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Emons G, Steiner E, Vordermark D, Uleer C, Paradies K, Tempfer C, Aretz S, Cremer W, Hanf V, Mallmann P, Ortmann O, Römer T, Schmutzler RK, Horn LC, Kommoss S, Lax S, Schmoeckel E, Mokry T, Grab D, Reinhardt M, Steinke-Lange V, Brucker SY, Kiesel L, Witteler R, Fleisch MC, Friedrich M, Höcht S, Lichtenegger W, Mueller M, Runnebaum I, Feyer P, Hagen V, Juhasz-Böss I, Letsch A, Niehoff P, Zeimet AG, Battista MJ, Petru E, Widhalm S, van Oorschot B, Panke JE, Weis J, Dauelsberg T, Haase H, Beckmann MW, Jud S, Wight E, Prott FJ, Micke O, Bader W, Reents N, Henscher U, Schallenberg M, Rahner N, Mayr D, Kreißl M, Lindel K, Mustea A, Strnad V, Goerling U, Bauerschmitz GJ, Langrehr J, Neulen J, Ulrich UA, Nothacker MJ, Blödt S, Follmann M, Langer T, Wenzel G, Weber S, Erdogan S. Endometrial Cancer. Guideline of the DGGG, DKG and DKH (S3-Level, AWMF Registry Number 032/034-OL, September 2022). Part 1 with Recommendations on the Epidemiology, Screening, Diagnosis and Hereditary Factors of Endometrial Cancer, Geriatric Assessment and Supply Structures. Geburtshilfe Frauenheilkd 2023; 83:919-962. [PMID: 37588260 PMCID: PMC10427205 DOI: 10.1055/a-2066-2051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/22/2023] [Indexed: 08/18/2023] Open
Abstract
Summary The S3-guideline on endometrial cancer, first published in April 2018, was reviewed in its entirety between April 2020 and January 2022 and updated. The review was carried out at the request of German Cancer Aid as part of the Oncology Guidelines Program and the lead coordinators were the German Society for Gynecology and Obstetrics (DGGG), the Gynecology Oncology Working Group (AGO) of the German Cancer Society (DKG) and the German Cancer Aid (DKH). The guideline update was based on a systematic search and assessment of the literature published between 2016 and 2020. All statements, recommendations and background texts were reviewed and either confirmed or amended. New statements and recommendations were included where necessary. Aim The use of evidence-based risk-adapted therapies to treat women with endometrial cancer of low risk prevents unnecessarily radical surgery and avoids non-beneficial adjuvant radiation therapy and/or chemotherapy. For women with endometrial cancer and a high risk of recurrence, the guideline defines the optimum level of radical surgery and indicates whether chemotherapy and/or adjuvant radiation therapy is necessary. This should improve the survival rates and quality of life of these patients. The S3-guideline on endometrial cancer and the quality indicators based on the guideline aim to provide the basis for the work of certified gynecological cancer centers. Methods The guideline was first compiled in 2018 in accordance with the requirements for S3-level guidelines and was updated in 2022. The update included an adaptation of the source guidelines identified using the German Instrument for Methodological Guideline Appraisal (DELBI). The update also used evidence reviews which were created based on selected literature obtained from systematic searches in selected literature databases using the PICO process. The Clinical Guidelines Service Group was tasked with carrying out a systematic search and assessment of the literature. Their results were used by interdisciplinary working groups as a basis for developing suggestions for recommendations and statements which were then modified during structured online consensus conferences and/or additionally amended online using the DELPHI process to achieve a consensus. Recommendations Part 1 of this short version of the guideline provides recommendations on epidemiology, screening, diagnosis, and hereditary factors. The epidemiology of endometrial cancer and the risk factors for developing endometrial cancer are presented. The options for screening and the methods used to diagnose endometrial cancer are outlined. Recommendations are given for the prevention, diagnosis, and therapy of hereditary forms of endometrial cancer. The use of geriatric assessment is considered and existing structures of care are presented.
