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Topisches Mitomycin C als Therapie konjunktivaler Tumore

Topical Mitomycin C as a therapy of conjunctival tumours

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Zusammenfassung

Die komplette Exzision mit tumorfreien Schnitträndern gilt sowohl bei der Therapie der Plattenepithelneoplasien als auch bei der Behandlung melanozytärer Neoplasien der Bindehaut als Therapie der Wahl. Dennoch ist bei diffuser Ausdehnung oder großen Tumoren eine komplette Exzision des Tumors im Gesunden nicht immer möglich. In diesem Fall sind alternative oder adjuvante Therapiemethoden notwendig. Die topische Chemotherapie mit Mitomycin C (MMC) gewinnt hierbei immer mehr an Bedeutung; die Vorteile bestehen vor allem in der guten Verträglichkeit und den geringen Nebenwirkungen.

Nach bisherigen Studienergebnissen stellt MMC bei Plattenepithelneoplasien der Bindehaut eine gute Therapieoption dar. Die positiven Ergebnisse müssen jedoch in großen Multizenterstudien mit Langzeitnachbeobachtungen bestätigt werden.

Melanozytäre Tumore der Bindehaut scheinen nicht so gut auf MMC anzusprechen. Bei einer primär erworbenen Melanose (PAM; „primary acquired melanosis“) kann MMC eine Therapieoption darstellen. Bei Verdacht auf ein malignes Melanom ist eine primäre Chemotherapie mit MMC jedoch obsolet. Es sollte hier allenfalls adjuvant eingesetzt werden, da sonst keine ausreichende Tumorkontrolle gewährleistet werden kann. Um die Wirksamkeit von MMC bei melanozytären Tumoren der Bindehaut abschließend bewerten zu können, sind weitere größere prospektive Studien nötig.

Abstract

Surgical excision with tumour free margins is the gold standard for squamous cell and melanocytic tumours of the conjunctiva. In cases of diffuse and extensive tumours a complete surgical excision is sometimes not possible. Therefore, alternative or adjuvant therapies are required. Topical chemotherapy with mitomycin C (MMC) is increasingly finding use in clinical practice. MMC has several advantages such as good tolerability and mild side effects. Present studies have shown that mitomycin C is a good option in squamous cell neoplasia of the conjunctiva. However, further multi-centre studies and long-term follow-up are needed.

The results in treating melanocytic tumours of the conjunctiva with MMC are less convincing. MMC seems to be an option for the treatment of primary acquired melanosis (PAM); but, if the tumour is suspicious for melanoma primary chemotherapy with MMC is obsolete. In these cases MMC can only be used as an adjuvant therapy, otherwise tumour control is not assured. However, prospective randomized controlled trials are necessary for a final evaluation of MMC therapy in melanocytic tumours of the conjunctiva.

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Abbreviations

MMC:

Mytomycin C

PAM:

„primary acquired melanosis“; primär erworbene Melanose

MM:

malignes Melanom

CIN:

konjunktivale intraepitheliale Neoplasie

PK:

Plattenepithelkarzinom

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  1. Zentrum für Augenheilkunde, Abteilung für Erkrankungen des vorderen Augenabschnittes, Universität Duisburg-Essen, 45122, Essen, Deutschland

    M. Schallenberg, N. Niederdräing, K.-P. Steuhl & D. Meller

  2. Universitätsaugenklinik Münster, Universitätsklinikum Münster, Münster, Deutschland

    M. Schallenberg

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  1. M. Schallenberg
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  2. N. Niederdräing
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Schallenberg, M., Niederdräing, N., Steuhl, KP. et al. Topisches Mitomycin C als Therapie konjunktivaler Tumore. Ophthalmologe 105, 777–784 (2008). https://doi.org/10.1007/s00347-008-1800-5

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