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HIPEC (hypertherme intraoperative intraperitoneale Chemotherapie) bei Ovarialkarzinom

Stellenwert und aktuelle Studien

Hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) in ovarian cancer

Importance and current trials

  • Gynäkologie aktuell
  • Published:
Der Gynäkologe Aims and scope

Zusammenfassung

Hintergrund

Die Mehrzahl der Patientinnen mit Ovarialkarzinom (> 70 %) überlebt die ersten 5 Jahre nach Diagnosestellung nicht, obwohl das Ovarialkarzinom lange auf eine intraperitoneale Ausbreitung begrenzt und grundsätzlich Chemotherapie-sensibel ist. Das Konzept, eine lokale Therapie an das Peritoneum zu bringen, ist schlüssig und durch die Daten hinsichtlich der Wirksamkeit durch die intraperitoneale postoperative Chemotherapie hinreichend belegt. Da die adjuvante, wiederholte intraperitoneale Therapie mit signifikanten Komplikations- und Abbruchraten einhergeht, erscheint die Durchführung der einmaligen, intraoperativen intraperitonealen hyperthermen Chemotherapie (HIPEC) eine mögliche Alternative.

Aktuelle Situation und Fragestellung

Die Datenlage zur Therapie mit HIPEC ist im Wesentlichen auf kleine Fall-Kontroll-Studien begrenzt, offene Studien zur HIPEC sind bisher in Deutschland nicht verfügbar. In Deutschland führen mehr als 25 gynäkologische und chirurgische Zentren regelmäßig die HIPEC bei Ovarialkarzinompatientinnen durch. Gleichzeitig liegen weiterhin keine qualitativ hochwertigen Daten aus Phase-III-Studien zur Durchführung der HIPEC bei Patientinnen mit Ovarialkarzinom vor.

Fazit

Die Zahl der außerhalb von Studien mit HIPEC therapierten Patientinnen in Deutschland nimmt weiter zu, die Behandlung erfolgt in vielen deutschen und internationalen Zentren in nicht standardisierter Form. Eine prospektive Studie zum Einsatz der HIPEC unter kontrollierten Bedingungen ist daher dringend erforderlich

Abstract

Background

Although ovarian cancer is usually limited to intraperitoneal dissemination for a long time and is basically sensitive to chemotherapy the majority of patients with ovarian cancer (> 70 %) will not survive the first 5 years following diagnosis. The concept and effectiveness of using a local chemotherapy on the peritoneum has been conclusively and suficciently proven by the data on intraperitoneal postoperative chemotherapy. Since adjuvant, repeated intraperitoneal chemotherapy is associated with significant rates of complication and correlated discontinuation of treatment, a one-time hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) could be considered a possible alternative.

Current situation and objectives

The data on treatment of patients using HIPEC are essentially limited to small case control studies and open trials on HIPEC in Germany are not yet available. In Germany more than 25 gynecological and surgical centers regularly perform HIPEC in patients with ovarian cancer. At the same time there are still no high evidential phase III trial data on the use of HIPEC in patients with ovarian cancer.

Conclusion

The number of patients in Germany treated with HIPEC outside of clinical studies is increasing and treatment is carried out in many German and international centers in a non-standardized form. Therefore, prospective clinical trials on the use of HIPEC under standardized and controlled conditions are urgently needed.

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Authors and Affiliations

  1. Center for Integrated Oncology Köln Bonn, Universitätsfrauenklinik Bonn, Sigmund-Freud Straße 25, 53117, Bonn, Deutschland

    M.-D. Keyver-Paik, A. Abramian & W. Kuhn

  2. Campus Kiel, Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland

    N. Maass

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  1. M.-D. Keyver-Paik
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  2. A. Abramian
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  3. N. Maass
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  4. W. Kuhn
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Correspondence to M.-D. Keyver-Paik.

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M.-D. Keyver-Paik, A. Abramian, W. Kuhn und N. Maass geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Keyver-Paik, MD., Abramian, A., Maass, N. et al. HIPEC (hypertherme intraoperative intraperitoneale Chemotherapie) bei Ovarialkarzinom. Gynäkologe 48, 549–552 (2015). https://doi.org/10.1007/s00129-015-3737-5

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  • DOI: https://doi.org/10.1007/s00129-015-3737-5

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