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Affiliation(s)
- Günter Emons
- Universitätsmedizin Göttingen, Klinik für Gynäkologie und Geburtshilfe, Göttingen, Germany
| | - Eric Steiner
- Frauenklinik GPR Klinikum Rüsselsheim am Main, Rüsselsheim, Germany
| | - Dirk Vordermark
- Universität Halle (Saale), Radiotherapie, Halle (Saale), Germany
| | - Christoph Uleer
- Facharzt für Frauenheilkunde und Geburtshilfe, Hildesheim, Germany
| | - Kerstin Paradies
- Konferenz onkologischer Kranken- und Kinderkrankenpfleger (KOK), Hamburg, Germany
| | - Clemens Tempfer
- Frauenklinik der Ruhr-Universität Bochum, Bochum/Herne, Germany
| | - Stefan Aretz
- Institut für Humangenetik, Universität Bonn, Zentrum für erbliche Tumorerkrankungen, Bonn, Germany
| | | | - Volker Hanf
- Frauenklinik Nathanstift – Klinikum Fürth, Fürth, Germany
| | | | - Olaf Ortmann
- Universität Regensburg, Fakultät für Medizin, Klinik für Frauenheilkunde und Geburtshilfe, Regensburg, Germany
| | - Thomas Römer
- Evangelisches Klinikum Köln Weyertal, Gynäkologie Köln, Köln, Germany
| | - Rita K. Schmutzler
- Universitätsklinikum Köln, Zentrum Familiärer Brust- und Eierstockkrebs, Köln, Germany
| | | | - Stefan Kommoss
- Universitätsklinikum Tübingen, Universitätsfrauenklinik Tübingen, Tübingen, Germany
| | - Sigurd Lax
- Institut für Pathologie, LKH Graz Süd-West, Graz, Austria
| | | | - Theresa Mokry
- Universitätsklinikum Heidelberg, Diagnostische und Interventionelle Radiologie, Heidelberg, Germany
| | - Dieter Grab
- Universitätsklinikum Ulm, Frauenheilkunde und Geburtshilfe, Ulm, Germany
| | - Michael Reinhardt
- Klinik für Nuklearmedizin, Pius Hospital Oldenburg, Oldenburg, Germany
| | - Verena Steinke-Lange
- MGZ – Medizinisch Genetisches Zentrum München, München, Germany
- Medizinische Klinik und Poliklinik IV, LMU München, München, Germany
| | - Sara Y. Brucker
- Universitätsklinikum Tübingen, Universitätsfrauenklinik Tübingen, Tübingen, Germany
| | - Ludwig Kiesel
- Universitätsklinikum Münster, Frauenklinik A Schweitzer Campus 1, Münster, Germany
| | - Ralf Witteler
- Universitätsklinikum Münster, Frauenklinik A Schweitzer Campus 1, Münster, Germany
| | - Markus C. Fleisch
- Helios, Universitätsklinikum Wuppertal, Landesfrauenklinik, Wuppertal, Germany
| | | | - Michael Friedrich
- Helios Klinikum Krefeld, Klinik für Frauenheilkunde und Geburtshilfe, Krefeld, Germany
| | - Stefan Höcht
- XCare, Praxis für Strahlentherapie Saarlouis, Saarlouis, Germany
| | - Werner Lichtenegger
- Universitätsmedizin Berlin, Frauenklinik Charité, Campus Virchow-Klinikum, Berlin, Germany
| | - Michael Mueller
- Universitätsklinik für Frauenheilkunde, Inselspital Bern, Bern, Switzerland
| | | | - Petra Feyer
- Vivantes Klinikum Neukölln, Klinik für Strahlentherapie und Radioonkologie, Berlin, Germany
| | - Volker Hagen
- Klinik für Innere Medizin II, St.-Johannes-Hospital Dortmund, Dortmund, Germany
| | | | - Anne Letsch
- Universitätsklinikum Schleswig Holstein, Campus Kiel, Innere Medizin, Kiel, Germany
| | - Peter Niehoff
- Strahlenklinik, Sana Klinikum Offenbach, Offenbach, Germany
| | - Alain Gustave Zeimet
- Medizinische Universität Innsbruck, Universitätsklinik für Gynäkologie und Geburtshilfe, Innsbruck, Austria
| | | | - Edgar Petru
- Med. Univ. Graz, Frauenheilkunde, Graz, Austria
| | | | - Birgitt van Oorschot
- Universitätsklinikum Würzburg, Interdisziplinäres Zentrum Palliativmedizin, Würzburg, Germany
| | - Joan Elisabeth Panke
- Medizinischer Dienst des Spitzenverbandes Bund der Krankenkassen e. V. Essen, Essen, Germany
| | - Joachim Weis
- Albert-Ludwigs-Universität Freiburg, Medizinische Fakultät, Tumorzentrum Freiburg – CCCF, Freiburg, Germany
| | - Timm Dauelsberg
- Universitätsklinikum Freiburg, Klinik für Onkologische Rehabilitation, Freiburg, Germany
| | | | | | | | - Edward Wight
- Frauenklinik des Universitätsspitals Basel, Basel, Switzerland
| | - Franz-Josef Prott
- Facharzt für Radiologie und Strahlentherapie, Wiesbaden, Wiesbaden, Germany
| | - Oliver Micke
- Franziskus Hospital Bielefeld, Klinik für Strahlentherapie und Radioonkologie, Bielefeld, Germany
