Zusammenfassung
Vaginalkarzinome sind selten. Für die Behandlung steht seit November 2018 eine S2k-Leitlinie zur freien Verfügung über die AWMF(Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften)-Homepage. Diese Leitlinie fußt mangels Fallzahlen und Studien im Wesentlichen auf Expertenmeinungen der AGO(Arbeitsgemeinschaft Gynäkologische Onkologie)-Kommission Vulva und Vagina und methodisch auf dem Konsensusprozess der AWMF. Da auch in absehbarer Zukunft keine randomisierten Studien zu erwarten sind, soll mit Hilfe eines Nationalen Interdisziplinären Krebsregisters Vaginalkarzinom wissensgenerierende Versorgungsforschung an dieser seltenen onkologischen Entität betrieben werden. Die hier in Kurzform dargestellte Leitlinie bietet dazu die Rahmenbedingungen für die Diagnostik, Therapie und Nachsorge
Abstract
Vaginal cancer is a rare occurrence. Since November 2018 the S2k guidelines for the treatment are freely available from the homepage of the Association of the Scientific Medical Societies in Germany (AWMF). Due to the lack of case numbers and studies, these guidelines are essentially based on expert opinions of the committee on the vulva and vagina of the Working Group for Gynecological Oncology (AGO) and methodologically on the consensus process of the AWMF. As no randomized studies can be expected in the foreseeable future, healthcare research generating knowledge on this rare oncological entity should be carried out with the assistance of a national interdisciplinary cancer register for vaginal cancer. The short form of the guidelines presented in this article provide the framework conditions for the diagnostics, treatment and aftercare.
Literatur
Adams TS, Cuello MA (2018) Cancer of the vagina. Int J Gynaecol Obstet 143(Suppl 2):14–21
Alemany L, Saunier M, Tinoco L, Quirós B, Alvarado-Cabrero I, Alejo M, Joura EA, Maldonado P, Klaustermeier J, Salmerón J, Bergeron C, Petry KU, Guimerà N, Clavero O, Murillo R, Clavel C, Wain V, Geraets DT, Jach R, Cross P, Carrilho C, Molina C, Shin HR, Mandys V, Nowakowski AM, Vidal A, Lombardi L, Kitchener H, Sica AR, Magaña-León C, Pawlita M, Quint W, Bravo IG, Muñoz N, de Sanjosé S, Bosch FX, HPV VVAP study group (2014) Large contribution of human papillomavirus in vaginal neoplastic lesions: a worldwide study in 597 samples. Eur J Cancer 50:2846–2854
Al-Kurdi M, Monaghan JM (1981) Thirty-two years experience in management of primary tumours of the vagina. Br J Obstet Gynaecol 88:1145–1150
Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, Washington MK et al (Hrsg) (2017) AJCC cancer staging manual, 8. Aufl. Springer, New York, S 641–647
Baiocchi G, Guimaraes GC, Rosa Oliveira RA, Kumagai LY, Faloppa CC, Aguiar S, Begnami MD, Soares FA, Lopes A (2012) Prognostic factors in pelvic exenteration for gynecological malignancies. Eur J Surg Oncol 38:948–954
Benedetti Panici P, Bellati F, Plotti F, Di Donato V, Antonilli M, Perniola G, Manci N, Muzii L, Angioli R (2008) Neoadjuvant chemotherapy followed by radical surgery in patients affected by vaginal carcinoma. Gynecol Oncol 111:307–311
Benn T, Brooks RA, Zhang Q, Powell MA, Thaker PH, Mutch DG, Zighelboim I (2011) Pelvic exenteration in gynecologic oncology: a single institution study over 20 years. Gynecol Oncol 122:14–18
Crum CP, Herrington CS, McCluggage WG, Regauer S, Wilkinson EJ (2014) Epithelial tumors of the vulva. In: Kurman RJ, Carcangiu ML, Herrington CS, Young RH (Hrsg) WHO classification of tumours of the female reproductive tract. IARC Press, Lynon, S 233–242
Dalrymple JL, Russell AH, Lee SW, Scudder SA, Leiserowitz GS, Kinney WK, Smith LH (2004) Chemoradiation for primary invasive squamous carcinoma of the vagina. Int J Gynecol Cancer 14:110–117
Dannecker C, Strand V, Hegewisch-Becker S (2014) Nachsorge beim Vulva- und Vaginalkarzinom. Onkologe 20:355–357
Darragh TM, Colgan TJ, Cox JT, Heller DS, Henry MR, Luff RD, McCalmont T, Nayar R, Palefsky JM, Stoler MH, Wilkinson EJ, Zaino RJ, Wilbur DC (2013) The Lower Anogenital Squamous Terminology Standardization project for HPV-associated lesions: background and consensus recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology. Int J Gynecol Pathol 32:76–115
