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Leo C, Horn LC, Koschke C, Böhlig L, Engeland K, Fink D, Höckel M. Der Einfluss wiederholter Hypoxie/Reoxygenierungs-Zyklen auf die Genexpression in Zervixkarzinomzellen. Geburtshilfe Frauenheilkd 2009. [DOI: 10.1055/s-0029-1238986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Dornhöfer N, Einenkel J, Höckel M. Die lateral erweiterte endopelvine Resektion (LEER) für die Behandlung maligner gynäkologischer Tumore mit Beckenwandbeteiligung. Geburtshilfe Frauenheilkd 2009. [DOI: 10.1055/s-0029-1238937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Manthey N, Einenkel J, Braumann UD, Wolf U, Hildebrandt G, Liebmann A, Höckel M. Rezidivlandschaften beim Zervixkarzinom – eine 3dimensionale Analyse der Topografie und Häufigkeitsverteilung von Rezidiven. Geburtshilfe Frauenheilkd 2009. [DOI: 10.1055/s-0029-1238988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Höckel M. Principles and practice of surgical treatment for cervical cancer: it's time for a change. WOMENS HEALTH 2009; 5:459-62. [PMID: 19702443 DOI: 10.2217/whe.09.41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Höckel M, Horn LC, Manthey N, Braumann UD, Wolf U, Teichmann G, Frauenschläger K, Dornhöfer N, Einenkel J. Resection of the embryologically defined uterovaginal (Müllerian) compartment and pelvic control in patients with cervical cancer: a prospective analysis. Lancet Oncol 2009; 10:683-92. [DOI: 10.1016/s1470-2045(09)70100-7] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Singer S, Götze H, Möbius C, Witzigmann H, Kortmann RD, Lehmann A, Höckel M, Schwarz R, Hauss J. Quality of care and emotional support from the inpatient cancer patient’s perspective. Langenbecks Arch Surg 2009; 394:723-31. [DOI: 10.1007/s00423-009-0489-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Accepted: 03/19/2009] [Indexed: 11/25/2022]
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Schwarz R, Krauss O, Höckel M, Meyer A, Zenger M, Hinz A. The Course of Anxiety and Depression in Patients with Breast Cancer and Gynaecological Cancer. Breast Care (Basel) 2008; 3:417-422. [PMID: 21048913 DOI: 10.1159/000177654] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND/AIMS: The aim of this study was to assess the course of anxiety and depression in cancer patients over time and to detect determinants of the changes in the scores. PATIENTS AND METHOD: Women with breast cancer and gynaecological cancer (n = 367) were tested at the beginning (T1) and at the end (T2) of treatment in the hospital, 6 months later (T3), and 12 months later (T4), using the Hospital Anxiety and Depression Scale (HADS). RESULTS: Anxiety and depression were highest at the start of the stay in the hospital. More than half of the women are at least doubtful cases in at least one of the two HADS dimensions. The mean scores declined from T1 to T4. After 1 year, depression scores are similar to those of the general population, while anxiety scores remain elevated. The decline of the HADS scores depends on treatment, time since diagnosis, and education. CONCLUSIONS: Women receiving radio- or chemotherapy (compared with surgery only), with a long time since diagnosis, and with a low educational level are at high risk of maintaining high anxiety and depression scores over time.
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Höckel M. Laterally extended endopelvic resection (LEER)—Principles and practice. Gynecol Oncol 2008; 111:S13-7. [DOI: 10.1016/j.ygyno.2008.07.022] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Accepted: 07/08/2008] [Indexed: 11/27/2022]
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Dornhöfer N, Höckel M. New developments in the surgical therapy of cervical carcinoma. Ann N Y Acad Sci 2008; 1138:233-52. [PMID: 18837903 DOI: 10.1196/annals.1414.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
For almost a century abdominal radical hysterectomy has been the standard surgical treatment of early-stage macroscopic carcinoma of the uterine cervix. The excessive parametrial resection of the original procedures of Wertheim, Okabayashi, and Meigs has later been "tailored" to tumor extent. Systematic pelvic and eventually periaortic lymph node dissection is performed to identify and treat regional disease. Adjuvant (chemo)radiation therapy is liberally added to improve locoregional tumor control when histopathological risk factors are present. The therapeutic index of the current surgical treatment, particularly if combined with radiation, appears to be inferior to that of primary chemoradiation as an oncologically equivalent therapeutic alternative. Several avenues of new conceptual and technical developments have been used since the 1990s with the goal of improving the therapeutic index. These are: surgical staging, including sentinel node biopsy and nodal debulking; minimal access and recently robotic radical hysterectomy; fertility-preserving surgery; nerve-sparing radical hysterectomy; total mesometrial resection based on developmentally defined surgical anatomy; and supraradical hysterectomy. The superiority of these new developments over the standard treatment remains to be demonstrated by controlled prospective trials. Multimodality therapy including surgery for locally advanced disease represents another area of clinical research. Both neoadjuvant chemotherapy followed by radical surgery, with or without adjuvant radiation, and completion surgery after (chemo)radiation are feasible and have to be compared to primary chemoradiation as the new nonsurgical treatment standard. Surgical treatment of postirradiation persisting or recurrent cervical carcinoma has been traditionally limited to pelvic exenteration for central disease. Applying the principle of developmentally derived anatomical compartments increases R0 resectability. The laterally extended endopelvic resection allows even the extirpation of a subset of visceral pelvic side wall tumors with clear margins. Many questions regarding the indication for these "ultraradical" operations, the surgery of irradiated tissues, and the optimal reconstructive procedures are still open and demand multi-institutional controlled trials to be answered.
