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Haussmann J, Budach W, Corradini S, Krug D, Bölke E, Tamaskovics B, Jazmati D, Haussmann A, Matuschek C. Whole Breast Irradiation in Comparison to Endocrine Therapy in Early Stage Breast Cancer-A Direct and Network Meta-Analysis of Published Randomized Trials. Cancers (Basel) 2023; 15:4343. [PMID: 37686620 PMCID: PMC10487067 DOI: 10.3390/cancers15174343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/09/2023] [Accepted: 08/15/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Multiple randomized trials have established adjuvant endocrine therapy (ET) and whole breast irradiation (WBI) as the standard approach after breast-conserving surgery (BCS) in early-stage breast cancer. The omission of WBI has been studied in multiple trials and resulted in reduced local control with maintained survival rates and has therefore been adapted as a treatment option in selected patients in several guidelines. Omitting ET instead of WBI might also be a valuable option as both treatments have distinctly different side effect profiles. However, the clinical outcomes of BCS + ET vs. BCS + WBI have not been formally analyzed. METHODS We performed a systematic literature review searching for randomized trials comparing BCS + ET vs. BCS + WBI in low-risk breast cancer patients with publication dates after 2000. We excluded trials using any form of chemotherapy, regional nodal radiation and mastectomy. The meta-analysis was performed using a two-step process. First, we extracted all available published event rates and the effect sizes for overall and breast-cancer-specific survival (OS, BCSS), local (LR) and regional recurrence, disease-free survival, distant metastases-free interval, contralateral breast cancer, second cancer other than breast cancer and mastectomy-free interval as investigated endpoints and compared them in a network meta-analysis. Second, the published individual patient data from the Early Breast Cancer Trialists' Collaborative Group (EBCTCG) publications were used to allow a comparison of OS and BCSS. RESULTS We identified three studies, including a direct comparison of BCS + ET vs. BCS + WBI (n = 1059) and nine studies randomizing overall 7207 patients additionally to BCS only and BCS + WBI + ET resulting in a four-arm comparison. In the network analysis, LR was significantly lower in the BCS + WBI group in comparison with the BCS + ET group (HR = 0.62; CI-95%: 0.42-0.92; p = 0.019). We did not find any differences in OS (HR = 0.93; CI-95%: 0.53-1.62; p = 0.785) and BCSS (OR = 1.04; CI-95%: 0.45-2.41; p = 0.928). Further, we found a lower distant metastasis-free interval, a higher rate of contralateral breast cancer and a reduced mastectomy-free interval in the BCS + WBI-arm. Using the EBCTCG data, OS and BCSS were not significantly different between BCS + ET and BCS + WBI after 10 years (OS: OR = 0.85; CI-95%: 0.59-1.22; p = 0.369) (BCSS: OR = 0.72; CI-95%: 0.38-1.36; p = 0.305). CONCLUSION Evidence from direct and indirect comparison suggests that BCS + WBI might be an equivalent de-escalation strategy to BCS + ET in low-risk breast cancer. Adverse events and quality of life measures have to be further compared between these approaches.
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Affiliation(s)
- Jan Haussmann
- Department of Radiation Oncology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, 40225 Düsseldorf, Germany; (J.H.); (W.B.); (B.T.); (D.J.); (C.M.)
| | - Wilfried Budach
- Department of Radiation Oncology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, 40225 Düsseldorf, Germany; (J.H.); (W.B.); (B.T.); (D.J.); (C.M.)
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians-University (LMU), 81377 Munich, Germany;
| | - David Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, 24105 Kiel, Germany;
| | - Edwin Bölke
- Department of Radiation Oncology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, 40225 Düsseldorf, Germany; (J.H.); (W.B.); (B.T.); (D.J.); (C.M.)
| | - Balint Tamaskovics
- Department of Radiation Oncology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, 40225 Düsseldorf, Germany; (J.H.); (W.B.); (B.T.); (D.J.); (C.M.)
| | - Danny Jazmati
- Department of Radiation Oncology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, 40225 Düsseldorf, Germany; (J.H.); (W.B.); (B.T.); (D.J.); (C.M.)
| | - Alexander Haussmann
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany;
| | - Christiane Matuschek
- Department of Radiation Oncology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, 40225 Düsseldorf, Germany; (J.H.); (W.B.); (B.T.); (D.J.); (C.M.)
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2
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Fischer JC, Balz V, Jazmati D, Bölke E, Freise NF, Keitel V, Feldt T, Jensen BEO, Bode J, Lüdde T, Häussinger D, Adams O, Schneider EM, Enczmann J, Rox JM, Hermsen D, Schulze-Bosse K, Kindgen-Milles D, Knoefel WT, van Griensven M, Haussmann J, Tamaskovics B, Plettenberg C, Scheckenbach K, Corradini S, Pedoto A, Maas K, Schmidt L, Grebe O, Esposito I, Ehrhardt A, Peiper M, Buhren BA, Calles C, Stöhr A, Gerber PA, Lichtenberg A, Schelzig H, Flaig Y, Rezazadeh A, Budach W, Matuschek C. Prognostic markers for the clinical course in the blood of patients with SARS-CoV-2 infection. Eur J Med Res 2022; 27:255. [PMID: 36411478 PMCID: PMC9676819 DOI: 10.1186/s40001-022-00864-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/20/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The presentation of peptides and the subsequent immune response depend on the MHC characteristics and influence the specificity of the immune response. Several studies have found an association between HLA variants and differential COVID-19 outcomes and have shown that HLA genotypes are associated with differential immune responses against SARS-CoV-2, particularly in severely ill patients. Information, whether HLA haplotypes are associated with the severity or length of the disease in moderately diseased individuals is absent. METHODS Next-generation sequencing-based HLA typing was performed in 303 female and 231 male non-hospitalized North Rhine Westphalian patients infected with SARS-CoV2 during the first and second wave. For HLA-Class I, we obtained results from 528 patients, and for HLA-Class II from 531. In those patients, who became ill between March 2020 and January 2021, the 22 most common HLA-Class I (HLA-A, -B, -C) or HLA-Class II (HLA -DRB1/3/4, -DQA1, -DQB1) haplotypes were determined. The identified HLA haplotypes as well as the presence of a CCR5Δ32 mutation and number of O and A blood group alleles were associated to disease severity and duration of the disease. RESULTS The influence of the HLA haplotypes on disease severity and duration was more pronounced than the influence of age, sex, or ABO blood group. These associations were sex dependent. The presence of mutated CCR5 resulted in a longer recovery period in males. CONCLUSION The existence of certain HLA haplotypes is associated with more severe disease.