| | - Werner Bader
- Klinikum Bielefeld Mitte, Zentrum für Frauenheilkunde, Bielefeld, Germany
| | | | | | | | | | | | - Doris Mayr
- LMU München, Pathologisches Institut, München, Germany
| | - Michael Kreißl
- Universität Magdeburg, Medizinische Fakultät, Universitätsklinik für Radiologie und Nuklearmedizin, Germany
| | - Katja Lindel
- Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Alexander Mustea
- Universitätsklinikum Bonn, Zentrum Gynäkologie und gynäkologische Onkologie, Bonn, Germany
| | - Vratislav Strnad
- Universitätsklinikum Erlangen, Brustzentrum Franken, Erlangen, Germany
| | - Ute Goerling
- Universitätsmedizin Berlin, Campus Charité Mitte, Charité Comprehensive Cancer Center, Berlin, Germany
| | - Gerd J. Bauerschmitz
- Universitätsmedizin Göttingen, Klinik für Gynäkologie und Geburtshilfe, Göttingen, Germany
| | - Jan Langrehr
- Martin-Luther-Krankenhaus, Klinik für Allgemein-, Gefäß- und Viszeralchirurgie, Berlin, Germany
| | - Joseph Neulen
- Uniklinik RWTH Aachen, Klinik für Gynäkologische Endokrinologie und Reproduktionsmedizin, Aachen, Germany
| | - Uwe Andreas Ulrich
- Martin-Luther-Krankenhaus, Johannesstift Diakonie, Gynäkologie, Berlin, Germany
| | | | | | - Markus Follmann
- Deutsche Krebsgesellschaft, Office des Leitlinienprogramms Onkologie, Berlin, Germany
| | - Thomas Langer
- Deutsche Krebsgesellschaft, Office des Leitlinienprogramms Onkologie, Berlin, Germany
| | - Gregor Wenzel
- Deutsche Krebsgesellschaft, Office des Leitlinienprogramms Onkologie, Berlin, Germany
| | - Sylvia Weber
- Universitätsmedizin Göttingen, Klinik für Gynäkologie und Geburtshilfe, Göttingen, Germany
| | - Saskia Erdogan
- Universitätsmedizin Göttingen, Klinik für Gynäkologie und Geburtshilfe, Göttingen, Germany
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Chiofalo B, Mazzon I, Di Angelo Antonio S, Amadore D, Vizza E, Laganà AS, Vocaturo G, Calagna G, Favilli A, Palmara V, Maranto M, Vitale SG, Cucinella G, Granese R, Ghezzi F, Sperduti I, Triolo O. Hysteroscopic Evaluation of Endometrial Changes in Breast Cancer Women with or without Hormone Therapies: Results from a Large Multicenter Cohort Study. J Minim Invasive Gynecol 2019; 27:832-839. [PMID: 31425735 DOI: 10.1016/j.jmig.2019.08.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/30/2019] [Accepted: 08/04/2019] [Indexed: 10/26/2022]
Abstract
STUDY OBJECTIVE The primary aim of our study was to investigate the incidence of endometrial pathologies, especially endometrial cancer, in women with breast cancer treated with tamoxifen (TAM), aromatase inhibitors (AIs), or receiving no treatment (NT). The secondary aim was to identify, in this cohort, ultrasonographic findings that represent robust indications for hysteroscopy and endometrial biopsy, to avoid unnecessary second-level diagnostic procedures. DESIGN Multicenter retrospective cohort study (Clinical Trial ID: NCT03898947). SETTING Data were collected from different Italian centers: Regina Elena National Cancer Institute of Rome, Arbor Vitae Centre of Rome, Gaetano Martino University Hospital of Messina, and Villa Sofia-Cervello Hospital of Palermo. PATIENTS We selected and consecutively included patients with a history of breast cancer who had undergone hysteroscopy for ultrasonographic or clinical indications between January 2007 and December 2016. INTERVENTIONS Diagnostic hysteroscopy with endometrial biopsy or operative hysteroscopy, when clinically indicated. MEASUREMENTS AND MAIN RESULTS A higher percentage of patients in the TAM and AI groups had a normal endometrium compared with those in the NT group, whereas the incidence of endometrial polyps was higher in the NT group than in the others; no significant differences were observed among the 3 groups for other benign conditions or for premalignant and malignant uterine diseases, such as endometrial atypical hyperplasia and adenocarcinoma. CONCLUSION TAM treatment does not seem to be associated with a higher rate of endometrial cancer in women with breast cancer compared with women treated with AIs or NT.
