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Aim This update of the interdisciplinary S3 guideline on the Diagnosis, Therapy and Follow-up of Cervical Cancer (AWMF Registry No. 032/033OL) was published in March 2021. This updated guideline was funded by German Cancer Aid (Deutsche Krebshilfe) as part of the German Guideline Program in Oncology. The guideline was coordinated by the German Society of Gynecology and Obstetrics (Deutsche Gesellschaft für Gynäkologie und Geburtshilfe, DGGG) and the Working Group on Gynecological Oncology (Arbeitsgemeinschaft Gynäkologische Onkologie, AGO) of the German Cancer Society (Deutsche Krebsgesellschaft, DKG). Method The process of updating the S3 guideline dating from 2014 was based on an appraisal of the available evidence using the criteria of evidence-based medicine, adaptations of existing evidence-based national and international guidelines or – if evidence was lacking – on a consensus of the specialists involved in compiling the update. After an initial review of the current literature was carried out according to a prescribed algorithm, several areas were identified which, in contrast to the predecessor version from September 2014, required new recommendations or statements which took account of more recently published literature and the appraisal of the new evidence. Recommendations The short version of this guideline consists of recommendations and statements on the epidemiology, screening, diagnostic workup and therapy of patients with cervical cancer. The most important new aspects included in this updated guideline include the newly published FIGO classification of 2018, the radical open surgery approach for cervical cancers up to FIGO stage IB1, and use of the sentinel lymph node technique for tumors ≤ 2 cm. Other changes include the use of PET-CT, new options in radiotherapy (e.g., intensity-modulated radiotherapy, image-guided adaptive brachytherapy), and drug therapies to treat recurrence or metastasis.

ZusammenfassungDer Nationale Krebsplan hebt die Bedeutung der ärztlichen Kommunikation hervor und fordert deren Integration in die medizinische Aus- und Weiterbildung. In diesem Sinne begegnet das Konzept der Heidelberger Meilenstein Kommunikation den besonderen Herausforderungen im Umgang mit Lungenkrebspatientnnen mit einem interprofessionellen, strukturierten und vorausschauenden Ansatz. Interprofessionelle Tandems, bestehend aus ÄrztInnen und Pflegefachpersonen, führen gemeinsam strukturierte Gespräche zu definierten Zeitpunkten im Erkrankungsverlauf mit LungenkrebspatientInnen und deren Angehörigen durch. Das Konzept zielt auf Sensitivität im Hinblick auf die Präferenzen der PatientInnen und hat die vorausschauende gemeinsame Entscheidungsfindung, Kontinuität in der Betreuung von LungenkrebspatientInnen sowie das frühe Erkennen und Behandeln palliativer Erkrankungsstadien zum Ziel. Im Rahmen eines abschließenden Symposiums zur Heidelberger Meilenstein Kommunikation (30.–31.01.2020) wurden Empfehlungen zur Versorgungssituation von LungenkrebspatientInnen im fortgeschrittenen Stadium erarbeitet. Darüber hinaus wurden die weiterführende Übertragbarkeit von HeiMeKOM in andere Settings und Kliniken und auf andere Erkrankungen sowie die Möglichkeit der Abbildung eines solchen Konzeptes in der Regelversorgung diskutiert. Dieser Artikel stellt die im Rahmen des Symposiums diskutierten Erfahrungen, Best Practice Beispiele und Empfehlungen vor, um deren Übertragbarkeit auf andere, ähnlich ausgerichtete Projekte zu ermöglichen. Langfristig angestrebt wird die Übertragung des Meilenstein-Konzeptes in andere Kliniken, vorrangig zertifizierte Lungenkrebszentren sowie die Überführung in eine dauerhafte Finanzierung. Für die Weiterverbreitung dieser therapeutischen Innovation und vor allem für die Überführung in die Regelversorgung ist neben der Integration des Konzeptes in Kompetenzkataloge der ärztlichen Weiterbildung sowie der Pflegefortbildung v. a. gesundheitspolitische Unterstützung erforderlich.