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Affiliation(s)
- Johannes C. Fischer
- grid.14778.3d0000 0000 8922 7789Institute for Transplant Diagnostics and Cell Therapeutics, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
| | - Vera Balz
- grid.14778.3d0000 0000 8922 7789Institute for Transplant Diagnostics and Cell Therapeutics, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
| | - Danny Jazmati
- grid.14778.3d0000 0000 8922 7789Department of Radiation Oncology, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
| | - Edwin Bölke
- grid.14778.3d0000 0000 8922 7789Department of Radiation Oncology, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
| | - Noemi F. Freise
- grid.14778.3d0000 0000 8922 7789Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
| | - Verena Keitel
- grid.14778.3d0000 0000 8922 7789Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
| | - Torsten Feldt
- grid.14778.3d0000 0000 8922 7789Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
| | - Björn-Erik Ole Jensen
- grid.14778.3d0000 0000 8922 7789Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
| | - Johannes Bode
- grid.14778.3d0000 0000 8922 7789Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
| | - Tom Lüdde
- grid.14778.3d0000 0000 8922 7789Institute for Virology, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
| | - Dieter Häussinger
- grid.14778.3d0000 0000 8922 7789Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
| | - Ortwin Adams
- grid.14778.3d0000 0000 8922 7789Institute for Virology, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
| | - E. Marion Schneider
- grid.410712.10000 0004 0473 882XDivision of Experimental Anesthesiology, University Hospital Ulm, Ulm, Germany
| | - Jürgen Enczmann
- grid.14778.3d0000 0000 8922 7789Institute for Transplant Diagnostics and Cell Therapeutics, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
| | - Jutta M. Rox
- grid.14778.3d0000 0000 8922 7789Institute for Transplant Diagnostics and Cell Therapeutics, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
| | - Derik Hermsen
- grid.14778.3d0000 0000 8922 7789Central Institute for Laboratory Diagnostics and Clinical Chemistry, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
| | - Karin Schulze-Bosse
- grid.14778.3d0000 0000 8922 7789Central Institute for Laboratory Diagnostics and Clinical Chemistry, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
| | - Detlef Kindgen-Milles
- grid.14778.3d0000 0000 8922 7789Department of Anesthesiology, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
| | - Wolfram Trudo Knoefel
- grid.14778.3d0000 0000 8922 7789Department of Surgery and Interdisciplinary Surgical Intensive Care Unit, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
| | - Martijn van Griensven
- grid.5012.60000 0001 0481 6099Department cBITE, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, The Netherlands
| | - Jan Haussmann
- grid.14778.3d0000 0000 8922 7789Department of Radiation Oncology, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
| | - Balint Tamaskovics
- grid.14778.3d0000 0000 8922 7789Department of Radiation Oncology, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
| | - Christian Plettenberg
- grid.14778.3d0000 0000 8922 7789Department of Ear, Nose and Throat Disease, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
| | - Kathrin Scheckenbach
- grid.14778.3d0000 0000 8922 7789Department of Ear, Nose and Throat Disease, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
| | - Stefanie Corradini
- grid.5252.00000 0004 1936 973XDepartment of Radiation Oncology, LMU University of Munich, Munich, Germany
| | - Alessia Pedoto
- grid.51462.340000 0001 2171 9952Department of Anesthesiology, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Kitti Maas
- grid.14778.3d0000 0000 8922 7789Department of Radiation Oncology, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
| | - Livia Schmidt
- grid.14778.3d0000 0000 8922 7789Department of Radiation Oncology, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
| | - Olaf Grebe
- Department of Cardiology and Rhythmology, Petrus Hospital, Wuppertal, Germany
| | - Irene Esposito
- grid.14778.3d0000 0000 8922 7789Institute of Pathology, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
| | - Anja Ehrhardt
- grid.412581.b0000 0000 9024 6397Institute of Virology, University of Witten/Herdecke, Witten, Germany
| | - Matthias Peiper
- grid.14778.3d0000 0000 8922 7789Medical Faculty, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
| | - Bettina Alexandra Buhren
- grid.14778.3d0000 0000 8922 7789Department of Radiation Oncology, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
| | - Christian Calles
- grid.14778.3d0000 0000 8922 7789Coordination Center for Clinical Studies, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
| | - Andreas Stöhr
- grid.14778.3d0000 0000 8922 7789Coordination Center for Clinical Studies, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
| | - Peter Arne Gerber
- grid.14778.3d0000 0000 8922 7789Department of Radiation Oncology, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
| | - Artur Lichtenberg
- grid.14778.3d0000 0000 8922 7789Department of Cardiac Surgery, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
| | - Hubert Schelzig
- grid.14778.3d0000 0000 8922 7789Department of Vascular Surgery, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
| | - Yechan Flaig
- grid.14778.3d0000 0000 8922 7789Department of Radiation Oncology, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
| | - Amir Rezazadeh
- grid.14778.3d0000 0000 8922 7789Department of Radiation Oncology, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
| | - Wilfried Budach
- grid.14778.3d0000 0000 8922 7789Department of Radiation Oncology, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
| | - Christiane Matuschek
- grid.14778.3d0000 0000 8922 7789Department of Radiation Oncology, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
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Haussmann J, Budach W, Nestle-Krämling C, Wollandt S, Tamaskovics B, Corradini S, Bölke E, Krug D, Fehm T, Ruckhäberle E, Audretsch W, Jazmati D, Matuschek C. Predictive Factors of Long-Term Survival after Neoadjuvant Radiotherapy and Chemotherapy in High-Risk Breast Cancer. Cancers (Basel) 2022; 14:cancers14164031. [PMID: 36011025 PMCID: PMC9406575 DOI: 10.3390/cancers14164031] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/08/2022] [Accepted: 08/17/2022] [Indexed: 11/24/2022] Open
Abstract
Simple Summary This retrospective analysis reports on the treatment outcomes of women diagnosed with high-risk breast cancer treated with chemotherapy in combination with radiotherapy before the surgical removal of the tumor. It is well established that the lack of visible tumor cells in the pathological tumors analysis by the time of surgery (known as pathological complete response, pCR) is a factor that improves survival without the tumor reappearing in the body. However, it is unknown whether that is only true when giving systemic therapy or when pCR is achieved with the help of radiotherapy. We collected patient information and survival times to analyze the outcome in our patient group. We found that women with a pCR treated with chemotherapy in combination with radiotherapy can expect favorable long-term survival. This was true across different types of breast cancer and chemotherapy substances. Abstract Background: Neoadjuvant radiotherapy (naRT) in addition to neoadjuvant chemotherapy (naCT) has been used for locally advanced, inoperable breast cancer or to allow breast conserving surgery (BCS). Retrospective analyses suggest that naRT + naCT might result in an improvement in pathological complete response (pCR rate and disease-free survival). pCR is a surrogate parameter for improved event-free and overall survival (OS) and allows for the adaption of the post-neoadjuvant therapy regimens. However, it is not clear whether pCR achieved with the addition of naRT has the same prognostic value. Patients and methods: We performed a retrospective re-analysis of 356 patients (cT1-cT4/cN0-N+) treated with naRT and naCT with a long-term follow-up. Patients underwent naRT on the breast and regional lymph nodes combined with a boost to the primary tumor. Chemotherapy with different agents was given either sequentially or concomitantly to naRT. We used the Cox proportional hazard regression model to estimate the effect of pCR in our cohort in different subgroups as well as chemotherapy protocols. Clinical response markers correlating with OS were also analyzed. Results: For patients with median follow-ups of 20 years, 10 years, 15 years, 20 years, and 25 years, OS rates were 69.7%, 60.6%, 53.1%, and 45.1%, respectively. pCR was achieved in 31.1% of patients and associated with a significant improvement in OS (HR = 0.58; CI-95%: 0.41–0.80; p = 0.001). The prognostic impact of pCR was evident across breast cancer subtypes and chemotherapy regimens. Multivariate analysis showed that age, clinical tumor and nodal stage, chemotherapy, and pCR were prognostic for OS. Conclusion: NaCT and naRT prior to surgical resection achieve good long-term survival in high-risk breast cancer. pCR after naRT maintains its prognostic value in breast cancer subtypes and across different subgroups. pCR driven by naRT and naCT independently influences long-term survival.