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Affiliation(s)
- Benito Chiofalo
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Drs. Chiofalo, Vizza, and Vocaturo); Arbor Vitae Centre, Nuova Villa Claudia Clinic, Rome, Italy (Drs. Mazzon and Di Angelo Antonio); Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University of Messina, Messina, Italy (Drs. Amadore, Palmara, Granese, and Triolo); Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy (Drs. Laganà and Ghezzi); Gynecology and Obstetrics Unit, Villa Sofia-Cervello Hospital, University of Palermo, Palermo, Italy (Drs. Calagna, Maranto, and Cucinella); Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy (Dr. Favilli); Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy (Dr.Vitale); Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Dr. Sperduti)
| | - Ivano Mazzon
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Drs. Chiofalo, Vizza, and Vocaturo); Arbor Vitae Centre, Nuova Villa Claudia Clinic, Rome, Italy (Drs. Mazzon and Di Angelo Antonio); Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University of Messina, Messina, Italy (Drs. Amadore, Palmara, Granese, and Triolo); Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy (Drs. Laganà and Ghezzi); Gynecology and Obstetrics Unit, Villa Sofia-Cervello Hospital, University of Palermo, Palermo, Italy (Drs. Calagna, Maranto, and Cucinella); Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy (Dr. Favilli); Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy (Dr.Vitale); Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Dr. Sperduti)
| | - Silvia Di Angelo Antonio
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Drs. Chiofalo, Vizza, and Vocaturo); Arbor Vitae Centre, Nuova Villa Claudia Clinic, Rome, Italy (Drs. Mazzon and Di Angelo Antonio); Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University of Messina, Messina, Italy (Drs. Amadore, Palmara, Granese, and Triolo); Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy (Drs. Laganà and Ghezzi); Gynecology and Obstetrics Unit, Villa Sofia-Cervello Hospital, University of Palermo, Palermo, Italy (Drs. Calagna, Maranto, and Cucinella); Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy (Dr. Favilli); Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy (Dr.Vitale); Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Dr. Sperduti)
| | - Donatella Amadore
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Drs. Chiofalo, Vizza, and Vocaturo); Arbor Vitae Centre, Nuova Villa Claudia Clinic, Rome, Italy (Drs. Mazzon and Di Angelo Antonio); Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University of Messina, Messina, Italy (Drs. Amadore, Palmara, Granese, and Triolo); Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy (Drs. Laganà and Ghezzi); Gynecology and Obstetrics Unit, Villa Sofia-Cervello Hospital, University of Palermo, Palermo, Italy (Drs. Calagna, Maranto, and Cucinella); Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy (Dr. Favilli); Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy (Dr.Vitale); Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Dr. Sperduti)
| | - Enrico Vizza
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Drs. Chiofalo, Vizza, and Vocaturo); Arbor Vitae Centre, Nuova Villa Claudia Clinic, Rome, Italy (Drs. Mazzon and Di Angelo Antonio); Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University of Messina, Messina, Italy (Drs. Amadore, Palmara, Granese, and Triolo); Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy (Drs. Laganà and Ghezzi); Gynecology and Obstetrics Unit, Villa Sofia-Cervello Hospital, University of Palermo, Palermo, Italy (Drs. Calagna, Maranto, and Cucinella); Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy (Dr. Favilli); Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy (Dr.Vitale); Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Dr. Sperduti)
| | - Antonio Simone Laganà
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Drs. Chiofalo, Vizza, and Vocaturo); Arbor Vitae Centre, Nuova Villa Claudia Clinic, Rome, Italy (Drs. Mazzon and Di Angelo Antonio); Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University of Messina, Messina, Italy (Drs. Amadore, Palmara, Granese, and Triolo); Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy (Drs. Laganà and Ghezzi); Gynecology and Obstetrics Unit, Villa Sofia-Cervello Hospital, University of Palermo, Palermo, Italy (Drs. Calagna, Maranto, and Cucinella); Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy (Dr. Favilli); Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy (Dr.Vitale); Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Dr. Sperduti).
