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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Peter BaumannM. D.
Dept. of Obstetrics and Gynecology · Wayne State University/Detroit Medical Center
4707 St. Antoine Blvd
Detroit, MI 48201
USA