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Affiliation(s)
- Jan Haussmann
- Department of Radiation Oncology, Heinrich Heine University, 40225 Dusseldorf, Germany
| | - Wilfried Budach
- Department of Radiation Oncology, Heinrich Heine University, 40225 Dusseldorf, Germany
| | - Carolin Nestle-Krämling
- Department of Gynecology and Obstetrics, Evangelisches Krankenhaus Dusseldorf, 40217 Dusseldorf, Germany
| | - Sylvia Wollandt
- Department of Senology, Sana-Kliniken Duesseldorf-Gerresheim, 40625 Dusseldorf, Germany
| | - Balint Tamaskovics
- Department of Radiation Oncology, Heinrich Heine University, 40225 Dusseldorf, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians University (LMU), 80366 Munich, Germany
| | - Edwin Bölke
- Department of Radiation Oncology, Heinrich Heine University, 40225 Dusseldorf, Germany
- Correspondence: ; Tel.: +49-0211-81-17990
| | - David Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Tanja Fehm
- Department of Gynecology and Obstetrics, Heinrich Heine University, 40225 Dusseldorf, Germany
| | - Eugen Ruckhäberle
- Department of Gynecology and Obstetrics, Heinrich Heine University, 40225 Dusseldorf, Germany
| | - Werner Audretsch
- Department of Senology and Breast Surgery, Breast Center at Marien Hospital Cancer Center, 40479 Dusseldorf, Germany
| | - Danny Jazmati
- Department of Radiation Oncology, Heinrich Heine University, 40225 Dusseldorf, Germany
| | - Christiane Matuschek
- Department of Radiation Oncology, Heinrich Heine University, 40225 Dusseldorf, Germany
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4
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Freise NF, Kivel M, Grebe O, Meyer C, Wafaisade B, Peiper M, Zeus T, Schmidt J, Neuwahl J, Jazmati D, Luedde T, Bölke E, Feldt T, Jensen BEO, Bode J, Keitel V, Haussmann J, Tamaskovics B, Budach W, Fischer JC, Knoefel WT, Schneider M, Gerber PA, Pedoto A, Häussinger D, van Griensven M, Rezazadeh A, Flaig Y, Kirchner J, Antoch G, Schelzig H, Matuschek C. Acute cardiac side effects after COVID-19 mRNA vaccination: a case series. Eur J Med Res 2022; 27:80. [PMID: 35655235 PMCID: PMC9160507 DOI: 10.1186/s40001-022-00695-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/27/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Vaccination against SARS-CoV-2 has been the main tool to contain the pandemic. The rush development of the 3 vaccines and their expedited approval have led to inoculation of millions of patients around the world, leading to a containment of the disease. Despite continuous viral mutations and the identification of weaker variants, the severity of the infections has been mild, with many patients being either asymptomatic or recovering at home. Currently the focus has shifted from the host of organ damage related to the infection to potential side effects of the vaccine. Myocarditis has been reported as one of the potential side effects from the mRNA vaccine, affecting young healthy individuals. Up to September 30, 2021, 1.243 cases of myocarditis after vaccination with BNT162b2 Comirnaty© were registered in young adults by the Paul-Ehrlich-Institute in Germany alone. The exact pathophysiology and the risk factors for myocarditis following vaccination remain unclear. We present a case series of eight patients with cardiac symptom shortly after SARS-CoV-2 mRNA vaccination (BNT162b6, Biontech, Comirnaty© or mRNA-1237 Moderna, Spikevax©). PATIENTS AND METHODS Eight patients between 13 and 56 years of age, vaccinated with either BNT162b2 or mRNA-1273 mRNA vaccine between January and August 2021 developed cardiac side effects shortly after either their first or second dose of the vaccine. Clinical data were retrieved from the clinical information system and analyzed. To support diagnosis of myocarditis or pericarditis, cardiac magnetic resonance imaging (MRI) was performed shortly after the onset of symptoms, with further investigations in severe cases. Symptoms were defined as dyspnea, chest pain and cardiac arrhythmia as determined by electrocardiography. RESULTS Eight patients (5 males and 3 females) developed cardiac symptoms compatible with myocarditis, according to the CDC criteria, shortly after SARS-CoV-2 mRNA vaccination. Three patients (2 males, 1 female) required hospitalization due to severe chest pain and elevated troponin levels. All patients recovered fully within 7 days from the symptom onset. CONCLUSIONS Our data suggest that cardiac adverse events such as myocarditis or pericarditis shortly after SARS-CoV-2 mRNA vaccination are rare but possible and occur particularly in male patients.
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Affiliation(s)
- Noemi F Freise
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Milena Kivel
- Department of Pediatric, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - Olaf Grebe
- Department of Cardiology and Rhythmology, Petrus Hospital, Wuppertal, Germany
| | - Christian Meyer
- Department for Cardiology, Rhythmology, Angiology and Intensive Care Medicine, cNEP Research Consortium, EVK Düsseldorf, Düsseldorf, Germany
| | - Bahram Wafaisade
- Department for Cardiology, Rhythmology, Angiology and Intensive Care Medicine, cNEP Research Consortium, EVK Düsseldorf, Düsseldorf, Germany
| | - Matthias Peiper
- Department for Cardiology, Rhythmology, Angiology and Intensive Care Medicine, cNEP Research Consortium, EVK Düsseldorf, Düsseldorf, Germany
| | - Tobias Zeus
- Medical Faculty, Department of Cardiology, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Jan Schmidt
- Medical Faculty, Department of Cardiology, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Judith Neuwahl
- Department of Radiation Oncology, University Hospital, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Danny Jazmati
- Department of Radiation Oncology, University Hospital, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Tom Luedde
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Edwin Bölke
- Department of Radiation Oncology, University Hospital, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Torsten Feldt
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Björn Erik Ole Jensen
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Johannes Bode
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Verena Keitel
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.,Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Magdeburg, Medical Faculty of Otto Von Guericke University Magdeburg, Leipziger Str. 44, 39104, Magdeburg, Germany
| | - Jan Haussmann
- Department of Radiation Oncology, University Hospital, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Balint Tamaskovics
- Department of Radiation Oncology, University Hospital, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Wilfried Budach
- Department of Radiation Oncology, University Hospital, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Johannes C Fischer
- Institute for Transplant Diagnostics and Cell Therapeutics, Heinrich Heine University, Düsseldorf, Germany
| | - Wolfram Trudo Knoefel
- Medical Faculty, Department of Surgery and Interdisciplinary Surgical Intensive Care Unit, Heinrich Heine University, Düsseldorf, Germany
| | - Marion Schneider
- Division of Experimental Anesthesiology, University Hospital Ulm, Ulm, Germany
| | - Peter Arne Gerber
- Medical Faculty, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - Alessia Pedoto
- Department of Anesthesiology, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Dieter Häussinger
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Martijn van Griensven
- Department cBITE, Maastricht University, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht, The Netherlands
| | - Amir Rezazadeh
- Department of Radiation Oncology, University Hospital, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Yechan Flaig
- Department of Radiation Oncology, University Hospital, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Julian Kirchner
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Hospital of Düsseldorf, Dusseldorf, Germany
| | - Gerald Antoch
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Hospital of Düsseldorf, Dusseldorf, Germany
| | - Hubert Schelzig
- Medical Faculty, Department of Vascular Surgery, University Hospital Heinrich Heine University, Düsseldorf, Germany
| | - Christiane Matuschek
- Department of Radiation Oncology, University Hospital, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
