer: a systematic review. Oncol Rev.  https://doi.org/10.4081/oncol.2014.250 CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Marnitz S (2015) NeoAdjuvant chemotherapy followed by radical hysterectomy (OP) versus primary chemo-radiation in cervical cancer FIGO stage IB2 and IIB (NACOPRAD). https://clinicaltrials.gov/ct2/show/study/NCT02422563#contacts (Erstellt: 15. Febr. 2017). Zugegriffen: 9.1.2019Google Scholar
  47. 47.
    Angioli R, Plotti F, Montera R, Aloisi A, Luvero D, Capriglione S, Benedetti-Panici P et al (2012) Neoadjuvant chemotherapy plus radical surgery followed by chemotherapy in locally advanced cervical cancer. Gynecol Oncol 127(2):290–296CrossRefGoogle Scholar
  48. 48.
    Wang N, Li WW, Li JP, Liu JY, Zhou YC, Zhang Y, Shi M et al (2014) Comparison of concurrent chemoradiotherapy followed by radical surgery and high-dose-rate intracavitary brachytherapy: a retrospective study of 240 patients with FIGO stage IIB cervical carcinoma. Onco Targets Ther 7:91CrossRefGoogle Scholar
  49. 49.
    Tewari KS, Sill MW, Long HJ III, Penson RT, Huang H, Ramondetta LM, Michael HE et al (2014) Improved survival with bevacizumab in advanced cervical cancer. N Engl J Med 370(8):734–743CrossRefGoogle Scholar
  50. 50.
    Tewari KS, Sill MW, Penson RT, Huang H, Ramondetta LM, Landrum LM, DiSaia PJ et al (2017) Bevacizumab for advanced cervical cancer: final overall survival and adverse event analysis of a randomised, controlled, open-label, phase 3 trial (Gynecologic Oncology Group 240). Lancet 390(10103):1654–1663CrossRefGoogle Scholar
  51. 51.
    Sturdza A, Hofmann S, Kranawetter M, Polterauer S, Grimm C, Krainer M, Schwameis R et al (2017) Increased genitourinary fistula rate after bevacizumab in recurrent cervical cancer patients initially treated with definitive radiochemotherapy and image-guided adaptive brachytherapy. Erhöhte urogenitale Fistelrate nach Bevacizumab bei Patientinnen mit rezidiviertem Zervixkarzinom nach primärer Behandlung mit definitiver Radiochemotherapie und bildgesteuerter adaptiver Brachytherapie. Strahlenther Onkol 193(12):1056–1065CrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  • Christof Schäfer
    • 1
    Email author
  • Gabor Galli
    • 2
  • Carsten Scholz
    • 3
  1. 1.Fachbereich StrahlentherapieMVZ Klinikum Straubing GmbHStraubingDeutschland
  2. 2.Sektion OnkologieKlinikum Straubing GmbHStraubingDeutschland
  3. 3.Klinik für Gynäkologie und GeburtshilfeKlinikum Straubing GmbHStraubingDeutschland

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