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Heinritz W, Strenge S, Kujat A, Höckel M, Froster UG. Different Phenotypes Including Gynecological Cancer in Three Female Patients with Peutz-Jeghers Syndrome and Mutations in the STK11 Gene. Oncol Res Treat 2008; 31:625-8. [DOI: 10.1159/000162284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Einenkel J, Braumann UD, Pannicke N, Höckel M, Horn LC. Expression of HGF-a, c-met and E-cadherin in carcinoma of the cervix uteri and correlation to different patterns of invasion. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1089011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Klostermann K, Horn LC, Kühndel K, Fahr K, Höckel M. Zytologische Befunde bei Patientinnen unter 21 Jahren in einer Dysplasiesprechstunde – Konsequenzen für das Screening. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1089043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Dornhöfer N, Einenkel J, Höckel M. Die lateral erweiterte endopelvine Resektion (LEER) für die Behandlung maligner gynäkologischer Tumore mit Beckenwandbeteiligung. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1089300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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66
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Leo C, Mayer A, Horn LC, Hentschel B, Vaupel P, Höckel M. Hypoxie in benignen und malignen Tumoren des Uterus. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1088607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Dornhöfer N, Einenkel J, Höckel M. Aktuelle Ergebnisse der totalen mesometrialen Resektion (TMMR) für die Therapie des Zervixkarzinoms. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1089318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Mayer A, Höckel M, Wree A, Leo C, Horn LC, Vaupel P. Lack of hypoxic response in uterine leiomyomas despite severe tissue hypoxia. Cancer Res 2008; 68:4719-26. [PMID: 18559518 DOI: 10.1158/0008-5472.can-07-6339] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hypoxia is now established as a key factor influencing the pathophysiology of malignant growth. Among other effects, hypoxia modulates the expression of a multitude of genes through the induction of hypoxia-inducible transcription factors. This differential gene expression favors angiogenesis, cell survival, an invasive/metastatic phenotype, and resistance to anticancer therapies. Because benign tumors do not exhibit these traits, one might expect these entities to be neither hypoxic nor to induce the genetic hypoxia response program. To test this hypothesis, an investigation of the oxygenation status of 17 leiomyomas and 1 leiomyosarcoma of the uterus using polarographic needle electrodes (Eppendorf pO(2) sensor) and the expression of hypoxia-related markers in biopsy specimens of the same tumors was carried out. Marker expression in eight additional archival leiomyosarcomas was also assessed. Leiomyoma tissue was generally found to be severely hypoxic, with median oxygen (O(2)) partial pressure values ranging from 1 to 5 mm Hg. In contrast, none of the hypoxia-related markers hypoxia-inducible factor (HIF)-1alpha, HIF-2alpha, glucose transporter-1, or carbonic anhydrase IX were expressed in any leiomyoma. Larger intercapillary distances were correlated with a poorer oxygenation status. Conversely, the expression of hypoxia-related markers was abundant in the leiomyosarcomas and they also exhibited a high-turnover phenotype (significantly increased proliferation and apoptosis). Uterine leiomyoma might therefore represent a state of oxygen-limited proliferation. Malignancy in the same organ system is associated with growth and metabolism beyond tissue-inherent limitations leading to the induction of hypoxia-related markers, thereby contributing to a self-perpetuating aggressive phenotype.
