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Frauenheilkunde up2date 2018; 12(03): 255-269
DOI: 10.1055/a-0629-2022
Gynäkologische Onkologie
Georg Thieme Verlag KG Stuttgart · New York

Uterine Sarkome

Symptomatik und therapeutische Maßnahmen bei einer heterogenen Tumorentität
Dominik Denschlag
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Publication History

Publication Date:
19 July 2018 (online)

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Mit einer Inzidenz von 1,5 – 3/100 000 Einwohnern treten uterine Sarkome sehr selten auf. Die operative Primärtherapie beinhaltet die totale Hysterektomie und Adnexektomie beidseits. Danach schließt sich adjuvant nur bei hormonabhängigen „Low-Grade“-Tumoren und dem endometrialen Stromasarkom eine endokrine Therapie an. Bei Metastasen ist beim Leiomyosarkom und undifferenzierten endometrialen Stromasarkom eine palliative Chemotherapie indiziert.
Kernaussagen

Uterine Sarkome sind mit 3% aller Uterusmalignome sehr seltene maligne Neoplasien der Uterusmuskulatur bzw. des uterinen Bindegewebes. Bei fehlenden spezifischen Symptomen sind ein schnell wachsender Uterus in der Postmenopause und Blutungsstörungen bzw. Postmenopausenblutung verdächtig. Die Primärtherapie besteht in der Regel aus der Hysterektomie mit Adnexektomie.

In der Adjuvanz ist eine Chemotherapie beim Leiomyosarkom nicht und beim undifferenzierten endometrialen Stromasarkom fraglich indiziert. Alternativ kann, vor allem bei hormonabhängigen „Low-Grade“-Tumoren und dem endometrialen Stromasarkom, eine endokrine Therapie mit MPA oder Aromatasehemmern erfolgen. Eine adjuvante Radiatio kommt in der Regel nicht zum Einsatz.

In der Rezidivsituation von uterinen Sarkomen sollte primär die operative Komplettresektion zur Prognoseverbesserung angestrebt werden. In der metastasierten Situation ist beim Leiomyosarkom und undifferenzierten endometrialen Stromasarkom eine palliative Chemotherapie indiziert.

In der im August 2015 publizierten S2k-Leitlinie für uterine Sarkome ist erstmals für Deutschland eine Leitlinie für diese heterogene Tumorentität erstellt worden.

Schlüsselwörter

Leiomyosarkom - endometriales Stromasarkom - undifferenziertes uterines Sarkom - Therapie - adjuvante Therapie - Radiatio
 

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