Quelle:
Fachblatt The Lancet Oncology
Therapie
Gebärmutterhalskrebs: neue OP-Methode verbessert die
Überlebenschancen um bis zu 20%
Mit
Hilfe einer neuen, verfeinerten Operationsmethode konnte
eine Arbeitsgruppe um Professor Michael Höckel an der Universität
Leipzig zeigen, dass sich die Behandlungserfolge bei einem
Gebärmutterhalskrebs im Frühstadium deutlich optimieren
lassen. Mit Hilfe dieser Technik kam es zu weniger
Komplikationen, zu einem Rückgang der Sterblichkeit und
einem erniedrigten Risiko von lokalen Neuerkrankungen (lokale
Rezidive).
Im renommierten Fachblatt The Lancet stellten die
Forscher die Therapiemethode vor, die als
totale mesometriale Resektion (TMMR) bezeichnet
wird. Bei dieser Technik wird in der Umgebung des
Tumors gezielter weniger Gewebe operativ entfernt, so dass
die für viele Komplikationen verantwortliche Schädigung
des autonomen Nervensystems weitgehend vermieden wird. Die
Autoren der Studie vermieden auch die heute übliche postoperative
Bestrahlung, die selbst auch viele Komplikationen verursacht.
Insgesamt
zeigte sich, dass 96% der mit einer TMMR behandelten Patientinnen
die Operation 5 Jahre überlebten. Obgleich 63% der
Patientinnen in eine Hochrisiko-Gruppe einzuordnen waren,
kam es nur in 5% zu einem erneuten Auftreten des Tumors.
Das ist deutlich besser als die bei der normalen Standard-Therapie
zu beobachtenden 28%.
Bei Patientinnen mit bereits eingetretenem Lymphknotenbefall
lag die 5-Jahres-Überlebensrate bei 91% gegenüber den derzeit
üblichen 68-78%.
Die Leipziger Forscher kamen zu dem Fazit, dass die Überlebenschancen
der betroffenen Patientinnen mit Hilfe der TMMR -
und unter Verzicht auf die derzeit noch übliche Bestrahlung
- um 15-20% erhöht
werden können.
|
Die
vollständige englischsprachige Version dieser Studie
finden Sie
hier
THE LANCET ONCOLOGY: Press Release
NEW SURGICAL TECHNIQUE SHOWS PROMISING RESULTS FOR PATIENTS WITH
CERVICAL CANCER
A new surgical technique could allow surgeons to perform a radical
hysterectomy in patients with early-stage cervical cancer—with
fewer complications, reduced morbidity, and a lower risk of local
tumour recurrence than current surgical methods, according to an
Article published Online
first and in the July edition of The Lancet Oncology.
The technique, called total mesometrial resection (TMMR), is a modified
version of the traditional radical hysterectomy and involves more
accurate, anatomically based resection of the cancer to prevent
damage to the pelvic autonomic nervous system and to minimise surgical
trauma.
For over 100 years radical hysterectomy has been the standard surgical
treatment for early-stage cervical cancer. However, the procedure
has a relatively high rate of tumour recurrence and many patients
experience postoperative bladder and bowel dysfunction because of
damage to the autonomic nerve system. In addition, postoperative
radiotherapy—given as part of standard treatment—can
have considerable unpleasant side-effects.
Current surgical practice is to remove the pelvic tissue adjacent
to the tumour along with the cervix because of the risk of it harbouring
cervical cancer. However, it has been suggested that local tumour
spread may be restricted to the Müllerian compartment (fallopian
tubes, uterus, and proximal, middle vagina and their embryologically
defined mesotissues) for relatively long phases in its natural course,
and that the removal of the complete Müllerian compartment in early-stage
disease could improve local tumour control while reducing surgery-associated
morbidity.
To improve on traditional radical hysterectomy and to show that
the early stages of tumour growth are confined to the Müllerian
compartment, Michael Höckel and colleagues assessed the effectiveness
of TMMR without radiotherapy, in 212 patients with early-stage cervical
cancer between 1999 and 2008 at the University of Leipzig in Germany.
In this study, they report the histopathological tumour stages,
resection margins, local recurrence, surgical morbidity, and 5-year
outcomes of these patients.
Overall, findings showed recurrence-free survival of 94% and 5-year
survival of 96%, with low treatment-related disease. At a median
follow-up of 41 months only 10 patients had a recurrence of their
cancer.
In addition, although 63% (134 patients) had high-risk histopathologic
factors such as positive lymph-nodes and large tumour size, the
overall recurrence rate was only 5%. This is considerably
better than the 28% overall recurrence rate seen in similar patients
treated with the normal surgical technique of radical hysterectomy.
Indeed, the 5-year survival in patients with positive lymph-nodes
was 91%, compared with previous reports in similar patients of 68–78%.
Importantly, 132 (63%) patients had no treatment-related complications,
75 (35%) had grade 1 complications, just 20 (9%) of patients experienced
grade 2 complications, and no grade 3 or 4 complications were reported.
The authors say that: “Based on historical controls, TMMR
without adjuvant radiation has the potential to improve survival
by
15–20%.” They conclude by calling for further evaluation
of the technique with multi-institutional controlled trials.
Professor Michael Höckel, University of Leipzig, Leipzig, Germany.
michael.hoeckel(no
spam)uniklinik-leipzig.de
For full Article,
see:
http://press.thelancet.com/tlocervical.pdf
Martine Persico
Elsevier - The Lancet
360 Park Avenue South
New York, NY 10010
(F) 212-633-3913
E-mail: pressoffice@lancet.com
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