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Hecht M, Eckstein M, Kallies A, Klautke G, Illmer T, von der Grün J, Laban S, Hautmann MG, Tamaskovics B, Brunner T, Hinke A, Frey B, Semrau S, Hartmann A, Balermpas P, Budach W, Gaipl US, Iro H, Gostian AO, Fietkau R. Pathologic response after induction chemo-immunotherapy with single or double immune checkpoint inhibition in locally advanced head and neck squamous cell carcinoma (HNSCC): Expansion cohorts of the CheckRad-CD8 trial. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.6064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6064 Background: Targeting the immune checkpoint CTLA-4 in addition to PD-1/PD-L1 alone did not increase efficacy in HNSCC, whereas this has not been studied in combination with chemotherapy. Induction chemo-immunotherapy followed by pathologic response-based patient selection for chemotherapy-free radioimmunotherapy was efficient in locally advanced HNSCC (J Immunother Cancer. 2022 Jan;10(1):e003747). The expansion cohorts of the CheckRad-CD8 trial studied safety and efficacy of induction chemo-immunotherapy with increased dose or without CTLA-4 inhibition. Methods: Patients with previously untreated stage III-IVB (AJCC 8th edition) HNSCC were eligible for this multicenter phase II trial. Induction chemo-immunotherapy of the main cohort (MC) consisted of a single cycle of cisplatin 30mg/m² d1-3, docetaxel 75mg/m² d1, durvalumab 1500mg fix dose d5 and tremelimumab 75mg fix dose d5. Patients in expansion cohort 1 (EC1) received this combination with high dose tremelimumab 300mg fix dose d5 and patients in expansion cohort 2 (EC2) received no tremelimumab. In EC1 and EC2 prophylactic G-CSF was recommended. Patients with at least 20% increase of intratumoral CD8+ immune cell density or pathological complete response (pCR) in the re-biopsy entered chemotherapy-free radioimmunotherapy up to a total dose of 70Gy. The current analysis focuses on toxicity and pathologic response after induction chemo-immunotherapy. Results: Between Sep 2018 and Sep 2021, 80 patients were enrolled in the MC (one excluded), 20 in EC1 and 20 in EC2 (one excluded) subsequently. In the MC, EC1 and EC2 a total of 56%, 50%, 58% were stage IV and 29%, 30%, 26% had p16 positive oropharyngeal tumors. Baseline median intratumoral CD8+ immune cell density was 395/mm², 505/mm² and 763/mm² in MC, EC1 and EC2. After induction chemo-immunotherapy 41 (52%), 12 (60%) and 11 (58%) of the patients had pCR in the re-biopsy in MC, EC1 and EC2. Patients with residual tumor after induction therapy had a median intratumoral CD8+ immune cell density of 670/mm², 781/mm² and 1605/mm², which was a median increase by factor 3.0, 2.1 and 4.8 in the corresponding patients’ tissue samples. In the cohorts MC, EC1 and EC2 the overall rate of grade 3-4 adverse events per patient was 1.38, 1.35 and 0.58. The corresponding rate of non-hematologic adverse events per patient was 0.84, 0.95 and 0.37, respectively. Conclusions: Neither increase of tremelimumab dosage nor its omission did significantly affect pathologic response to induction chemo-immunotherapy with cisplatin/ docetaxel/ durvalumab. Non-hematologic toxicity was slightly increased for high dose tremelimumab and clearly decreased without tremelimumab. The role of concomitant administration of tremelimumab with radiotherapy cannot be assessed until the final study analysis. Clinical trial information: NCT03426657.
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Affiliation(s)
- Markus Hecht
- Department of Radiation Oncology, Universitatsklinikum Erlangen, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| | - Markus Eckstein
- Institute of Pathology, Universitatsklinikum Erlangen, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| | - Annett Kallies
- Department of Radiation Oncology, Universitatsklinikum Erlangen, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| | - Gunther Klautke
- Department of Radiation Oncology, Klinikum Chemnitz, Chemnitz, Germany
| | - Thomas Illmer
- Private Praxis Oncology Arnoldstraße, Dresden, Germany
| | - Jens von der Grün
- Department of Radiation Oncology, University Hospital Frankfurt, Goethe-Universität Frankfurt, Frankfurt Am Main, Germany
| | - Simon Laban
- Department of Otolaryngology-Head and Neck Surgery, University Hospital Ulm, Universität Ulm, Ulm, Germany
| | - Matthias G. Hautmann
- Department of Radiation Oncology, University Hospital Regensburg, Universität Regensburg, Regensburg, Germany
| | - Balint Tamaskovics
- Department of Radiation Oncology, University Hospital Düsseldorf, Heinrich Heine Universität Düsseldorf, Dusseldorf, Germany
| | - Thomas Brunner
- Department of Radiation Oncology, University Hospital Magdeburg, Otto von Guericke Universität Magdeburg, Freiburg, Germany
| | - Axel Hinke
- CCRC Cancer Clinical Research Consulting, Düsseldorf, Germany
| | - Benjamin Frey
- Department of Radiation Oncology, Universitatsklinikum Erlangen, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| | - Sabine Semrau
- Department of Radiation Oncology, Universitatsklinikum Erlangen, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, Universitatsklinikum Erlangen, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| | | | | | - Udo S Gaipl
- Department of Radiation Oncology, Universitatsklinikum Erlangen, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| | - Heinrich Iro
- Department of Otholaryngology-Head and Neck Surgery, Universitatsklinikum Erlangen, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| | - Antoniu-Oreste Gostian
- Department of Otholaryngology-Head and Neck Surgery, Universitatsklinikum Erlangen, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, Universitatsklinikum Erlangen, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
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Beck M, Hartwich J, Eckstein M, Schmidt D, Gostian AO, Müller S, Rutzner S, Gaipl US, von der Grün J, Illmer T, Hautmann MG, Klautke G, Döscher J, Brunner T, Tamaskovics B, Hartmann A, Iro H, Kuwert T, Fietkau R, Hecht M, Semrau S. F18-FDG PET/CT imaging early predicts pathologic complete response to induction chemoimmunotherapy of locally advanced head and neck cancer: preliminary single-center analysis of the checkrad-cd8 trial. Ann Nucl Med 2022; 36:623-633. [PMID: 35534690 PMCID: PMC9226092 DOI: 10.1007/s12149-022-01744-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/12/2022] [Indexed: 11/05/2022]
Abstract
Aim In the CheckRad-CD8 trial patients with locally advanced head and neck squamous cell cancer are treated with a single cycle of induction chemo-immunotherapy (ICIT). Patients with pathological complete response (pCR) in the re-biopsy enter radioimmunotherapy. Our goal was to study the value of F-18-FDG PET/CT in the prediction of pCR after induction therapy. Methods Patients treated within the CheckRad-CD8 trial that additionally received FDG- PET/CT imaging at the following two time points were included: 3–14 days before (pre-ICIT) and 21–28 days after (post-ICIT) receiving ICIT. Tracer uptake in primary tumors (PT) and suspicious cervical lymph nodes (LN +) was measured using different quantitative parameters on EANM Research Ltd (EARL) accredited PET reconstructions. In addition, mean FDG uptake levels in lymphatic and hematopoietic organs were examined. Percent decrease (Δ) in FDG uptake was calculated for all parameters. Biopsy of the PT post-ICIT acquired after FDG-PET/CT served as reference. The cohort was divided in patients with pCR and residual tumor (ReTu). Results Thirty-one patients were included. In ROC analysis, ΔSUVmax PT performed best (AUC = 0.89) in predicting pCR (n = 17), with a decline of at least 60% (sensitivity, 0.77; specificity, 0.93). Residual SUVmax PT post-ICIT performed best in predicting ReTu (n = 14), at a cutpoint of 6.0 (AUC = 0.91; sensitivity, 0.86; specificity, 0.88). Combining two quantitative parameters (ΔSUVmax ≥ 50% and SUVmax PT post-ICIT ≤ 6.0) conferred a sensitivity of 0.81 and a specificity of 0.93 for determining pCR. Background activity in lymphatic organs or uptake in suspected cervical lymph node metastases lacked significant predictive value. Conclusion FDG-PET/CT can identify patients with pCR after ICIT via residual FDG uptake levels in primary tumors and the related changes compared to baseline. FDG-uptake in LN + had no predictive value. Trial registry ClinicalTrials.gov identifier: NCT03426657.