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Mustea A, Oskay-Oezcelik G, Sommer HL, Keil E, Höckel M, Pfisterer J, Camara O, Hindenburg H, Lichtenegger W, Sehouli J. Safety of erythropoetin administration in first-line chemotherapy of ovarian carcinoma: Results of a prospective study. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.16574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Bringmann H, Singer S, Höckel M, Stolzenburg JU, Krauß O, Schwarz R. Long-term course of psychiatric disorders in cancer patients: a pilot study. PSYCHO-SOCIAL MEDICINE 2008; 5:Doc03. [PMID: 19742285 PMCID: PMC2736520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND About one third of cancer patients suffer from a psychiatric disorder. However, only few studies feature long-term assessment of psychiatric disease in cancer patients, covering a broad range of diagnoses, and employing high-quality instruments. PATIENTS AND METHODS A total of 62 patients underwent assessments during a 3-year follow-up period after initial cancer diagnosis. The Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders was administered to measure psychiatric morbidity at baseline (t₁) and two follow-ups (t₂ and t₃). Follow-up assessments took place from 6 to 18 months (t₂) and from 24 to 36 months (t₃) after baseline. Biomedical and psychosocial factors were evaluated to identify predictors of psychiatric disorders using univariate and multivariate analyses. RESULTS At t₁, at least one DSM-IV diagnosis was found in 29% of the cases. At follow-ups, the frequency of psychiatric morbidity increased to 36% at t₂ and 44% at t₃, respectively. New occurrence of psychiatric disease at follow-ups was 18% at t₂, and 38%, at t₃. Predictors of psychiatric disorders were low social support, low physical functioning, metastases, complications of disease, and loss of sportive activity. CONCLUSION Persistence and amount of newly diagnosed psychiatric disorders during three years after cancer treatment should be considered in the treatment of cancer patients, especially in individuals with accordant predictive factors.
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Meyer A, Lehmann A, Schwarz R, Höckel M, Pilch H. Psychoonkologische Betreuung von Brustkrebspatientinnen - erste Erfahrungen des zertifizierten universitären Brustzentrums Leipzig. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-989312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Leo C, Horn LC, Rauscher C, Hentschel B, Liebmann A, Hildebrandt G, Höckel M. Expression of erythropoietin and erythropoietin receptor in cervical cancer and relationship to survival, hypoxia, and apoptosis. Clin Cancer Res 2007; 12:6894-900. [PMID: 17145806 DOI: 10.1158/1078-0432.ccr-06-1285] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Physiologically, hypoxia induces the expression of erythropoietin (Epo) in adult kidney cells. Epo, in turn, acts on the Epo receptor (EpoR) in RBC precursors to stimulate growth and prevent apoptosis. Because hypoxia plays a major role in the malignant progression of tumors and Epo and its receptors have also been detected in malignant tumors, we investigated the expression of Epo and EpoR and their relationship with hypoxia, proliferation, apoptosis, and clinicopathologic variables in cervical cancer. EXPERIMENTAL DESIGN Intratumoral oxygen measurement and needle biopsies of the tumors were done in 48 patients with cervical cancer. The obtained tissue was analyzed by immunohistochemistry with antibodies against Epo, EpoR, and Ki-67 as well as by terminal deoxynucleotidyl transferase-mediated deoxyuracil triphosphate nick-end labeling assays. RESULTS Epo and EpoR were expressed in 88% and 92% of samples, respectively. Cervical cancers with higher Epo expression showed a significantly reduced overall survival (3 years, 50.0% versus 80.6%; P = 0.0084). Epo and EpoR expression correlated significantly with apoptosis (r = 0.49, P = 0.001 and r = 0.36, P = 0.021). Furthermore, EpoR expression correlated significantly with tumor size (r = 0.32, P = 0.032) and was significantly associated with the presence of lymphovascular space involvement (P = 0.037). However, we observed no correlation between Epo or EpoR expression and intratumoral hypoxia, although in well-oxygenated tumors, EpoR localized significantly more often to the invasion front (P = 0.047). CONCLUSIONS This study analyzes Epo/EpoR expression and their relationship with intratumoral pO(2) levels as well as with survival in patients with cervical cancer. The data suggest a critical role of the endogenous Epo/EpoR system in cervical cancer.
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Höckel M, Dornhöfer N. Neue Prinzipien und Techniken in der operativen Therapie des Zervixkarzinoms: Aktuelle systematische Übersicht. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-965814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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75
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