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Moderne Konzepte in der Behandlung des Endometriumkarzinoms

Modern therapy concepts for endometrial cancer

  • Schwerpunkt: Pathologie des Endometriums
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Zusammenfassung

Das Endometriumkarzinom wird meist im frühen Stadium symptomatisch und hat eine günstige Prognose. Die traditionelle Therapie bestand in der abdominalen Hysterektomie mit beidseitiger Adnexexstirpation. Hiermit werden die frühen, gut differenzierten Stadien (endometrioid, pT1a, pT1b; G1, G2) wahrscheinlich gut therapiert. Bei höheren Stadien, höherem Grading und vor allem bei den Typ-II-Karzinomen (serös, klarzellig) ist diese Therapie inadäquat. Der Nutzen einer systematischen pelvinen und paraaortalen Lymphonodektomie in dieser Situation muss jedoch prospektiv evaluiert werden. Eine perkutane Strahlentherapie des Beckens verbessert im Stadium I und II zwar die lokale Kontrolle, hat aber keinen positiven Effekt auf das Überleben. Eine vergleichbare Verbesserung der lokalen Kontrolle wird, bei erheblich weniger Nebenwirkungen, auch durch eine Brachytherapie der Scheide erreicht. Eine adjuvante Chemotherapie ist beim Endometriumkarzinom wahrscheinlich wirksam. Der Einsatz einer alleinigen adjuvanten Chemotherapie oder die Kombination mit Brachy- und/oder Teletherapie muss prospektiv evaluiert werden.

Abstract

Most cases of endometrial cancer (EC) become symptomatic at an early stage and have a good prognosis. EC has been traditionally treated with total abdominal hysterectomy plus bilateral salpingo-oophorectomy. For early stage, low grade cases (endometrioid, pT1a, pT1b; G1, G2) this is adequate therapy. For higher stages and grades, especially for type II EC (serous, clear cell) this therapy is insufficient. The efficacy of systematic pelvic and paraaortic lymphadenectomy for high risk EC, however, remains to be evaluated. External pelvic radiotherapy has been shown to improve local control in stage I and II EC, but has no positive effect on survival. A comparable improvement of local control can be achieved by vaginal brachytherapy with significantly less toxicity. Adjuvant chemotherapy is probably efficacious in EC. Its usefulness as exclusive adjuvant therapy or in combination with brachytherapy and/or external beam therapy remains to be evaluated by prospective trials.

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  1. Klinik für Gynäkologie und Geburtshilfe, Georg-August-Universität Göttingen, Robert-Koch-Str. 40, 37075 , Göttingen, Deutschland

    G. Emons, M. Hellriegel & T. Hawighorst

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  1. G. Emons
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  2. M. Hellriegel
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  3. T. Hawighorst
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Correspondence to G. Emons.

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Emons, G., Hellriegel, M. & Hawighorst, T. Moderne Konzepte in der Behandlung des Endometriumkarzinoms. Pathologe 30, 268–273 (2009). https://doi.org/10.1007/s00292-009-1149-9

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  • DOI: https://doi.org/10.1007/s00292-009-1149-9

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