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Affiliation(s)
- M Beck
- Clinic of Nuclear Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Bayern, Germany.
| | - J Hartwich
- Clinic of Nuclear Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Bayern, Germany
| | - M Eckstein
- Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany
| | - D Schmidt
- Clinic of Nuclear Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Bayern, Germany
| | - A O Gostian
- Department of Otolaryngology-Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany
| | - S Müller
- Department of Otolaryngology-Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany
| | - S Rutzner
- Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany
| | - U S Gaipl
- Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany
| | - J von der Grün
- Department of Radiotherapy and Oncology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - T Illmer
- Medical Oncology Clinic Dresden Freiberg, Dresden, Saxony, Germany
| | - M G Hautmann
- Department of Radiotherapy, Universität Regensburg, Regensburg, Bayern, Germany
| | - G Klautke
- Department of Radiation Oncology, Chemnitz Hospital, Chemnitz, Sachsen, Germany
| | - J Döscher
- Department of Otolaryngology-Head and Neck Surgery, Universität Ulm, Ulm, Baden-Württemberg, Germany
| | - T Brunner
- Department of Radiation Oncology, Otto Von Guericke Universität Magdeburg, Magdeburg, Sachsen-Anhalt, Germany
| | - B Tamaskovics
- Department of Radiation Oncology, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Nordrhein-Westfalen, Germany
| | - A Hartmann
- Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany
| | - H Iro
- Department of Otolaryngology-Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany
| | - T Kuwert
- Clinic of Nuclear Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Bayern, Germany
| | - R Fietkau
- Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany
| | - M Hecht
- Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany
| | - S Semrau
- Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany
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Haussmann J, Matuschek C, Bölke E, Tamaskovics B, Corradini S, Wessalowski R, Maas K, Schmidt L, Orth K, Peiper M, Keitel V, Feldt T, Jensen BEO, Luedde T, Fischer J, Knoefel WT, Ashmawy H, Pedotoa A, Kammers K, Budach W. Comparison of Different Systemic Therapeutic Regimes in Resectable Soft-Tissue Sarcoma-Results of a Network Meta-Analysis. Cancers (Basel) 2021; 13:cancers13225631. [PMID: 34830786 PMCID: PMC8615898 DOI: 10.3390/cancers13225631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/12/2021] [Accepted: 10/29/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary This analysis was conducted to compare different systemic treatment options in the therapy of localized and resectable soft-tissue sarcoma. We tested these in a network against the current standard of resection with or without radiotherapy, which allowed direct and indirect comparisons. Chemotherapy given after the local therapy and chemotherapy added to regional hyperthermia before the operation were associated with a longer survival and likeliness of being disease free and alive. Chemotherapy tailored to the specific subtype of sarcoma did not improve outcomes. Adjuvant chemotherapy might be more helpful in male rather than female patients. Abstract Background: The standard treatment of high-risk soft-tissue sarcoma consists of surgical resection followed by risk-adapted radiation therapy. Further treatment options that may improve local and systemic tumor control, including chemotherapy, are not well established. Due to the heterogeneity of the disease, different systemic approaches as well as their application at different time points have been attempted. Methods: We conducted a systematic literature search for randomized clinical trials in the treatment of localized, resectable high-risk adult soft-tissue sarcoma comparing different treatment modalities according to the PRISMA guidelines. We extracted published hazard ratios and number of events for the endpoints overall and disease-free survival (OS; DFS) as well as local and distant recurrence-free interval (LRFI; DRFI). The different modalities were compared in a network meta-analysis against the defined standard treatment surgery ± radiotherapy using the inverse-variance heterogeneity model. Results: The literature search identified 25 trials including 3453 patients. Five different treatment modalities were compared in the network meta-analysis. The addition of adjuvant chemotherapy significantly improved OS compared to surgery ± radiotherapy alone (HR = 0.86; CI-95%: 0.75–0.97; p = 0.017). Likewise, neoadjuvant chemotherapy combined with regional hyperthermia (naCTx + HTx) also led to superior OS (HR = 0.45; CI-95%: 0.20–1.00; p = 0.049). Both neoadjuvant chemotherapy alone (naCTx) and perioperative chemotherapy (periCTx) did not improve OS (HR = 0.61; CI-95%: 0.29–1.29; p = 0.195 and HR = 0.66; CI-95%: 0.30–1.48; p = 0.317, respectively). Histology-tailored chemotherapy (htCTx) also did not improve survival compared to surgery ± radiotherapy (HR = 1.08; CI-95%: 0.45–2.61; p = 0.868). The network analysis of DFS, LRFI, and DRFI revealed a similar pattern between the different treatment regimens. Adjuvant chemotherapy significantly improved DFS, LRFI, and DRFI compared to surgery ± radiotherapy. In direct comparison, this advantage of adjuvant chemotherapy was restricted to male patients (HR = 0.78; CI-95%: 0.65–0.92; p = 0.004) with no effect for female patients (HR = 1.08; CI-95%: 0.90–1.29; p = 0.410). Conclusions: Standardized chemotherapy in high-risk soft-tissue sarcoma appears to be of added value irrespective of timing. The benefit of adjuvant chemotherapy seems to be restricted to male patients. The addition of regional hyperthermia to neodjuvant chemotherapy achieved the best effect sizes and might warrant further investigation.
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Affiliation(s)
- Jan Haussmann
- Department of Radiation Oncology, Heinrich Heine University, 40225 Dusseldorf, Germany; (J.H.); (C.M.); (B.T.); (K.M.); (L.S.); (K.O.); (M.P.); (W.B.)
| | - Christiane Matuschek
- Department of Radiation Oncology, Heinrich Heine University, 40225 Dusseldorf, Germany; (J.H.); (C.M.); (B.T.); (K.M.); (L.S.); (K.O.); (M.P.); (W.B.)
| | - Edwin Bölke
- Department of Radiation Oncology, Heinrich Heine University, 40225 Dusseldorf, Germany; (J.H.); (C.M.); (B.T.); (K.M.); (L.S.); (K.O.); (M.P.); (W.B.)
- Correspondence: ; Tel.: +49-0211-81-17990; Fax: +49-0211-81-18051
| | - Balint Tamaskovics
- Department of Radiation Oncology, Heinrich Heine University, 40225 Dusseldorf, Germany; (J.H.); (C.M.); (B.T.); (K.M.); (L.S.); (K.O.); (M.P.); (W.B.)
