title: Adjuvant treatment decisions for patients with endometrial cancer in Germany: results of the nationwide AGO pattern of care studies from the years 2013, 2009 and 2006.
abstract: OBJECTIVE
  In 2013, 2009 and 2006, the Arbeitsgemeinschaft Gynäkologische Onkologie evaluated the therapeutic approaches for endometrial carcinoma and the adherence to their guideline in Germany. Here, the adjuvant treatment decisions were presented.
  
  
  METHODS
  A questionnaire was developed and sent to all 682 German gynecological departments in 2013 (775 in 2009 and 500 in 2006, respectively). The results of the questionnaires were compared with the recommendations of the guideline and with each other using Fisher's exact test.
  
  
  RESULTS
  Responses were available in 40.0 % in 2013, 33.3 % in 2009 and 35.8 % in 2006. Participants recommended external beam radiotherapy (EBRT) in 13 out of 16 requested stages and vaginal brachytherapy (VBT) in only 10 out of 16 requested stages as suggested by the guideline. Comparing the results of 2013 with 2009, less participants used EBRT and VBT in 7 out of 16 and in 6 out of 16 requested stages, respectively. Conversely, more participants offered adjuvant chemotherapy (CT) in 2013 (90.4 %) compared to 61.9 % in 2009 (p < 0.001) and 48.8 % in 2006 (p < 0.001), respectively. However, the stage-adjusted recommendations of CT were not in line with the guideline in 11 out of 15 requested stages. In total, 77.3 % of the participants use a multiple drug schedule with a platinum and a taxane compound.
  
  
  CONCLUSIONS
  The results suggest non-adherence to the guideline concerning the stage-adjusted use of VBT and CT in endometrial carcinoma. These findings emphasize great uncertainties and the need of more clarifying trials. Furthermore, a shift from radiotherapy toward CT is observable.
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital Mainz, Langenbeckstr. 1, 55131, Mainz, Germany, battist@uni-mainz.de.
authors.forename: Marco Johannes
authors.initials: MJ
authors.lastname: Battista
authors.forename: Marcus
authors.initials: M
authors.lastname: Schmidt
authors.forename: Nicole
authors.initials: N
authors.lastname: Rieks
authors.forename: Isabel
authors.initials: I
authors.lastname: Sicking
authors.forename: Stefan
authors.initials: S
authors.lastname: Albrich
authors.forename: Michael
authors.initials: M
authors.lastname: Eichbaum
authors.forename: Heinz
authors.initials: H
authors.lastname: Koelbl
authors.forename: Peter
authors.initials: P
authors.lastname: Mallmann
authors.forename: Gerald
authors.initials: G
authors.lastname: Hoffmann
authors.forename: Eric
authors.initials: E
authors.lastname: Steiner
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001918:Brachytherapy; D002291:Carcinoma, Papillary / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D018284:Cystadenocarcinoma, Serous / Q000473:pathology / Q000628:therapy*; D003657:Decision Making; D016889:Endometrial Neoplasms / Q000473:pathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006301:Health Services Needs and Demand; D006801:Humans; D009367:Neoplasm Staging; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D011795:Surveys and Questionnaires; D013997:Time Factors; D014621:Vagina / Q000528:radiation effects