Geburtshilfe Frauenheilkd 2013; 73(3): 227-238
DOI: 10.1055/s-0032-1328302
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Aspects of Therapy for Cervical Cancer in Germany 2012 – Results from a Survey of German Gynaecological Hospitals

Aspekte der Therapie des Zervixkarzinoms in Deutschland 2012 – Ergebnisse einer Umfrage unter den deutschen Kliniken für Gynäkologie
M. Mangler
1   Gynecology, Charité, Berlin
,
N. Zech
2   Gynäkologie, Charité, Berlin
,
A. Schneider
2   Gynäkologie, Charité, Berlin
,
C. Köhler
2   Gynäkologie, Charité, Berlin
,
S. Marnitz
3   Radiotherapie, Charité, Berlin
› Institutsangaben
Weitere Informationen

Publikationsverlauf

received 08. Januar 2013
revised 24. Januar 2013

accepted 01. Februar 2013

Publikationsdatum:
04. April 2013 (online)

   Lizenzen und Reprints

Abstract

Introduction: In spite of the existence of guidelines and international recommendations, many aspects in the diagnosis, therapy and follow-up of patients with cervical cancer are not based on validated data. A broad spectrum of different opinions and procedures concerning the therapy for patients with cervical cancer is under controversial discussion by the responsible gynaecologists in German hospitals. Methods: The present study is intended to picture the current treatment situation for cervical cancer in Germany. For this purpose a specially developed questionnaire with questions divided into 19 subsections was sent to all 688 gynaecological hospitals in Germany. Results: The response rate to the questionnaire was 34 %. 91 % of the hospitals treated between 0 and 25 patients with cervical cancer per year. 7.5 % treated between 26 and 50 and 1.4 % of the hospitals more than 50 patients per year. The bimanual examination was the most frequently used staging method (98 %); PET-CT was the least used staging method (2.3 %). Interestingly 48 % of the hospitals used surgical staging. The great majority of the hospitals (71 %) used abdominal radical hysterectomy (Wertheim-Meigs operation) to treat their patients. TMMR via laparotomy was used by 13 %. 16 % of the hospitals performed laparoscopic or robot-assisted radical hysterectomies. The sentinel concept was hardly used even in the early stages. It must be emphasised that in 74 % of the hospitals radical hysterectomies were performed even in cases with positive pelvic lymph nodes and in 43 % also in cases with positive paraaortic lymph nodes. The therapy of choice for FIGO IIB cancers is primary radiochemotherapy (RCTX) in 21 % of the hospitals; operative staging followed by radiochemotherapy in 24 % and treatment by radical hysterectomy followed by adjuvant RCTX was employed in this situation by 46 % of the hospitals. In 15–97 % of the hospitals for node-negative and in sano resected patients in stage pT1B1/1B2 after radical hysterectomy, an adjuvant RCTX is recommended when further risk factors exist (LVSI, tumour > 4 cm, age < 40 years, adenocarcinoma, S3). Conclusion: A broad spectrum of differing staging and therapy concepts is in use for patients with cervical cancer in Germany. A standardisation of therapy is needed. An update of national guidelines could help to achieve more transparency and a standardisation of treatment for patients with cervical cancer.

Zusammenfassung

Einleitung: Trotz der vorhandenen Leitlinien und internationalen Empfehlungen fußen viele Aspekte der Diagnostik, Therapie und der Nachsorge von Patientinnen mit Zervixkarzinomen nicht auf validen Daten. Von den behandelnden Gynäkologen in den deutschen Kliniken wird ein breites Spektrum an verschiedenen Meinungen und Herangehensweisen an die Therapie der Zervixkarzinompatientinnen kontrovers diskutiert. Methoden: Die vorliegende Studie sollte die derzeitige Behandlungssituation des Zervixkarzinoms in Deutschland abbilden. Dazu wurde ein speziell dafür entwickelter Fragebogen, der Fragen zu 19 Teilbereichen abdeckte, an alle 688 deutschen Kliniken für Gynäkologie versandt. Resultate: Die Rücklaufrate der Fragebögen war 34 %. 91 % der Kliniken behandelten zwischen 0 und 25 Patientinnen mit Zervixkarzinomen pro Jahr. 7,5 % zwischen 26 und 50 und 1,4 % der Kliniken mehr als 50 Patientinnen/Jahr. Die bimanuelle Untersuchung war die am häufigsten eingesetzte Stagingmethode (98 %), das PET-CT wurde zum Staging am seltensten beansprucht (2,3 %). Interessanterweise setzten 48 % der Kliniken ein operatives Staging um. Die große Mehrheit der Kliniken (71 %) therapierte die Patientinnen per abdominaler radikaler Hysterektomie (Wertheim-Meigs-Operation). Die TMMR per Laparotomie wurde von 13 % eingesetzt, 16 % der Kliniken operierten laparoskopisch oder roboterassoziiert per radikaler Hysterektomie. Das Sentinel-Konzept wurde auch bei Frühstadien kaum verwandt. Hervorzuheben ist, dass in 74 % der Kliniken radikale Hysterektomien auch bei positiven pelvinen Lymphknoten und in 43 % auch bei positiven paraaortalen Lymphknoten durchgeführt wurden. Die Therapie der Wahl bei FIGO-IIB-Karzinomen war die primäre Radiochemotherapie (RCTX) in 21 % der Kliniken, ein operatives Staging gefolgt von einer Radiochemotherapie in 24 % und die Behandlung per radikaler Hysterektomie gefolgt von adjuvanter RCTX wurde in dieser Situation von 46 % der Kliniken umgesetzt. In 15–97 % der Kliniken wurde bei nodalnegativen und in sano resezierten Patientinnen nach radikaler Hysterektomie im Stadium pT1B1/1B2 eine adjuvante RCTX empfohlen, wenn weitere Risikofaktoren auftraten (LVSI, Tumor > 4 cm, Alter < 40 Jahre, Adenokarzinome, G3). Zusammenfassung: Ein breites Spektrum an verschiedenen Staging- und Therapiekonzepten bei Patientinnen mit Zervixkarzinom wird in Deutschland eingesetzt. Es bedarf einer Standardisierung der Therapie. Ein Update der nationalen Leitlinien kann helfen, mehr Klarheit und eine Standardisierung in die Behandlung von Patientinnen mit Zervixkarzinom zu bringen.

Key words

staging of cervical cancer - radiochemotherapy for cervical cancer - radical hysterectomy - questionnaire on treatment situation - therapeutic concepts - stage-dependent therapy

Schlüsselwörter

Staging bei Zervixkarzinom - Radiochemotherapie bei Zervixkarzinom - radikale Hysterektomie - Umfrage zur Behandlungssituation - Therapiekonzepte - stadienabhängige Therapie

Supporting Information

 

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