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital LMU University, 81377 Munich, Germany;
| | - Rüdiger Wessalowski
- Department of Paediatric Haematology and Oncology, Medical Faculty, Heinrich-Heine-University Dusseldorf, 40225 Dusseldorf, Germany;
| | - Kitti Maas
- Department of Radiation Oncology, Heinrich Heine University, 40225 Dusseldorf, Germany; (J.H.); (C.M.); (B.T.); (K.M.); (L.S.); (K.O.); (M.P.); (W.B.)
| | - Livia Schmidt
- Department of Radiation Oncology, Heinrich Heine University, 40225 Dusseldorf, Germany; (J.H.); (C.M.); (B.T.); (K.M.); (L.S.); (K.O.); (M.P.); (W.B.)
| | - Klaus Orth
- Department of Radiation Oncology, Heinrich Heine University, 40225 Dusseldorf, Germany; (J.H.); (C.M.); (B.T.); (K.M.); (L.S.); (K.O.); (M.P.); (W.B.)
| | - Matthias Peiper
- Department of Radiation Oncology, Heinrich Heine University, 40225 Dusseldorf, Germany; (J.H.); (C.M.); (B.T.); (K.M.); (L.S.); (K.O.); (M.P.); (W.B.)
| | - Verena Keitel
- Department of Gastroenterology, Hepatology and Infectious Diseases University Hospital Dusseldorf, Medical Faculty, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225 Dusseldorf, Germany; (V.K.); (T.F.); (B.-E.O.J.); (T.L.)
| | - Torsten Feldt
- Department of Gastroenterology, Hepatology and Infectious Diseases University Hospital Dusseldorf, Medical Faculty, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225 Dusseldorf, Germany; (V.K.); (T.F.); (B.-E.O.J.); (T.L.)
| | - Björn-Erik Ole Jensen
- Department of Gastroenterology, Hepatology and Infectious Diseases University Hospital Dusseldorf, Medical Faculty, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225 Dusseldorf, Germany; (V.K.); (T.F.); (B.-E.O.J.); (T.L.)
| | - Tom Luedde
- Department of Gastroenterology, Hepatology and Infectious Diseases University Hospital Dusseldorf, Medical Faculty, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225 Dusseldorf, Germany; (V.K.); (T.F.); (B.-E.O.J.); (T.L.)
| | - Johannes Fischer
- Institute for Transplant Diagnostics and Cell Therapeutics, University Hospital Dusseldorf, Medical Faculty, Heinrich-Heine-University, 40225 Dusseldorf, Germany;
| | - Wolfram Trudo Knoefel
- Department of Surgery and Interdisciplinary Surgical Intensive Care Unit, Medical Faculty, Heinrich Heine University, 40225 Dusseldorf, Germany; (W.T.K.); (H.A.)
| | - Hany Ashmawy
- Department of Surgery and Interdisciplinary Surgical Intensive Care Unit, Medical Faculty, Heinrich Heine University, 40225 Dusseldorf, Germany; (W.T.K.); (H.A.)
| | - Alessia Pedotoa
- Department of Anesthesiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - Kai Kammers
- Division of Biostatistics and Bioinformatics, Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA;
| | - Wilfried Budach
- Department of Radiation Oncology, Heinrich Heine University, 40225 Dusseldorf, Germany; (J.H.); (C.M.); (B.T.); (K.M.); (L.S.); (K.O.); (M.P.); (W.B.)
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Matuschek C, Budach W, Tamaskovics B, Fischer J, Boelke E, Corradini S, Kammers K, Kraemling CN, Fehm T, Wollandt S, Speer V, Haussmann J. 86: Predictive Factors of Survival After Neoadjuvant Radiotherapy and Chemotherapy in High-Risk Breast Cancer. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08964-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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9
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Fischer JC, Schmidt AG, Bölke E, Uhrberg M, Keitel V, Feldt T, Jensen B, Häussinger D, Adams O, Schneider EM, Balz V, Enczmann J, Rox J, Hermsen D, Schulze-Bosse K, Kindgen-Milles D, Knoefel WT, van Griensven M, Haussmann J, Tamaskovics B, Plettenberg C, Scheckenbach K, Corradini S, Pedoto A, Maas K, Schmidt L, Grebe O, Esposito I, Ehrhardt A, Peiper M, Buhren BA, Calles C, Stöhr A, Lichtenberg A, Freise NF, Lutterbeck M, Rezazadeh A, Budach W, Matuschek C. Association of HLA genotypes, AB0 blood type and chemokine receptor 5 mutant CD195 with the clinical course of COVID-19. Eur J Med Res 2021; 26:107. [PMID: 34530915 PMCID: PMC8444184 DOI: 10.1186/s40001-021-00560-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/23/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND COVID-19, the pandemic disease caused by infection with SARS-CoV-2, may take highly variable clinical courses, ranging from symptom-free and pauci-symptomatic to fatal disease. The goal of the current study was to assess the association of COVID-19 clinical courses controlled by patients' adaptive immune responses without progression to severe disease with patients' Human Leukocyte Antigen (HLA) genetics, AB0 blood group antigens, and the presence or absence of near-loss-of-function delta 32 deletion mutant of the C-C chemokine receptor type 5 (CCR5). PATIENT AND METHODS An exploratory observational study including 157 adult COVID-19 convalescent patients was performed with a median follow-up of 250 days. The impact of different HLA genotypes, AB0 blood group antigens, and the CCR5 mutant CD195 were investigated for their role in the clinical course of COVID-19. In addition, this study addressed levels of severity and morbidity of COVID-19. The association of the immunogenetic background parameters were further related to patients' humoral antiviral immune response patterns by longitudinal observation. RESULTS Univariate HLA analyses identified putatively protective HLA alleles (HLA class II DRB1*01:01 and HLA class I B*35:01, with a trend for DRB1*03:01). They were associated with reduced durations of disease instead decreased (rather than increased) total anti-S IgG levels. They had a higher virus neutralizing capacity compared to non-carriers. Conversely, analyses also identified HLA alleles (HLA class II DQB1*03:02 und HLA class I B*15:01) not associated with such benefit in the patient cohort of this study. Hierarchical testing by Cox regression analyses confirmed the significance of the protective effect of the HLA alleles identified (when assessed in composite) in terms of disease duration, whereas AB0 blood group antigen heterozygosity was found to be significantly associated with disease severity (rather than duration) in our cohort. A suggestive association of a heterozygous CCR5 delta 32 mutation status with prolonged disease duration was implied by univariate analyses but could not be confirmed by hierarchical multivariate testing. CONCLUSION The current study shows that the presence of HLA class II DRB1*01:01 and HLA class I B*35:01 is of even stronger association with reduced disease duration in mild and moderate COVID-19 than age or any other potential risk factor assessed. Prospective studies in larger patient populations also including novel SARS-CoV-2 variants will be required to assess the impact of HLA genetics on the capacity of mounting protective vaccination responses in the future.
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Affiliation(s)
- Johannes C Fischer
- Institute for Transplantation Diagnostics and Cell Therapeutics, University Hospital Dusseldorf, Medical Faculty, Heinrich-Heine-University, 40225, Dusseldorf, Germany
| | - Albrecht G Schmidt
- Department of Radiation Oncology, University Hospital Dusseldorf, Medical Faculty, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Edwin Bölke
- Department of Radiation Oncology, University Hospital Dusseldorf, Medical Faculty, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany.
