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

Abstract

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 sit-

ESGO Survey on Current Practice in the Management of Cervical Cancer

“…Intraoperative assessment of LN was performed routinely in the management of early disease by 45% of respondents in our survey, compared with 13% in the United Kingdom survey, 9 57% in the German survey, 8 and 39% in the SGO survey. 7 The main reason for intraoperative assessment of LN is to adjust the strategy of surgical treatment immediately at the surgery.…”

“…In a similar survey from Germany, the 2 leading imaging modalities were CT (44%) and MRI (52%), whereas PET/CT was used only by 2% of respondents. 8 Another interesting outcome of the German study was the frequent implementation of cystoscopy (73%) and rectoscopy (70%). In our survey, cystoscopy and rectoscopy were routinely used only by 17% and 10% of respondents, respectively.…”

“…It is accepted without further pelvic LN staging in stage T1a1 LVSI-positive and T1a2 LVSI-negative by 26% and 22% of respondents, respectively. In the German survey, 8 published in 2013, SLNB was routinely used in cases with tumor less than 2 cm only by 9% of respondents. These figures may reflect a trend toward higher acceptance of SLN concept in the management of early-stage cervical cancer in recent years at least in Europe.…”

Use of Laparoscopy in the Treatment of Endometrial and Cervical Cancer - Results of a 2012 Germany-wide Survey

“…A response rate of 128 completed questionnaires for a voluntary and unremunerated survey must be considered good, given that, in our experience, the response rates for other comparable surveys undertaken in Germany were not much higher (e.g. the rate for the cervical cancer survey by Mangler et al was 34 % [26]). The calculated response rate of 23.7 % may even be slightly higher, as we did not send out the letters to 560 hospitals but to AGE members, and the stipulation was that only one questionnaire should be returned (anonymously) per hospital.…”

Postoperative Health-Related Quality of Life of Cervical Cancer Patients – A Comparison between the Wertheim-Meigs Operation and Total Mesometrial Resection (TMMR)

“…In FIGO stages IB-IIB the standard treatment comprises radical hysterectomy (RH) according to Wertheim-Meigs with, if necessary, subsequent radiotherapy or with postoperative radiochemotherapy [7]. In a survey of Germany gynaecological departments 71.5 % reported use of the operation according to Wertheim-Meigs [8]. In the meantime, however, beside the standard surgical methods, there are also various nerve-sparing procedures such as, e.g., total mesometrial resection.…”