| | - Giuseppe Vocaturo
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Drs. Chiofalo, Vizza, and Vocaturo); Arbor Vitae Centre, Nuova Villa Claudia Clinic, Rome, Italy (Drs. Mazzon and Di Angelo Antonio); Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University of Messina, Messina, Italy (Drs. Amadore, Palmara, Granese, and Triolo); Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy (Drs. Laganà and Ghezzi); Gynecology and Obstetrics Unit, Villa Sofia-Cervello Hospital, University of Palermo, Palermo, Italy (Drs. Calagna, Maranto, and Cucinella); Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy (Dr. Favilli); Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy (Dr.Vitale); Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Dr. Sperduti)
| | - Gloria Calagna
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Drs. Chiofalo, Vizza, and Vocaturo); Arbor Vitae Centre, Nuova Villa Claudia Clinic, Rome, Italy (Drs. Mazzon and Di Angelo Antonio); Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University of Messina, Messina, Italy (Drs. Amadore, Palmara, Granese, and Triolo); Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy (Drs. Laganà and Ghezzi); Gynecology and Obstetrics Unit, Villa Sofia-Cervello Hospital, University of Palermo, Palermo, Italy (Drs. Calagna, Maranto, and Cucinella); Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy (Dr. Favilli); Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy (Dr.Vitale); Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Dr. Sperduti)
| | - Alessandro Favilli
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Drs. Chiofalo, Vizza, and Vocaturo); Arbor Vitae Centre, Nuova Villa Claudia Clinic, Rome, Italy (Drs. Mazzon and Di Angelo Antonio); Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University of Messina, Messina, Italy (Drs. Amadore, Palmara, Granese, and Triolo); Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy (Drs. Laganà and Ghezzi); Gynecology and Obstetrics Unit, Villa Sofia-Cervello Hospital, University of Palermo, Palermo, Italy (Drs. Calagna, Maranto, and Cucinella); Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy (Dr. Favilli); Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy (Dr.Vitale); Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Dr. Sperduti)
| | - Vittorio Palmara
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Drs. Chiofalo, Vizza, and Vocaturo); Arbor Vitae Centre, Nuova Villa Claudia Clinic, Rome, Italy (Drs. Mazzon and Di Angelo Antonio); Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University of Messina, Messina, Italy (Drs. Amadore, Palmara, Granese, and Triolo); Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy (Drs. Laganà and Ghezzi); Gynecology and Obstetrics Unit, Villa Sofia-Cervello Hospital, University of Palermo, Palermo, Italy (Drs. Calagna, Maranto, and Cucinella); Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy (Dr. Favilli); Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy (Dr.Vitale); Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Dr. Sperduti)
| | - Marianna Maranto
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Drs. Chiofalo, Vizza, and Vocaturo); Arbor Vitae Centre, Nuova Villa Claudia Clinic, Rome, Italy (Drs. Mazzon and Di Angelo Antonio); Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University of Messina, Messina, Italy (Drs. Amadore, Palmara, Granese, and Triolo); Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy (Drs. Laganà and Ghezzi); Gynecology and Obstetrics Unit, Villa Sofia-Cervello Hospital, University of Palermo, Palermo, Italy (Drs. Calagna, Maranto, and Cucinella); Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy (Dr. Favilli); Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy (Dr.Vitale); Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Dr. Sperduti)
| | - Salvatore Giovanni Vitale
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Drs. Chiofalo, Vizza, and Vocaturo); Arbor Vitae Centre, Nuova Villa Claudia Clinic, Rome, Italy (Drs. Mazzon and Di Angelo Antonio); Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University of Messina, Messina, Italy (Drs. Amadore, Palmara, Granese, and Triolo); Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy (Drs. Laganà and Ghezzi); Gynecology and Obstetrics Unit, Villa Sofia-Cervello Hospital, University of Palermo, Palermo, Italy (Drs. Calagna, Maranto, and Cucinella); Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy (Dr. Favilli); Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy (Dr.Vitale); Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Dr. Sperduti)
| | - Gaspare Cucinella
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Drs. Chiofalo, Vizza, and Vocaturo); Arbor Vitae Centre, Nuova Villa Claudia Clinic, Rome, Italy (Drs. Mazzon and Di Angelo Antonio); Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University of Messina, Messina, Italy (Drs. Amadore, Palmara, Granese, and Triolo); Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy (Drs. Laganà and Ghezzi); Gynecology and Obstetrics Unit, Villa Sofia-Cervello Hospital, University of Palermo, Palermo, Italy (Drs. Calagna, Maranto, and Cucinella); Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy (Dr. Favilli); Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy (Dr.Vitale); Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Dr. Sperduti)