| | - Markus Uhrberg
- Institute for Transplantation Diagnostics and Cell Therapeutics, University Hospital Dusseldorf, Medical Faculty, Heinrich-Heine-University, 40225, Dusseldorf, Germany
| | - Verena Keitel
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Dusseldorf, Medical Faculty, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Torsten Feldt
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Dusseldorf, Medical Faculty, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Björn Jensen
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Dusseldorf, Medical Faculty, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Dieter Häussinger
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Dusseldorf, Medical Faculty, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Ortwin Adams
- Institute for Virology, University Hospital Dusseldorf, Medical Faculty, Heinrich-Heine-University Dusseldorf, Universitaetsstr. 1, 40225, Dusseldorf, Germany
| | - E Marion Schneider
- Division of Experimental Anesthesiology, University Hospital Ulm, Ulm, Germany
| | - Vera Balz
- Institute for Transplantation Diagnostics and Cell Therapeutics, University Hospital Dusseldorf, Medical Faculty, Heinrich-Heine-University, 40225, Dusseldorf, Germany
| | - Jürgen Enczmann
- Institute for Transplantation Diagnostics and Cell Therapeutics, University Hospital Dusseldorf, Medical Faculty, Heinrich-Heine-University, 40225, Dusseldorf, Germany
| | - Jutta Rox
- Institute for Transplantation Diagnostics and Cell Therapeutics, University Hospital Dusseldorf, Medical Faculty, Heinrich-Heine-University, 40225, Dusseldorf, Germany
| | - Derik Hermsen
- Central Institute for Laboratory Diagnostics and Clinical Chemistry, Medical Faculty Heinrich-Heine University, Dusseldorf, Germany
| | - Karin Schulze-Bosse
- Central Institute for Laboratory Diagnostics and Clinical Chemistry, Medical Faculty Heinrich-Heine University, Dusseldorf, Germany
| | - Detlef Kindgen-Milles
- Medical Faculty, Department of Anesthesiology, Heinrich Heine University, Dusseldorf, Germany
| | - Wolfram Trudo Knoefel
- Medical Faculty, Department of Surgery and Interdisciplinary Surgical Intensive Care Unit, Heinrich Heine University, Dusseldorf, Germany
| | - Martijn van Griensven
- Department cBITE, Maastricht University, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht, the Netherlands
| | - Jan Haussmann
- Department of Radiation Oncology, University Hospital Dusseldorf, Medical Faculty, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Balint Tamaskovics
- Department of Radiation Oncology, University Hospital Dusseldorf, Medical Faculty, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Christian Plettenberg
- Medical Faculty, Department of Ear, Nose and Throat Disease, Heinrich Heine University, Dusseldorf, Germany
| | - Kathrin Scheckenbach
- Medical Faculty, Department of Ear, Nose and Throat Disease, Heinrich Heine University, Dusseldorf, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Alessia Pedoto
- Department of Anesthesiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kitti Maas
- Department of Radiation Oncology, University Hospital Dusseldorf, Medical Faculty, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Livia Schmidt
- Department of Radiation Oncology, University Hospital Dusseldorf, Medical Faculty, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Olaf Grebe
- Department of Cardiology and Rhythmology, Petrus Hospital, Wuppertal, Germany
| | - Irene Esposito
- Institute of Pathology, University of Dusseldorf, Dusseldorf, Germany
| | - Anja Ehrhardt
- Institute of Virology, University of Witten/Herdecke, Witten, Germany
| | - Matthias Peiper
- Medical Faculty, University of Dusseldorf, Dusseldorf, Germany
| | - Bettina Alexandra Buhren
- Department of Radiation Oncology, University Hospital Dusseldorf, Medical Faculty, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Christian Calles
- Medical Faculty, Coordination Center for Clinical Studies, University of Dusseldorf, Dusseldorf, Germany
| | - Andreas Stöhr
- Medical Faculty, Coordination Center for Clinical Studies, University of Dusseldorf, Dusseldorf, Germany
| | - Artur Lichtenberg
- Department of Cardiac Surgery, Medical Faculty, University of Dusseldorf, Dusseldorf, Germany
| | - Noemi F Freise
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Dusseldorf, Medical Faculty, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Matthias Lutterbeck
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Dusseldorf, Medical Faculty, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Amir Rezazadeh
- Department of Radiation Oncology, University Hospital Dusseldorf, Medical Faculty, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Wilfried Budach
- Department of Radiation Oncology, University Hospital Dusseldorf, Medical Faculty, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Christiane Matuschek
- Department of Radiation Oncology, University Hospital Dusseldorf, Medical Faculty, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
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Fischer JC, Schmidt AG, Bölke E, Keitel V, Feldt T, Jensen B, Freise NF, Häussinger D, Schneider EM, Hermsen D, Kindgen-Milles D, Knoefel WT, Haussmann J, Tamaskovics B, Plettenberg C, Scheckenbach K, Corradini S, Rox J, Balz V, Maas K, Schmidt L, Grebe O, Ehrhardt A, Gerber PA, Peiper M, Buhren BA, Lichtenberg A, Rezazadeh A, Budach W, Matuschek C. Correction to: Informed consent and informed intervention: SARS‑CoV‑2 vaccinations not just call for disclosure of newly emerging safety data but also for hypothesis generation and testing. Eur J Med Res 2021; 26:104. [PMID: 34517930 PMCID: PMC8436013 DOI: 10.1186/s40001-021-00574-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Johannes C Fischer
- Institute for Transplantation Diagnostics and Cell Therapeutics, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - Albrecht G Schmidt
- Department of Radiation Oncology, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Edwin Bölke
- Department of Radiation Oncology, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Verena Keitel
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Torsten Feldt
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Björn Jensen
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Noemi F Freise
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Dieter Häussinger
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - E Marion Schneider
- Division of Experimental Anesthesiology, University Hospital Ulm, Ulm, Germany
| | - Derik Hermsen
- Central Institute for Laboratory Diagnostics and Clinical Chemistry, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Detlef Kindgen-Milles
- Department of Anesthesiology, Medical Faculty, Heinrich Heine University, Dusseldorf, Germany
| | - Wolfram Trudo Knoefel
- Department of Surgery and Interdisciplinary Surgical Intensive Care Unit, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.,Medicine, Department cBITE, Maastricht, The Netherlands
| | - Jan Haussmann
- Department of Radiation Oncology, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Balint Tamaskovics
- Department of Radiation Oncology, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Christian Plettenberg
- Department of Otolaryngology-Head and Neck Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Kathrin Scheckenbach
- Department of Otolaryngology-Head and Neck Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Jutta Rox
- Institute for Transplantation Diagnostics and Cell Therapeutics, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - Vera Balz
- Institute for Transplantation Diagnostics and Cell Therapeutics, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - Kitti Maas
- Department of Radiation Oncology, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Livia Schmidt
- Department of Radiation Oncology, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Olaf Grebe
- Department of Cardiology and Rhythmology, Petrus Hospital, Wuppertal, Germany
| | - Anja Ehrhardt
- Institute of Virology, University of Witten/Herdecke, Witten, Germany
| | | | - Matthias Peiper
- Department of Cardiac Surgery, Medical Faculty, University of Dusseldorf, Düsseldorf, Germany
| | - Bettina Alexandra Buhren
- Department of Radiation Oncology, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Artur Lichtenberg
- Department of Cardiac Surgery, Medical Faculty, University of Dusseldorf, Düsseldorf, Germany
| | - Amir Rezazadeh
- Department of Radiation Oncology, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Wilfried Budach
- Department of Radiation Oncology, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Christiane Matuschek
- Department of Radiation Oncology, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
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Müller-Huesmann H, von der Heyde E, Hahn D, Langer C, Kubuschok B, Bockmühl U, Klautke G, Mauz PS, Reuter B, Beutner D, Büntzel J, von der Grün J, Busch CJ, Tamaskovics B, Riera-Knorrenschild J, Gutsche K, Welslau M, Gauler T, Waldenberger D, Dietz A. 924P HANNA: Effectiveness and quality-of-life data from a real-world study of patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN) treated with nivolumab in Germany. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Hoff NP, Freise NF, Schmidt AG, Firouzi-Memarpuri P, Reifenberger J, Luedde T, Bölke E, Meller S, Homey B, Feldt T, Jensen BEO, Keitel V, Schmidt L, Maas K, Haussmann J, Tamaskovics B, Budach W, Fischer JC, Buhren BA, Knoefel WT, Schneider M, Gerber PA, Pedoto A, Häussinger D, Grebe O, van Griensven M, Braun SA, Salzmann S, Rezazadeh A, Matuschek C. Delayed skin reaction after mRNA-1273 vaccine against SARS-CoV-2: a rare clinical reaction. Eur J Med Res 2021; 26:98. [PMID: 34433495 PMCID: PMC8386154 DOI: 10.1186/s40001-021-00557-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 07/20/2021] [Indexed: 02/07/2023] Open
Abstract
Background The coronavirus disease 2019 (COVID‐19) is associated with a wide clinical spectrum of skin manifestations, including urticarial, vesicular, vasculitic and chilblain‐like lesions. Recently, delayed skin reactions have been reported in 1% individuals following mRNA vaccination against SARS-CoV-2. The exact pathophysiology and the risk factors still remain unclear. Patients and methods 6821 employees and patients were vaccinated at our institutions between February and June 2021. Every patient received two doses of the mRNA-1273 vaccine in our hospitals, and reported back in case of any side effects which were collected in our hospital managed database. Results Eleven of 6821 vaccinated patients (0.16%) developed delayed skin reactions after either the first or second dose of the mRNA-1273 vaccine against SARS-CoV-2. Eight of 11 patients (73%) developed a rash after the first dose, while in 3/11 (27%), the rash occurred after the second dose. More females (9/11) were affected. Four of 11 patients required antihistamines, with two needing additional topical steroids. All the cutaneous manifestations resolved within 14 days. None of the skin reactions after the first dose of the vaccine prevented the administration of the second dose. There were no long-term cutaneous sequelae in any of the affected individuals. Conclusion Our data suggests that skin reactions after the use of mRNA-1273 vaccine against SARS-CoV-2 are possible, but rare. Further studies need to be done to understand the pathophysiology of these lesions.
