Zusammenfassung
Da das Endometriumkarzinom meist in den Frühstadien entdeckt und dann chirurgisch ausreichend therapiert wird, kommen Hormon- und Chemotherapie fast ausschließlich in der palliativen Situation zur Anwendung. Primär sollten dabei die Möglichkeiten der gut verträglichen Hormontherapie mit den zur Verfügung stehenden Gestagenen (Medroxyprogesteronacetat, Megestrolacetat) ausgeschöpft werden. Daneben sind in Einzelfällen auch Tamoxifen oder GnRH-Analoga einsetzbar. Die Ansprechraten sind relativ gering (max. 25 %) und die Remissionsdauern meist kurz. Für die adjuvante Hormontherapie gibt es bisher keine Indikation. - Auch der Nutzen einer adjuvanten Chemotherapie bei Patientinnen mit High-risk-Endometriumkarzinom ist nicht belegt. In Einzelfällen mit hohem Risiko (serös-papillärer Histologie, extrauteriner Ausbreitung) kann postoperativ vor oder nach der Bestrahlung eine adjuvante Chemotherapie erwogen werden. Dabei sind das Alter und die Begleitmorbidität der Patientin zu berücksichtigen. Letztlich bestimmend für die Prognose ist die stadienadaptierte Operation auch bei älteren und adipösen Frauen. - Bisher haben die verschiedenen Chemotherapien beim disseminierten Endometriumkarzinom keinen entscheidenden Durchbruch erzielt. Die empfohlene Standardkombination bleibt bis auf weiteres Cisplatin/Doxorubicin. Die wichtigste Wirkstoffgruppe sind dabei die Anthracycline. Durch eine Monotherapie mit Doxo- oder Epirubicin lassen sich bei besserer Verträglichkeit befriedigende Behandlungsergebnisse erzielen. Zur Zeit wird in einer multizentrischen Phase-II-Studie die Verträglichkeit und Wirksamkeit von Docetaxel wöchentlich beim rezidivierten oder metastasierten Endometriumkarzinom geprüft.
Summary
Endometrial cancer is usually diagnosed at an early stage where surgery alone is the adequate therapy. Chemotherapy and hormonal treatment are therefore almost exclusively performed in palliative situations. Hormonal treatment with progestogens (medroxyprogesterone acetate and megestrol acetate) should be the therapy of choice primarily as these drugs are very well tolerated. Tamoxifen and GnRH analogs are further options but are seldom used. The response rates to hormonal treatment are relatively low (max. 25 %) with short remissions in most cases. - So far neither hormonal treatment nor cytotoxic chemotherapy has been shown to have substantial benefits in the adjuvant setting. In some selected high risk cases (serous papillary carcinomas, extra uterine manifestation) adjuvant chemotherapy may be an option following surgery, before or after radiotherapy. Age, general condition and morbidity of the patients need to be considered as limiting factors for chemotherapy. Crucial for the prognosis of all endometrial cancer patients however, is the stage adapted surgery. - Cytotoxic chemotherapy has failed to bring a break through in the therapy of advanced endometrial cancer. Cisplatin plus doxorubicin is the standard combination to date, with anthracyclines being the more important component. In a mono-therapy setting, doxorubicin and epirubicin are well tolerated and convenient in their efficacy. For recurrent and metastatic disease, docetaxel is being evaluated for efficacy and side effects in a multicenter phase II trial.
Schlüsselwörter
Endometriumkarzinom - Hormontherapie - Chemotherapie - Prognose
Key words
Endometrial cancer - Hormonal therapy - Chemotherapy - Prognosis
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PD Dr. T. Krauß
Universitäts-Frauenklinik Göttingen
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