Lymphadenektomie beim limitierten Lymphknotenrezidiv des Prostatakarzinoms nach kurativer Lokaltherapie
Tóm tắt
Durch die moderne Bildgebung, insbesondere durch die Positronen-Emissions-Tomographie (PET), werden zunehmend vermeintlich isolierte Lymphknotenrezidive nach lokaler Therapie des Prostatakarzinoms nachgewiesen. Es stellt sich die Frage, ob durch eine Lymphadenektomie eine Verzögerung des Krankheitsprogresses möglich ist. Aus der Literatur und eigenen Erfahrungen wurden Aussagen zum Wert der PET/CT, zu perioperativen Komplikationen und zu onkologischen Ergebnissen abgeleitet. In 6 Studien wurde von 83 Patienten mit einer Lymphadenektomie wegen des Verdachts auf ein Lymphknotenrezidiv berichtet. Bei histologischer Bestätigung konnte für keinen Patienten eine Heilung erreicht werden. Beim Lymphknotenrezidiv des Prostatakarzinoms handelt es sich daher höchstwahrscheinlich um eine systemische Erkrankung und nicht um ein lokal begrenztes Tumorgeschehen. Im Falle eines PSA-Ansprechens nach der Lymphadenektomie ist in der Regel von einem progressionsfreien Intervall von unter 12 Monaten auszugehen. Insgesamt ist die Datenlage zu den onkologischen Ergebnissen des Eingriffs jedoch unzureichend, sodass die Lymphadenektomie beim Lymphknotenrezidiv bislang einem nicht bewiesenen Therapieansatz entspricht.
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