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Patterns of care in patients with cervical cancer 2012

Results of a survey among German radiotherapy departments and out-patient health care centers

Aspekte der Therapie des Zervixkarzinoms in Deutschland 2012

Ergebnisse einer Umfrage unter strahlentherapeutischen Abteilungen und ambulante Kliniken

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Abstract

Background

Platinum-based primary or adjuvant chemoradiation is the treatment of choice for patients with cervical cancer. However, despite national guidelines and international recommendations, many aspects in diagnosis, therapy, and follow-up of patients with cervical cancer are not based on valid data.

Methods

To evaluate the current patterns of care for patients with cervical cancer in Germany, a questionnaire with 25 items was sent to 281 radiooncologic departments and out-patient health care centers.

Results

The response rate was 51 %. While 87 % of institutions treat 0–25 patients/year, 12 % treat between 26 and 50 and only 1 % treat more than 50 patients/year. In 2011, the stage distribution of 1,706 treated cervical cancers were IB1, IB2, IIA, IIB, IIIA/IIIB, and IV in 11, 12, 11, 22, 28, and 16 %, respectively. CT (90 %) and MRI (86 %) are mainly used as staging procedures in contrast to PET-CT with 14 %. Interestingly, 27 % of institutions advocate surgical staging prior to chemoradiation. In the majority of departments 3D-based (70 %) and intensity-modulated radiotherapy (76 %) are used for percutaneous radiation, less frequently volumetric arc techniques (26 %). Nearly all colleagues (99.3 %) apply conventional fractioning of 1.8–2 Gy for external-beam radiotherapy, in 19 % combined with a simultaneous integrated boost. Cisplatinum mono is used as a radiosensitizer with 40 mg/m2 weekly by 90 % of radiooncologists. For boost application in the primary treatment, HDR (high-dose rate) brachytherapy is the dominant technique (84 %). In patients after radical hysterectomy pT1B1/1B2, node negative and resection in sound margins adjuvant chemoradiation is applied due to the occurrence of 1–4 other risk factors in 16–97 %. There is a broad spectrum of recommended primary treatment strategies in stages IIB and IVA.

Conclusion

Results of the survey underline the leading role but also differences in the use of chemoradiation in the treatment of cervical cancer patients in Germany.

Zusammenfassung

Hintergrund

Die platinbasierte primäre oder adjuvante Radiochemotherapie zählt zur Therapie der Wahl bei der Behandlung von Patientinnen mit Zervixkarzinom. Trotz nationaler Leitlinien und internationale Empfehlungen basieren viele Aspekte der Diagnose, Therapie und des Follow-up nicht auf validen Daten.

Methoden

Um aktuelle Aspekte der Therapie bei Patientinnen mit einem Zervixkarzinom zu evaluieren, wurde 2012 ein Fragebogen mit 25 Positionen an 281 radioonkologische Kliniken und ambulante Zentren in ganz Deutschland gesandt.

Ergebnisse

Die Rücklaufrate des Fragebogens lag bei 51 %. Pro Jahr behandelten 87 % der Kliniken 0–25 Patientinnen, 12 % zwischen 26 und 50 und nur 1 % mehr als 50 Patientinnen. Im Befragungszeitraum 2011 war die Stadienverteilung von 1706 behandelten Frauen mit Zervixkarzinom folgendermaßen: FIGO IB1 11 %, IB2 12 %, IIA 11 %, IIB 22 %, IIIA/IIIB 28 % und IV 16 %. Zum Staging wurden hauptsächlich CT (90 %) und MRT (86 %) eingesetzt, seltener ein PET-CT (14 %). Interessanterweise empfahlen 27 % der radioonkologischen Kliniken ein chirurgisches Staging vor der Radiochemotherapie. In der Mehrzahl der befragten Abteilungen wurden 3-D-basierte (70 %) und intensitätsmodulierte (76 %) Konzepte zur perkutanen Radiatio eingesetzt, weniger häufig die „Volumetric Arc Technique“ (VMAT; 26 %). Fast alle Radioonkologen (99,3 %) applizierten konventionelle Fraktionen mit 1,8–2 Gy bei der EBRT, 19 % kombinierten diese mit einem simultanen Boost (SIB). 90 % der Radioonkologen setzten Cisplatin mono als Radiosensitizer ein mit wöchentlich 40 mg/m2. Zur Boost-Behandlung in der Primärtherapie wurde am häufigsten eine HDR-Brachytherapie eingesetzt (84 %). In den FIGO-Stadien 1B1/1B2 nach radikaler Hysterektomie wurde in 16–97 % trotz negativer Lymphknoten und freier Abtragungsebenen eine RCT angewandt, wenn 1–4 weitere intermediate Risikofaktoren auftraten. Für Patientinnen in den FIGO-Stadien IIB und IVA wird ein breites Therapiespektrum primär angewendet.

Schlussfolgerung

Die Ergebnisse der Befragung unterstreichen die Relevanz der primären Radiochemotherapie in der Therapie von Patientinnen mit Zevixkarzinom, aber sie demonstrieren auch den uneinheitlichen Einsatz der RCT in Deutschland.

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Acknowledgment

Authors thank to all colleagues who supported this survey.

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On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiooncology, Charité Universitätsmedizin, Augustenburger Platz 1, 13353, Berlin, Germany

    S. Marnitz M.D., A. Rauer & V. Budach M.D.

  2. Department of Gynecology, Charité Universitätsmedizin, Berlin, Germany

    C. Köhler M.D., A. Schneider M.D., M.P.H. & M. Mangler M.D.

  3. Department of Gynecologic Oncology, Barretos Cancer Centre, Barretos, Brazil

    A. Tsunoda M.D.

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  1. S. Marnitz M.D.
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Simone Marnitz and Christhardt Köhler contributed equally to this article.

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Marnitz, S., Köhler, C., Rauer, A. et al. Patterns of care in patients with cervical cancer 2012. Strahlenther Onkol 190, 34–40 (2014). https://doi.org/10.1007/s00066-013-0403-5

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