Therapie der fortgeschrittenen Stadien des Seminoms (Stadien I und II A/B)

  • C. Clemm
Conference paper

Zusammenfassung

Nach den großen Erfolgen der Chemotherapie beim nichtseminomatösen Hodentumor, wird zunehmend beim Seminom die primäre Chemotherapie im fortgeschrittenen Stadium favorisiert. Die Remissionsraten liegen dabei zwischen 63–100% und scheinen, verglichen mit den Nicht-Seminomen, besser zu sein. Trotz einzelner Berichte über erfolgreiche Strahlentherapie beim “bulky” Seminom muß deshalb außerhalb von Studien ab dem Stadium IIC die primäre Chemotherapie empfohlen werden. Dabei zeigen die Ergebnisse mit den Kombinationstherapien PVB, PEB und VIP sehr gute Effektivität. Auch von Monotherapien mit Cisplatin oder Carboplatin werden Remissionsraten von annähernd 90% beschrieben, was aber noch in größeren Studien bestätigt werden muß. Es erscheint klar, daß eine ausgedehnte Vorbestrahlung vermieden werden sollte, da sie die Ergebnisse einer nachfolgenden Chemotherapie verschlechtert. Offen ist dagegen die Frage einer kombinierten Strahlen- und Chemotherapie ebenso wie die Indikation zur sekundären Operation.

Abstract

Because of the good results of chemotherapy in nonseminomatous testicular cancer, initial chemotherapy is increasingly recommended for “bulky” seminoma. The remission rate ranges between 63% and 100% and seems slightly superior to that for nonseminomas. Inspite of some favorable reports on radiotherapy in “bulky” seminoma, initial chemotherapy is advisable for seminoma stages IIC, III, and IV. Combination chemotherapy with PVB, PEB, and VIP leads to good results, with nearly 90% complete remission rates; similar results occur with monotherapy using cisplatin or carboplatin, although the latter has not been demonstrated in a large study. It seems clear that prior extensive radiotherapy makes the results of chemotherapy worse, and should be avoided. Whether chemo- and radiotherapy should be combined and the indications for secondary surgery need to be further clarified.

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Copyright information

© Springer-Verlag Berlin Heidelberg 1988

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  • C. Clemm

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