1 3 J Cancer Res Clin Oncol (2015) 141:555–562 DOI 10.1007/s00432-014-1834-9 ORIGINAL ARTICLE – CLINICAL ONCOLOGY 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 Marco Johannes Battista · Marcus Schmidt · Nicole Rieks · Isabel Sicking · Stefan Albrich · Michael Eichbaum · Heinz Koelbl · Peter Mallmann · Gerald Hoffmann · Eric Steiner Received: 8 July 2014 / Accepted: 11 September 2014 / Published online: 26 September 2014 © Springer-Verlag Berlin Heidelberg 2014 Results Responses were available in 40.0 % in 2013, 33.3 % in 2009 and 35.8 % in 2006. Participants recom- mended 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. Further- more, a shift from radiotherapy toward CT is observable. Keywords Endometrial cancer · Pattern of care · Radiotherapy · Chemotherapy · Guideline Introduction Endometrial carcinoma (EC) has the most favorable prog- nosis among gynecological malignancies; thus, treatment- related morbidity should be minimized (Robert Koch Insti- tut 2010). However, a distinct portion of patients develops distant metastasis and is faced with low survival rates (Rob- ert Koch Institut 2010). These patients have to be identified by correct surgical staging and require effective adjuvant treatment (AGO 2006, 2013; Emons and Kimmig 2008). Abstract Purpose In 2013, 2009 and 2006, the Arbeitsgemein- schaft 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. M. J. Battista (*) · M. Schmidt · N. Rieks · I. Sicking · S. Albrich · G. Hoffmann Department of Gynecology and Obstetrics, University Hospital Mainz, Langenbeckstr. 1, 55131 Mainz, Germany e-mail: battist@uni-mainz.de; Battist@mail.uni-mainz.de M. Eichbaum Department of Gynecology and Obstetrics, Marienkrankenhaus Frankfurt am Main, Frankfurt am Main, Germany M. Eichbaum · P. Mallmann · E. Steiner Scientific Board Uterine Neoplasm of the Arbeitsgemeinschaft Gynäkologische Onkologie (AGO), Taufingen, Germany H. Koelbl Department of Gynecology and Gynecological Oncology, Medical University of Vienna, General Hospital (AKH), Vienna, Austria P. Mallmann Department of Gynecology and Obstetrics, University Hospital of Cologne, Cologne, Germany E. Steiner Department of Gynecology and Obstetrics, GP Ruesselsheim, Ruesselsheim, Germany