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Endometriumkarzinom

Endometrial cancer

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Der Gynäkologe Aims and scope

An Erratum to this article was published on 01 March 2005

Zusammenfassung

Das operative Staging einschließlich der pelvinen und paraaortalen Lymphonodektomie (Ausnahme FIGO-Stadium Ia, G1, G2) stellt die wichtigste Komponente der Primärtherapie des Endometriumkarzinoms dar. Bei pN0 ist bei zusätzlichen Risikofaktoren (G2, G3, pT1b,c) eine vaginale Brachytherapie indiziert. Eine perkutane Teletherapie sollte gezielt bei nachgewiesenem Lymphknotenbefall (FIGO IIIc) durchgeführt werden. Bei Befall der Zervix (FIGO II) scheint die Durchführung einer erweiterten radikalen Hysterektomie von Vorteil zu sein. In fortgeschritteneren Stadien wird nach möglichst kompletter operativer Entfernung der Tumormanifestationen die adjuvante Strahlentherapie durch eine zusätzliche Chemotherapie ergänzt. Hier liegt aber noch Forschungsbedarf vor. Der Nutzen einer adjuvanten endokrinen Therapie konnte bisher nicht belegt werden. In der palliativen Situation sollten bei gut differenzierten und rezeptorpositiven Tumoren zunächst endokrine Therapien eingesetzt werden, sofern keine hohe Eilbedürftigkeit vorliegt. In allen anderen Fällen oder bei primärem Progress unter endokriner Therapie ist eine palliative Chemotherapie indiziert. Angesichts der unzureichenden Datenlage sollten auch Patientinnen mit Endometriumkarzinom möglichst in qualifizierten klinischen Studien behandelt werden.

Abstract

Surgical staging including pelvic and paraaortic lymph node dissection (except for FIGO stage IA, G1, G2) is the most important component of primary therapy of endometrial cancer. When retroperitoneal disease is excluded (pN0), a vaginal brachytherapy is indicated in G2 or G3 tumors or in stages pT1b,c. Percutaneous radiotherapy should be performed in pN+ cases (FIGO IIIc). A radical hysterectomy is probably of benefit in cases with cervical involvement (FIGO II). In more advanced stages, tumor lesions should be surgically removed. Adjuvant radiotherapy in advanced stages has been successfully supplemented with additional chemotherapy. A benefit of adjuvant endocrine therapies could not be demonstrated. In the palliative setting, endocrine therapies are the method of first choice when the tumor is well differentiated, expresses hormone receptors, and the lesions are not acutely life-threatening. In all other cases or primary progression under endocrine therapy, palliative chemotherapy is indicated. In view of the very limited data, patients with endometrial cancer should be treated in the context of qualified clinical trials.

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  1. Klinik für Gynäkologie und Geburtshilfe, Georg-August-Universität Göttingen

    V. Hanf, A. R. Günthert, T. Hawighorst & G. Emons

  2. Klinik für Gynäkologie und Geburtshilfe, Georg-August-Universität, Robert-Koch-Straße 40, 37075 , Göttingen

    G. Emons

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  1. V. Hanf
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  2. A. R. Günthert
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Correspondence to G. Emons.

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Ein Erratum zu diesem Beitrag können Sie unter http://dx.doi.org/10.1007/s00129-005-1664-6 finden.

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Hanf, V., Günthert, A.R., Hawighorst, T. et al. Endometriumkarzinom. Gynäkologe 37, 907–915 (2004). https://doi.org/10.1007/s00129-004-1593-9

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