| | - Roberta Granese
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Drs. Chiofalo, Vizza, and Vocaturo); Arbor Vitae Centre, Nuova Villa Claudia Clinic, Rome, Italy (Drs. Mazzon and Di Angelo Antonio); Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University of Messina, Messina, Italy (Drs. Amadore, Palmara, Granese, and Triolo); Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy (Drs. Laganà and Ghezzi); Gynecology and Obstetrics Unit, Villa Sofia-Cervello Hospital, University of Palermo, Palermo, Italy (Drs. Calagna, Maranto, and Cucinella); Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy (Dr. Favilli); Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy (Dr.Vitale); Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Dr. Sperduti)
| | - Fabio Ghezzi
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Drs. Chiofalo, Vizza, and Vocaturo); Arbor Vitae Centre, Nuova Villa Claudia Clinic, Rome, Italy (Drs. Mazzon and Di Angelo Antonio); Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University of Messina, Messina, Italy (Drs. Amadore, Palmara, Granese, and Triolo); Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy (Drs. Laganà and Ghezzi); Gynecology and Obstetrics Unit, Villa Sofia-Cervello Hospital, University of Palermo, Palermo, Italy (Drs. Calagna, Maranto, and Cucinella); Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy (Dr. Favilli); Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy (Dr.Vitale); Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Dr. Sperduti)
| | - Isabella Sperduti
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Drs. Chiofalo, Vizza, and Vocaturo); Arbor Vitae Centre, Nuova Villa Claudia Clinic, Rome, Italy (Drs. Mazzon and Di Angelo Antonio); Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University of Messina, Messina, Italy (Drs. Amadore, Palmara, Granese, and Triolo); Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy (Drs. Laganà and Ghezzi); Gynecology and Obstetrics Unit, Villa Sofia-Cervello Hospital, University of Palermo, Palermo, Italy (Drs. Calagna, Maranto, and Cucinella); Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy (Dr. Favilli); Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy (Dr.Vitale); Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Dr. Sperduti)
| | - Onofrio Triolo
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Drs. Chiofalo, Vizza, and Vocaturo); Arbor Vitae Centre, Nuova Villa Claudia Clinic, Rome, Italy (Drs. Mazzon and Di Angelo Antonio); Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University of Messina, Messina, Italy (Drs. Amadore, Palmara, Granese, and Triolo); Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy (Drs. Laganà and Ghezzi); Gynecology and Obstetrics Unit, Villa Sofia-Cervello Hospital, University of Palermo, Palermo, Italy (Drs. Calagna, Maranto, and Cucinella); Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy (Dr. Favilli); Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy (Dr.Vitale); Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Dr. Sperduti)
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4
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Emons G, Steiner E, Vordermark D, Uleer C, Bock N, Paradies K, Ortmann O, Aretz S, Mallmann P, Kurzeder C, Hagen V, van Oorschot B, Höcht S, Feyer P, Egerer G, Friedrich M, Cremer W, Prott FJ, Horn LC, Prömpeler H, Langrehr J, Leinung S, Beckmann MW, Kimmig R, Letsch A, Reinhardt M, Alt-Epping B, Kiesel L, Menke J, Gebhardt M, Steinke-Lange V, Rahner N, Lichtenegger W, Zeimet A, Hanf V, Weis J, Mueller M, Henscher U, Schmutzler RK, Meindl A, Hilpert F, Panke JE, Strnad V, Niehues C, Dauelsberg T, Niehoff P, Mayr D, Grab D, Kreißl M, Witteler R, Schorsch A, Mustea A, Petru E, Hübner J, Rose AD, Wight E, Tholen R, Bauerschmitz GJ, Fleisch M, Juhasz-Boess I, Sigurd L, Runnebaum I, Tempfer C, Nothacker MJ, Blödt S, Follmann M, Langer T, Raatz H, Wesselmann S, Erdogan S. Interdisciplinary Diagnosis, Therapy and Follow-up of Patients with Endometrial Cancer. Guideline (S3-Level, AWMF Registry Nummer 032/034-OL, April 2018) - Part 1 with Recommendations on the Epidemiology, Screening, Diagnosis and Hereditary Factors of Endometrial Cancer. Geburtshilfe Frauenheilkd 2018; 78:949-971. [PMID: 30364388 PMCID: PMC6195426 DOI: 10.1055/a-0713-1218] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 08/22/2018] [Indexed: 12/30/2022] Open
Abstract
Summary
The first German interdisciplinary S3-guideline on the diagnosis, therapy and follow-up of patients with endometrial cancer was published in April 2018. Funded by German Cancer Aid as part of an Oncology Guidelines Program, the lead coordinators of the guideline were the German Society of Gynecology and Obstetrics (DGGG) and the Gynecological Oncology Working Group (AGO) of the German Cancer Society (DKG).
