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Endometriumkarzinom – operative Strategie und Adjuvanz

Ein möglicher Paradigmenwechsel

Endometrial cancer – operative strategy and adjuvant treatment

A possible paradigm shift

  • Gynäkologie aktuell
  • Published:
Der Gynäkologe Aims and scope

Zusammenfassung

In der Behandlung des Endometriumkarzinoms kommt der operativen Therapie unstrittig die zentrale Bedeutung zu. Die Hysterektomie mit beidseitiger Adnexektomie ist als Standard akzeptiert, zur Notwendigkeit einer höheren Radikalität sowohl in Bezug auf die Hysterektomie als auch die Indikationsstellung für eine pelvine und paraaortale Lymphonodektomie bei erhöhtem Rezidiv- und Metastasierungsrisiko dagegen, besteht weiterhin kein allgemeiner Konsens. Auf dem Boden einer sorgfältigen Analyse vorhandener Daten und neuer Erkenntnisse zum Ausbreitungsverhalten maligner Tumoren nehmen die Autoren eine subjektive Standortbestimmung vor und formulieren mögliche Die klassischen Behandlungsverfahren und deren Kombination werden in der internationalen NESTEC(Network Study in Endometrial Cancer)-Studie untersucht. Inwieweit sich das neue operative Konzept der radikalen Kompartment-basierten Operation (PMMR und therapeutische LNE) nach Höckel für eine Senkung lokoregionärer Rezidive auch des Endometriumkarzinoms eignet, muss ebenfalls prospektiv untersucht werden: Möglicherweise könnte die Radiatio aus der Primärtherapie vollständig herausgenommen werden und stünde so als lokoregionär hocheffektive Methode für eine Salvagetherapie beim Rezidiv zur Verfügung.

Abstract

The operative therapy indisputably plays the central role in the treatment of endometrial cancer. Hysterectomy with bilateral adnexectomy seems to be the accepted standard; however, this is contrasted by the necessity for greater radicality with respect to hysterectomy as well as indications for pelvic and para-aortic lymphadenectomy with an increased risk of recurrence and metastasis and is still a matter of intensive debate. This article presents a thorough assessment based on available data and a subjective estimation of the consequences for future therapeutic strategies. Different treatment strategies are currently investigated in the international network study in endometrial cancer (NESTEC); additional prospective trials should be carried out to evaluate whether radical compartment-based operations according to Höckel, e.g. partial mesometrial resection (PMMR) and therapeutic lymphadenectomy, are suitable for reducing local regional recurrences and also endometrial cancer. If this holds true radiation could be completely removed from the primary therapy and would then be available as a highly effective local and regional method for salvage therapy of recurrence.

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  1. Universitätsfrauenklinik Essen, Westdeutsches Tumorzentrum, Universität Duisburg-Essen, Duisburg-Essen, Deutschland

    R. Kimmig, B. Aktas & M. Heubner

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  1. R. Kimmig
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  2. B. Aktas
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  3. M. Heubner
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Correspondence to R. Kimmig.

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Kimmig, R., Aktas, B. & Heubner, M. Endometriumkarzinom – operative Strategie und Adjuvanz. Gynäkologe 46, 339–344 (2013). https://doi.org/10.1007/s00129-013-3185-z

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  • DOI: https://doi.org/10.1007/s00129-013-3185-z

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