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

作者：Mangler M^*; Zech N; Schneider A; Koehler C; Marnitz S

来源：Geburtshilfe und Frauenheilkunde, 2013, 73(3): 227-238.

DOI：10.1055/s-0032-1328302

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

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.

• 出版日期2013-3