Purpose
The use of evidence-based, risk-adapted therapy to treat low-risk women with endometrial cancer avoids unnecessarily radical surgery and non-useful adjuvant radiotherapy and/or chemotherapy. This can significantly reduce therapy-induced morbidity and improve the patientʼs quality of life as well as avoiding unnecessary costs. For women with endometrial cancer and a high risk of recurrence, the guideline defines the optimal surgical radicality together with the appropriate chemotherapy and/or adjuvant radiotherapy where required. The evidence-based optimal use of different therapeutic modalities should improve survival rates and the quality of life of these patients. The S3-guideline on endometrial cancer is intended as a basis for certified gynecological cancer centers. The aim is that the quality indicators established in this guideline will be incorporated in the certification processes of these centers.
Methods
The guideline was compiled in accordance with the requirements for S3-level guidelines. This includes, in the first instance, the adaptation of source guidelines selected using the DELBI instrument for appraising guidelines. Other consulted sources include reviews of evidence which were compiled from literature selected during systematic searches of literature databases using the PICO scheme. In addition, an external biostatistics institute was commissioned to carry out a systematic search and assessment of the literature for one area of the guideline. The identified materials were used by the interdisciplinary working groups to develop suggestions for Recommendations and Statements, which were then modified during structured consensus conferences and/or additionally amended online using the DELPHI method with consent being reached online. The guideline report is freely available online.
Recommendations
Part 1 of this short version of the guideline presents recommendations on epidemiology, screening, diagnosis and hereditary factors, The epidemiology of endometrial cancer and the risk factors for developing endomentrial cancer are presented. The options for screening and the methods used to diagnose endometrial cancer including the pathology of the cancer are outlined. Recommendations are given for the prevention, diagnosis, and therapy of hereditary forms of endometrial cancer.
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Affiliation(s)
- Günter Emons
- Klinik für Gynäkologie und Geburtshilfe, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Eric Steiner
- Frauenklinik, GPR Klinikum Rüsselsheim am Main, Rüsselsheim, Germany
| | | | - Christoph Uleer
- Facharzt für Frauenheilkunde und Geburtshilfe, Hildesheim, Hildesheim, Germany
| | - Nina Bock
- Klinik für Gynäkologie und Geburtshilfe, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Kerstin Paradies
- Konferenz Onkologischer Kranken- und Kinderkrankenpflege, Hamburg, Germany
| | - Olaf Ortmann
- Frauenheilkunde und Geburtshilfe, Universität Regensburg, Regensburg, Germany
| | - Stefan Aretz
- Institut für Humangenetik, Universität Bonn, Zentrum für erbliche Tumorerkrankungen, Universitätsklinikum Bonn, Bonn, Germany
| | | | | | - Volker Hagen
- Klinik für Innere Medizin II, St.-Johannes-Hospital Dortmund, Dortmund, Germany
| | - Birgitt van Oorschot
- Interdisziplinäres Zentrum Palliativmedizin, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Stefan Höcht
- Xcare, Praxis für Strahlentherapie, Saarlouis, Saarlouis, Germany
| | - Petra Feyer
- Klinik für Strahlentherapie und Radioonkologie, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Gerlinde Egerer
- Zentrum für Innere Medizin, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | | | | | | | | | - Heinrich Prömpeler
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Jan Langrehr
- Klinik für Allgemein-, Gefäß- und Viszeralchirurgie, Martin-Luther-Krankenhaus, Berlin, Germany
| | | | | | - Rainer Kimmig