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 Using 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 extent of surgical radicality together with the appropriate chemotherapy and/or adjuvant radiotherapy if required. An evidence-based optimal use of different therapeutic modalities should improve the survival rates and quality of life of these patients. This 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 included 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 part of the guideline. Identified materials were used by the interdisciplinary working groups to develop suggestions for Recommendations and Statements, which were then subsequently modified during structured consensus conferences and/or additionally amended online using the DELPHI method, with consent between members achieved online. The guideline report is freely available online. Recommendations Part 2 of this short version of the guideline presents recommendations for the therapy of endometrial cancer including precancers and early endometrial cancer as well as recommendations on palliative medicine, psycho-oncology, rehabilitation, patient information and healthcare facilities to treat endometrial cancer. The management of precancers of early endometrial precancerous conditions including fertility-preserving strategies is presented. The concept used for surgical primary therapy of endometrial cancer is described. Radiotherapy and adjuvant medical therapy to treat endometrial cancer and uterine carcinosarcomas are described. Recommendations are given for the follow-up care of endometrial cancer, recurrence and metastasis. Palliative medicine, psycho-oncology including psychosocial care, and patient information and rehabilitation are presented. Finally, the care algorithm and quality assurance steps for the diagnosis, therapy and follow-up of patients with endometrial cancer are outlined.

Zusammenfassung Hintergrund Ein Qualitätsmerkmal von integrierter Palliativversorgung in der Onkologie ist die Förderung der Lebensqualität bei Angehörigen von Tumorpatienten. Die Förderung der Selbstwirksamkeit (SW) durch das Behandlerteam ist ein möglicher Ansatzpunkt. Ziel dieser qualitativen Studie ist es, Hinweise zur Förderung der SW zu identifizieren. Methodik Zwei Fokusgruppen mit je vier Angehörigen wurden anhand der allgemeinen SW, erhoben mittels Skala von Schwarzer und Jerusalem 1, gebildet. Die Auswertung erfolgte mittels modifizierter Grounded Theory nach Strauss und Corbin 2. Ergebnisse Die Analyse ergab Ungewissheit als zentralen Belastungsfaktor. Als wesentliche Anforderungsbereiche wurden 1) Ungewissheit aushalten, 2) Interaktion mit Ärzten, 3) Instrumentelle Unterstützung geben und 4) Umstrukturierung des eigenen Lebens identifiziert. Schlussfolgerung Zur Förderung der SW von Angehörigen ist v. a. Unterstützung bei der Bewältigung von Ungewissheiten notwendig. Dies kann über eine aktive Einbindung in die Behandlung erfolgen. Ein personalisierter Ansatz, orientiert an der individuellen Lebenssituation, sowie Screenings zu Bedürfnissen und Ressourcen sind notwendig.

Physical methods became recently more important as an alternative to anticoagulation for prophylaxis of thromboembolism and were studied for their efficacy. The AV-impulse-system proved efficient in reducing thromboembolic complications in patients undergoing hip surgery by increasing the return of venous blood in the deep veins of the leg. In a preclinical trial we studied the influence of the AV-impulse-system and of active forefoot movement on venous blood return in 12 lower extremities of 6 healthy individuals immobilized in below the knee plaster casts. Our results show a significant increase in venous blood flow caused by the AV-impulse-system (p < 0.05) and by active forefoot movements (p < 0.05). Prevention of thromboembolic complications in trauma and orthopaedic patients immobilized in plaster cast seems possible by using the AV-impulse-system which significantly increases the venous blood flow independent from patient compliance.

84 knee joints were examined by a 3-dimensional MR method and the results correlated with subsequent arthroscopy. The findings showed good demonstration of the normal anatomical structures and excellent reliability for the diagnosis of meniscus tears (sensitivity 91%, specificity 95%), cruciate ligament lesions (sensitivity 90%, specificity 99%) and serious cartilage damage (sensitivity 100%, specificity 100%). Demonstration of mild cartilage damage (sensitivity 60%, specificity 99%) was better than with a spin echo technique but is not yet optimal. It is concluded that, by using a 3-dimensional technique, time-consuming spin echo sequences can be abandoned. Significant advantages of the 3-D method are the speed of the examination, narrow section thickness, marked flexibility in contrast rendering and the ability for multiplanar reconstruction.

A case of fibromuscular dysplasia (FMD) with involvement of the aorta is described in a 44-year-old woman. So far only 3 cases of aortal FMD have been mentioned, all in female patients. Our observation is characterized by a solitary stenosis of the lower abdominal aorta and it resembles histologically the "intimal fibroplasia" type of renal FMD. The review of the literature about FMD in general reveals that mostly the renal arteries are affected, followed by cervical artery FMD with only rare occurrence in other vessels. Though the etiology is basically unknown several factors have been made responsible, namely hereditary disposition, congenital rubella infection, female hormones, paucity of the vasa vasorum, and stretch-traction-stress. The disease has been classified into several histological subgroups and also according to the roentgenologic form which typically shows a "string of beads" appearance. There is a definitive female sex preponderance of 5:1, which is the same for all affected vessels; whereas in respect to age there is a marked distinction in so far that renal FMD patients on average are 11 years younger than patients with the cervicocephalic form of the disease.