title: Patterns of care in patients with cervical cancer 2012: results of a survey among German radiotherapy departments and out-patient health care centers.
abstract: BACKGROUND
  Platinum-based primary or adjuvant chemoradiation is the treatment of choice for patients with cervical cancer. However, despite national guidelines and international recommendations, many aspects in diagnosis, therapy, and follow-up of patients with cervical cancer are not based on valid data.
  
  
  METHODS
  To evaluate the current patterns of care for patients with cervical cancer in Germany, a questionnaire with 25 items was sent to 281 radiooncologic departments and out-patient health care centers.
  
  
  RESULTS
  The response rate was 51%. While 87% of institutions treat 0-25 patients/year, 12 % treat between 26 and 50 and only 1% treat more than 50 patients/year. In 2011, the stage distribution of 1,706 treated cervical cancers were IB1, IB2, IIA, IIB, IIIA/IIIB, and IV in 11, 12, 11, 22, 28, and 16%, respectively. CT (90%) and MRI (86%) are mainly used as staging procedures in contrast to PET-CT with 14%. Interestingly, 27% of institutions advocate surgical staging prior to chemoradiation. In the majority of departments 3D-based (70%) and intensity-modulated radiotherapy (76%) are used for percutaneous radiation, less frequently volumetric arc techniques (26%). Nearly all colleagues (99.3%) apply conventional fractioning of 1.8-2 Gy for external-beam radiotherapy, in 19% combined with a simultaneous integrated boost. Cisplatinum mono is used as a radiosensitizer with 40 mg/m(2) weekly by 90% of radiooncologists. For boost application in the primary treatment, HDR (high-dose rate) brachytherapy is the dominant technique (84%). In patients after radical hysterectomy pT1B1/1B2, node negative and resection in sound margins adjuvant chemoradiation is applied due to the occurrence of 1-4 other risk factors in 16-97%. There is a broad spectrum of recommended primary treatment strategies in stages IIB and IVA.
  
  
  CONCLUSIONS
  Results of the survey underline the leading role but also differences in the use of chemoradiation in the treatment of cervical cancer patients in Germany.
authors.affiliation: Department of Radiooncology, Charité Universitätsmedizin, Augustenburger Platz 1, 13353, Berlin, Germany, simone.marnitz@charite.de.
authors.forename: S
authors.initials: S
authors.lastname: Marnitz
authors.forename: C
authors.initials: C
authors.lastname: Köhler
authors.forename: A
authors.initials: A
authors.lastname: Rauer
authors.forename: A
authors.initials: A
authors.lastname: Schneider
authors.forename: V
authors.initials: V
authors.lastname: Budach
authors.forename: A
authors.initials: A
authors.lastname: Tsunoda
authors.forename: M
authors.initials: M
authors.lastname: Mangler
mesh_terms: D000553:Ambulatory Care / Q000706:statistics & numerical data*; D001918:Brachytherapy / Q000706:statistics & numerical data; D059186:Chemoradiotherapy, Adjuvant / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006748:Hospital Departments / Q000706:statistics & numerical data*; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D018787:Radiation Oncology / Q000706:statistics & numerical data*; D020266:Radiotherapy, Conformal / Q000706:statistics & numerical data; D061089:Radiotherapy, Image-Guided / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000532:radiotherapy*