Deutsche Gesellschaft für Gynäkologie und Geburtshilfe, Österreichische Gesellschaft für Gynäkologie und Geburtshilfe, Schweizerische Gesellschaft für Gynäkologie und Geburtshilfe (2018) Diagnosis, therapy and follow-up of vaginal cancer and its precursors. S2k-level, AWMF registry no. 032/042. https://www.awmf.org/uploads/tx_szleitlinien/032-042k_S2k_Vaginalkarzinom-Vorstufen-Diagnostik-Therapie-Nachsorge_2019-03.pdf. Zugegriffen: 11.02.2020
Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (2015) Diagnosis, therapy, and follow-up care of vulvar cancer and its precursors. S2k-level, AWMF registry no. 015/059. http://www.awmf.org/leitlinien/detail/ll/015-059.html. Zugegriffen: 11.02.2020
Ferenzcy AS, Colgan TJ, Herrington CS, Hirschowitz L, Löning T, Park KJ, Stoler M, Wells M, Wilbur DC, Wright T (2014) Epitehlial tumors of the vagina. In: Kurman RJ, Carcangiu ML, Herrington CS, Young RH (Hrsg) WHO classification of tumours of the female reproductive tract. IARC Press, Lyon, S 210–217
Frega A, Sopracordevole F, Assorgi C, Lombardi D, De Sanctis V, Catalano A, Matteucci E, Milazzo GN, Ricciardi E, Moscarini M (2013) Vaginal intraepithelial neoplasia: a therapeutical dilemma. Anticancer Res 33:29–38
Frumovitz M, Gayed IW, Jhingran A, Euscher ED, Coleman RL, Ramirez PT, Levenback CF (2008) Lymphatic mapping and sentinel lymph node detection in women with vaginal cancer. Gynecol Oncol 108:478–481
Gadducci A, Fabrini MG, Lanfredini N, Sergiampietri C (2015) Squamous cell carcinoma of the vagina: natural history, treatment modalities and prognostic factors. Crit Rev Oncol Hematol 93:211–224
Gardner CS, Sunil J, Klopp AH, Devine CE, Sagebiel T, Viswanathan C, Bhosale PR (2015) Primary vaginal cancer: role of MRI in diagnosis, staging and treatment. Br J Radiol 88(1052):20150033. https://doi.org/10.1259/bjr.20150033
Gunderson CC, Nugent EK, Elfrink SH, Gold MA, Moore KN (2013) A contemporary analysis of epidemiology and management of vaginal intraepithelial neoplasia. Am J Obstet Gynecol 208:410.e411–410.e416
Gunderson CC, Nugent EK, Yunker AC, Rocconi RP, Graybill WS, Erickson BK, Moore KN (2013) Vaginal cancer: the experience from 2 large academic centers during a 15-year period. J Low Genit Tract Dis 17:409–413
Hertel H, Soergel P, Muecke J, Schneider M, Papendorf F, Laenger F, Gratz KF, Hillemanns P (2013) Is there a place for sentinel technique in treatment of vaginal cancer? Feasibility, clinical experience, and results. Int J Gynecol Cancer 23:1692–1698
Höckel M, Horn LC, Einenkel J (2012) (Laterally) extended endopelvic resection: surgical treatment of locally advanced and recurrent cancer of the uterine cervix and vagina based on ontogenetic anatomy. Gynecol Oncol 127:297–302
Horn LC, Schierle K, Schmidt D, Ulrich U, Liebmann A, Wittekind C (2011) Current TNM/FIGO classification for cervical and endometrial cancer as well as malignant mixed mullerian tumors. Facts and background. Pathologe 32:239–243
Horn LC, Schierle K (2009) Pathologie der Präkanzerosen und der Karzinome von Vulva und Vagina sowie morphologische Prognosefaktoren. Onkologe 15:15–27
Hyde SE, Valmadre S, Hacker NF, Schilthuis MS, Grant PT, van der Velden J (2007) Squamous cell carcinoma of the vulva with bulky positive groin nodes-nodal debulking versus full groin dissection prior to radiation therapy. Int J Gynecol Cancer 17:154–158
Kim JY, Lee KA, Kim BG, Bae DS, Lee JW (2013) Vaginal cancer with multiple liver and pulmonary metastases that achieved long-term survival. Obstet Gynecol Sci 56:416–419
Laliscia C, Fabrini MG, Delishaj D, Coraggio G, Morganti R, Tana R, Paiar F, Gadducci A (2016) Concomitant external-beam irradiation and chemotherapy followed by high-dose rate brachytherapy boost in the treatment of squamous cell carcinoma of the vagina: a single-center retrospective study. Anticancer Res 36:1885–1889
Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft DKH, AWMF) (2014) S3-Leitlinie Diagnostik, Therapie und Nachsorge der Patientin mit Zervixkarzinom, Langversion, 1.0, AWMF-Registernummer: 032/033OL
Lim MC, Bae J, Park JY, Lim S, Kang S, Seo SS, Kim JY, Rho JW, Park SY (2008) Experiences of pretreatment laparoscopic surgical staging in patients with locally advanced cervical cancer: results of a prospective study. J Gynecol Oncol 19:123–128
Lutz S, Berk L, Chang E, Chow E, Hahn C, Hoskin P, Howell D, Konski A, Kachnic L, Lo S, Sahgal A, Silverman L, von Gunten C, Mendel E, Vassil A, Bruner DW, Hartsell W (2011) Palliative radiotherapy for bone metastases: an ASTRO evidence-based guideline. Int J Radiat Oncol Biol Phys 79:965–976
Marnitz S, Köhler C, Roth C, Füller J, Bischoff A, Wendt T, Schneider A, Budach V (2007) Stage-adjusted chemoradiation in cervical cancer after transperitoneal laparoscopic staging. Strahlenther Onkol 183:473–478
Marnitz S, Köhler C, Roth C, Füller J, Hinkelbein W, Schneider A (2005) Is there a benefit of pretreatment laparoscopic transperitoneal surgical staging in patients with advanced cervical cancer? Gynecol Oncol 99:536–544
Nooij LS, Ongkiehong PJ, van Zwet EW, Bosse T, Creutzberg CL, Gaarenstroom KN, van Poelgeest MI (2015) Groin surgery and risk of recurrence in lymph node positive patients with vulvar squamous cell carcinoma. Gynecol Oncol 139:458–464
Oonk MH, de Hullu JA, Hollema H, Mourits MJ, Pras E, Wymenga AN, van der Zee AG (2003) The value of routine follow-up in patients treated for carcinoma of the vulva. Cancer 98:2624–2629
Peters WA 3rd, Kumar NB, Morley GW (1985) Microinvasive carcinoma of the vagina: a distinct clinical entity? Am J Obstet Gynecol 153:505–507
Plentl AA, Friedman EA (1971) Lymphatic system of the female genitalia. The morphologic basis of oncologic diagnosis and therapy. Major Probl Obstet Gynecol 2:1–223
Salani R, Backes FJ, Fung MF, Holschneider CH, Parker LP, Bristow RE, Goff BA (2011) Posttreatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncologists recommendations. Am J Obstet Gynecol 204:466–478
Schnürch H‑G, Ackermann S, Alt-Radtke CD, Angleitner L, Barinoff J, Beckmann MW, Böing C, Dannecker C, Fehm T, Gaase R, Gaß P, Gebhardt M, Gieseking F, Günthert A, Hack CC, Hantschmann P, Horn LC, Koch M, Letsch A, Mallmann P, Mangold B, Marnitz S, Mehlhorn G, Paradies K, Reinhardt MJ, Tholen R, Torsten U, Weikel W, Wölber L, Hampl M (2019) Diagnostik, Therapie und Nachsorge des Vaginalkarzinoms und seiner Vorstufen. Leitlinie der DGGG und der DKG (S2k-Level, AWMF Registry No. 032/042, Oktober 2018). Geburtshilfe Frauenheilkd 79:1060–1077
Smith SC, Koh WJ (2001) Palliative radiation therapy for gynaecological malignancies. Best Pract Res Clin Obstet Gynaecol 15:265–278
Waggoner SE, Mittendorf R, Biney N, Anderson D, Herbst AL (1994) Influence of in utero diethylstilbestrol exposure on the prognosis and biologic behavior of vaginal clear-cell adenocarcinoma. Gynecol Oncol 55:238–244
Wittekind C (2017) TNM-Klassifikation maligner Tumoren, 8. Aufl. Wiley-VCH, Weinheim, S 213–215
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H.-G. Schnürch gibt an, dass kein Interessenkonflikt besteht. M. Hampl erhielt/erhält Honorare und Reisekosten für Vorträge und Expertentätigkeit von den Firmen MSD, MD Horizonte, Gedeon Richter, Astra Zeneca, RG, Amedes und Honorar für Autorentätigkeit der Zeitschrift Omnimed, Gyn Praktische Geburtshilfe, Springer und Thieme Verlag.
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L. Kiesel, Münster
R. Kimmig, Essen
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Schnürch, HG., Hampl, M. Zur S2k-Leitlinie „Vaginalkarzinom“. Gynäkologe 53, 698–705 (2020). https://doi.org/10.1007/s00129-020-04619-x
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DOI: https://doi.org/10.1007/s00129-020-04619-x
Schlüsselwörter
- Sentinellymphknoten
- Vaginale Neoplasien
- Laserbehandlung
- Plattenepithelkarzinom der Vagina
- Plattenepitheliale intraepitheliale Läsionen