- Women's Department, University Hospital of Essen, Essen, Germany
| | - Anne Letsch
- Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Charité, Campus Benjamin Franklin, Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Reinhardt
- Klinik für Nuklearmedizin, Pius Hospital Oldenburg, Oldenburg, Germany
| | - Bernd Alt-Epping
- Klinik für Palliativmedizin, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Ludwig Kiesel
- Obstetrics and Gynecology, Reproductive Medicine, University of Muenster, Germany, Münster, Germany
| | - Jan Menke
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Marion Gebhardt
- Frauenselbsthilfe nach Krebs e. V., Erlangen, Erlangen/Forchheim, Germany
| | - Verena Steinke-Lange
- MGZ - Medizinisch Genetisches Zentrum, München und Medizinische Klinik und Poliklinik IV, Campus Innenstadt, Klinikum der Universität München, München, Germany
| | - Nils Rahner
- Institut für Humangenetik, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Werner Lichtenegger
- Frauenklinik Charité, Campus Virchow-Klinikum, Universitätsmedizin Berlin, Berlin, Germany
| | - Alain Zeimet
- Frauenheilkunde, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Volker Hanf
- Frauenklinik Nathanstift - Klinikum Fürth, Fürth, Germany
| | - Joachim Weis
- Stiftungsprofessur Selbsthilfeforschung, Tumorzentrum/CCC Freiburg, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Michael Mueller
- Universitätsklinik für Frauenheilkunde, Inselspital Bern, Bern, Switzerland
| | | | - Rita K Schmutzler
- Center for Familial Breast and Ovarian Cancer, University Hospital of Cologne, Cologne, Germany
| | - Alfons Meindl
- Frauenklinik am Klinikum rechts der Isar, München, Germany
| | - Felix Hilpert
- Mammazentrum, Krankenhaus Jerusalem, Hamburg, Germany
| | - Joan Elisabeth Panke
- Medizinischer Dienst des Spitzenverbandes Bund der Krankenkassen e. V., Essen, Germany
| | - Vratislav Strnad
- Strahlenklinik, Universitätsklinikum Erlangen, CCC ER-EMN, Universitäts-Brustzentrum Franken, Erlangen, Germany
| | | | - Timm Dauelsberg
- Winkelwaldklinik Nordrach, Fachklinik für onkologische Rehabilitation, Nordrach, Germany
| | - Peter Niehoff
- Strahlenklinik, Sana Klinikum Offenbach, Offenbach, Germany
| | - Doris Mayr
- Pathologisches Institut, LMU München, München, Germany
| | - Dieter Grab
- Frauenklinik Klinikum Harlaching, München, Germany
| | - Michael Kreißl
- Universitätsklinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany
| | - Ralf Witteler
- Obstetrics and Gynecology, Reproductive Medicine, University of Muenster, Germany, Münster, Germany
| | | | | | - Edgar Petru
- Frauenheilkunde, Medizinische Universität Graz, Graz, Austria
| | - Jutta Hübner
- Klinikum für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | | | - Edward Wight
- Frauenklinik des Universitätsspitals Basel, Basel, Switzerland
| | - Reina Tholen
- Deutscher Verband für Physiotherapie, Referat Bildung und Wissenschaft, Köln, Germany
| | - Gerd J Bauerschmitz
- Klinik für Gynäkologie und Geburtshilfe, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Markus Fleisch
- Landesfrauenklinik, HELIOS Universitätsklinikum Wuppertal, Wuppertal, Germany
| | - Ingolf Juhasz-Boess
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Saar, Germany
| | - Lax Sigurd
- Institut für Pathologie, Landeskrankenhaus Graz West, Graz, Austria
| | | | - Clemens Tempfer
- Marien Hospital Herne - Universitätsklinikum der Ruhr-Universität Bochum, Herne, Germany
| | | | | | - Markus Follmann
- Deutsche Krebsgesellschaft, Office des Leitlinienprogramms Onkologie, Berlin, Germany
| | - Thomas Langer
- Deutsche Krebsgesellschaft, Office des Leitlinienprogramms Onkologie, Berlin, Germany
| | - Heike Raatz
- Institut für Klinische Epidemiologie & Biostatistik (CEB), Basel, Switzerland
| | | | - Saskia Erdogan
- Klinik für Gynäkologie und Geburtshilfe, Universitätsmedizin Göttingen, Göttingen, Germany
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