Zusammenfassung
Da das Endometriumkarzinom meist in den Frühstadien entdeckt und dann chirurgisch
ausreichend therapiert wird, kommen Hormon- und Chemotherapie fast ausschließlich
in der palliativen Situation zur Anwendung. Primär sollten dabei die Möglichkeiten
der gut verträglichen Hormontherapie mit den zur Verfügung stehenden Gestagenen (Medroxyprogesteronacetat,
Megestrolacetat) ausgeschöpft werden. Daneben sind in Einzelfällen auch Tamoxifen
oder GnRH-Analoga einsetzbar. Die Ansprechraten sind relativ gering (max. 25 %) und
die Remissionsdauern meist kurz. Für die adjuvante Hormontherapie gibt es bisher keine
Indikation. - Auch der Nutzen einer adjuvanten Chemotherapie bei Patientinnen mit
High-risk-Endometriumkarzinom ist nicht belegt. In Einzelfällen mit hohem Risiko (serös-papillärer
Histologie, extrauteriner Ausbreitung) kann postoperativ vor oder nach der Bestrahlung
eine adjuvante Chemotherapie erwogen werden. Dabei sind das Alter und die Begleitmorbidität
der Patientin zu berücksichtigen. Letztlich bestimmend für die Prognose ist die stadienadaptierte
Operation auch bei älteren und adipösen Frauen. - Bisher haben die verschiedenen Chemotherapien
beim disseminierten Endometriumkarzinom keinen entscheidenden Durchbruch erzielt.
Die empfohlene Standardkombination bleibt bis auf weiteres Cisplatin/Doxorubicin.
Die wichtigste Wirkstoffgruppe sind dabei die Anthracycline. Durch eine Monotherapie
mit Doxo- oder Epirubicin lassen sich bei besserer Verträglichkeit befriedigende Behandlungsergebnisse
erzielen. Zur Zeit wird in einer multizentrischen Phase-II-Studie die Verträglichkeit
und Wirksamkeit von Docetaxel wöchentlich beim rezidivierten oder metastasierten Endometriumkarzinom
geprüft.
Summary
Endometrial cancer is usually diagnosed at an early stage where surgery alone is the
adequate therapy. Chemotherapy and hormonal treatment are therefore almost exclusively
performed in palliative situations. Hormonal treatment with progestogens (medroxyprogesterone
acetate and megestrol acetate) should be the therapy of choice primarily as these
drugs are very well tolerated. Tamoxifen and GnRH analogs are further options but
are seldom used. The response rates to hormonal treatment are relatively low (max.
25 %) with short remissions in most cases. - So far neither hormonal treatment nor
cytotoxic chemotherapy has been shown to have substantial benefits in the adjuvant
setting. In some selected high risk cases (serous papillary carcinomas, extra uterine
manifestation) adjuvant chemotherapy may be an option following surgery, before or
after radiotherapy. Age, general condition and morbidity of the patients need to be
considered as limiting factors for chemotherapy. Crucial for the prognosis of all
endometrial cancer patients however, is the stage adapted surgery. - Cytotoxic chemotherapy
has failed to bring a break through in the therapy of advanced endometrial cancer.
Cisplatin plus doxorubicin is the standard combination to date, with anthracyclines
being the more important component. In a mono-therapy setting, doxorubicin and epirubicin
are well tolerated and convenient in their efficacy. For recurrent and metastatic
disease, docetaxel is being evaluated for efficacy and side effects in a multicenter
phase II trial.
Schlüsselwörter
Endometriumkarzinom - Hormontherapie - Chemotherapie - Prognose
Key words
Endometrial cancer - Hormonal therapy - Chemotherapy - Prognosis
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PD Dr. T. Krauß
Universitäts-Frauenklinik Göttingen
Robert Koch-Str. 40
D-37075 Göttingen
Phone: +49-551/396576
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Email: tkrauss@med.uni-goettingen.de
