Gynecological Cancers: A Challenge of Individualized Therapy in the Adjuvant and Palliative Setting

in early stages. Most of the patients are older and have advanced stages at the time of diagnosis. But insufficient surgery leads to underestimation of tumor stage and a high load of tumor residues worsening the overall prognosis, as postsurgical chemotherapy cannot compensate for inadequate surgery. Locally advanced or relapsed cervical cancer is often associated with local complications such as infiltration of adjacent organs and fixation to the pelvic wall. Surgical approaches to this situation are usually confined to centrally located tumor masses after prior radiation therapy. Infiltration of the pelvic walls signified inoperability. A new promising method introduced by Höckel [5] is the laterally extended endopelvic resection (LEER) which offers better chances for long-term survival even in these cases. The broad spectrum of individualized tumor therapy demonstrated by the topics above show the importance of exact tumor staging in the adjuvant and palliative setting and the necessity to confine oncologic therapy to specialized centers with the required infrastructure and well-trained staff. Rolf Kreienberg, Ulm