Behandlungsstrategien beim Endometriumkarzinom

Zusammenfassung

Der Brennpunkt dieser Arbeit ist auf die Kontroversen in der Behandlungsstruktur des Endometrium-Karzinoms gerichtet, dem am weitesten verbreiteten Malignom des weiblichen Genitaltraktes. Es werden aktuelle Behandlungsrichtlinien, insbesondere die Bedeutung des operativen stagings, diskutiert und kurz die gegenwärtig laufenden prospektiv-randomisierten Studien beschrieben. Konkrete Behandlungsempfehlungen finden sich in den beigefügten Tabellen. Adenokarzinome stellen die Mehrheit der Karzinome des Endometriums dar. Papillär-seröse Karzinome und das klarzellige Karzinom repräsentieren demgegenüber 1-10 % der Karzinome des Endometriums. Während Adenokarzinome mit „Stahl und Strahl” behandelt werden können, ist die Identifizierung angemessener Behandlungsmodalitäten für Patientinnen mit papillär-serösen und klarzelligen Karzinomen und schlechter Prognose von kritischer Bedeutung. Untersuchungen zum Stellenwert der Strahlentherapie oder Chemotherapie sind aufgrund der beobachteten kleinen Fallzahlen und heterogener Behandlungsmodalitäten nur von begrenzter Aussagefähigkeit. Auf die einzelne Patientin abzustellende Behandlungsstrategien hängen von begleitenden Risikofaktoren ab, in erster Linie aber davon, ob die Patientin einem operativen staging unterzogen wurde. Grenzüberschreitende, kooperative, prospektiv randomisierte Studien sind notwendig, um offene Fragen zu beantworten.

Abstract

This paper focuses on the controversies surrounding management of endometrial cancer, the most common carcinoma of the female genital tract. We discuss current management strategies, especially the importance of surgical staging and briefly describe ongoing prospective randomized trials. Actual treatment suggestions are attached as tables. Adenocarcinomas represent the majority of endometrial cancers. In contrast, papillary-serous and clear cell carcinomas comprise 1-10 % of endometrial cancers. While adenocarcinomas may well be treated by surgery and radiation therapy, identifying appropriate treatment modalities for patients with papillary-serous and clear cell carcinoma and poor prognosis is of critical importance. Data on radiation therapy or chemotherapy, to date, are of limited value secondary to small sample sizes and the heterogeneous treatment modalities that many times were applied. Individualized treatment strategies have to take into account accompanying co-morbidities, more importantly, though, whether the patient underwent surgical staging. Co-operative, prospective randomized trials across borders are needed more than ever to answer remaining questions.

Schlüsselwörter

Endometrium-Karzinom - operatives staging - Chemotherapie - Strahlentherapie

Key words

Endometrial cancer - surgical staging - radiation therapy - chemotherapy

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