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

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.

Status of Sentinel Lymph Node Biopsy in Endometrial Cancer

“…Further prospective randomised studies, including the molecular pathology risk profile of endometrial cancer, are essential for better assessment of the long-term effectiveness of SLN, especially in patients with high-risk cancers. According to the recommendation of the current DKG-DKH-AWMF S3 guideline, SLN alone should be performed in endometrial cancer only in controlled studies 5 . Based on the recent data, a new version of the DKG-DKH-AWMF guideline could contain the evaluation regarding the applicability of the available SLN algorithms (for low-, intermediate- and high-risk endometrial cancer).…”

“…Based on the available results, clinical practice to date and the current European guidelines and consensus recommendations (DKG-DKH-AWMF, ESMO-ESGO-ESTRO) follow a risk-adapted indication for SLNE; uterine risk factors for lymph node metastasis and prognosis determine whether SLNE is indicated (high-risk group) or not (low-risk group) 5 , 10 . For patients with intermediate-risk endometrial cancer (e.g.…”

“…For patients with intermediate-risk endometrial cancer (e.g. pT1a, G3, pT1b, G1/2) there is a more or less problematic “can be considered” recommendation 5 , 10 . This risk-adapted concept can show numerous limitations: the existing risk of over- or undertreatment of patients; the uterine risk factors can only be determined accurately from the final specimen; no evidence for a survival advantage for SLNE in prospective randomised studies; the systematic surgery and quality of the SLNE cannot be judged objectively in the absence of standardisation; the molecular pathology risk profile of the endometrial cancer for the indication for adjuvant therapy is not considered due to the lack of prospective study data.…”

“…The possibility of adequate staging while avoiding systematic lymphadenectomy (SLNE) leads to a significant reduction in the rate of peri- and postoperative morbidity. Nevertheless, the status of sentinel lymph node biopsy (SLN) in endometrial cancer has not yet been fully elucidated and is variously assessed internationally 5 , 6 , 7 , 8 , 9 . A recent international survey of 489 physicians specialising in gynaecological oncology showed that SLN in endometrial cancer was already implemented by 50.3% of those surveyed from Europe and by 69.5% of those surveyed from USA 9 .…”

“…The current S3 guideline of the German Cancer Society (DKG)/German Cancer Aid (DKH)/Working Group of Scientific Medical Societies (AWMF) recommends that “sentinel lymph node biopsy alone should be performed in endometrial cancer only in the context of controlled studies” 5 , 6 , 7 . The consensus recommendation of the European Society Medical of Oncology (ESMO), the European Society of Gynaecologic Oncology (ESGO) and the European Society for Radiotherapy and Oncology (ESTRO) likewise assesses SLN as an experimental procedure 10 .…”