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Affiliation(s)
- Norman-Philipp Hoff
- Department of Dermatology, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - Noemi F Freise
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Albrecht G Schmidt
- Department of Radiation Oncology, University Hospital Medical Faculty, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Parnian Firouzi-Memarpuri
- Department of Dermatology, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - Julia Reifenberger
- Department of Dermatology, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - Tom Luedde
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Edwin Bölke
- Department of Radiation Oncology, University Hospital Medical Faculty, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Stephan Meller
- Department of Dermatology, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - Bernhard Homey
- Department of Dermatology, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - Torsten Feldt
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Björn Erik Ole Jensen
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Verena Keitel
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Livia Schmidt
- Department of Radiation Oncology, University Hospital Medical Faculty, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Kitti Maas
- Department of Radiation Oncology, University Hospital Medical Faculty, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Jan Haussmann
- Department of Radiation Oncology, University Hospital Medical Faculty, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Balint Tamaskovics
- Department of Radiation Oncology, University Hospital Medical Faculty, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Wilfried Budach
- Department of Radiation Oncology, University Hospital Medical Faculty, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Johannes C Fischer
- Institute for Transplant Diagnostics and Cell Therapeutics, Heinrich Heine University, Düsseldorf, Germany
| | | | - Wolfram Trudo Knoefel
- Department of Surgery and Interdisciplinary Surgical Intensive Care Unit Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Marion Schneider
- Division of Experimental Anesthesiology, University Hospital Ulm, Ulm, Germany
| | - Peter Arne Gerber
- Medical Faculty, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - Alessia Pedoto
- Department of Anesthesiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Dieter Häussinger
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Olaf Grebe
- Department of Cardiology and Rhythmology, Petrus Hospital, Wuppertal, Germany
| | - Martijn van Griensven
- Department cBITE, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, The Netherlands
| | - Stephan A Braun
- Department of Dermatology, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine-University, 40225, Düsseldorf, Germany.,Department of Dermatology, University Hospital Münster, Münster, Germany
| | - Stefan Salzmann
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | - Amir Rezazadeh
- Department of Radiation Oncology, University Hospital Medical Faculty, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Christiane Matuschek
- Department of Radiation Oncology, University Hospital Medical Faculty, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
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13
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Fischer JC, Schmidt AG, Bölke E, Keitel V, Feldt T, Jensen B, Freise NF, Häussinger D, Schneider EM, Hermsen D, Kindgen-Milles D, Knoefel WT, Haussmann J, Tamaskovics B, Plettenberg C, Scheckenbach K, Corradini S, Rox J, Balz V, Maas K, Schmidt L, Grebe O, Erhardt A, Gerber PA, Peiper M, Buhren BA, Lichtenberg A, Rezazadeh A, Budach W, Matuschek C. Informed consent and informed intervention: SARS-CoV-2 vaccinations not just call for disclosure of newly emerging safety data but also for hypothesis generation and testing. Eur J Med Res 2021; 26:87. [PMID: 34362461 PMCID: PMC8343366 DOI: 10.1186/s40001-021-00558-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 07/09/2021] [Indexed: 12/21/2022] Open
Abstract
Background COVID-19 infection is a major threat to patients and health care providers around the world. One solution is the vaccination against SARS-CoV-2. Methods We performed a comprehensive query of the latest publications on the prevention of viral infections including the recent vaccination program and its side effects. Results The situation is evolving rapidly and there is no reasonable alternative to population-scale vaccination programs as currently enrolled. Conclusion Therefore, regulatory authorities should consider supplementing their conventional mandate of post-approval pharmacovigilance, which is based on the collection, assessment, and regulatory response to emerging safety findings.
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Affiliation(s)
- Johannes C Fischer
- Institute for Transplantation Diagnostics and Cell Therapeutics, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - Albrecht G Schmidt
- Department of Radiation Oncology, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Edwin Bölke
- Department of Radiation Oncology, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Verena Keitel
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Torsten Feldt
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Björn Jensen
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Noemi F Freise
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Dieter Häussinger
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - E Marion Schneider
- Division of Experimental Anesthesiology, University Hospital Ulm, Ulm, Germany
| | - Derik Hermsen
- Central Institute for Laboratory Diagnostics and Clinical Chemistry, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Detlef Kindgen-Milles
- Department of Anesthesiology, Medical Faculty, Heinrich Heine University, Dusseldorf, Germany
| | - Wolfram Trudo Knoefel
- Department of Surgery and Interdisciplinary Surgical Intensive Care Unit, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.,Medicine, Department cBITE, Maastricht, The Netherlands
| | - Jan Haussmann
- Department of Radiation Oncology, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Balint Tamaskovics
- Department of Radiation Oncology, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Christian Plettenberg
- Department of Otolaryngology-Head and Neck Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Kathrin Scheckenbach
- Department of Otolaryngology-Head and Neck Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Jutta Rox
- Institute for Transplantation Diagnostics and Cell Therapeutics, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - Vera Balz
- Institute for Transplantation Diagnostics and Cell Therapeutics, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - Kitti Maas
- Department of Radiation Oncology, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Livia Schmidt
- Department of Radiation Oncology, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Olaf Grebe
- Department of Cardiology and Rhythmology, Petrus Hospital, Wuppertal, Germany
| | - Anja Erhardt
- Institute of Virology, University of Witten/Herdecke, Witten, Germany
| | | | - Matthias Peiper
- Department of Cardiac Surgery, Medical Faculty, University of Dusseldorf, Düsseldorf, Germany
| | - Bettina Alexandra Buhren
- Department of Radiation Oncology, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Artur Lichtenberg
- Department of Cardiac Surgery, Medical Faculty, University of Dusseldorf, Düsseldorf, Germany
| | - Amir Rezazadeh
- Department of Radiation Oncology, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Wilfried Budach
- Department of Radiation Oncology, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Christiane Matuschek
- Department of Radiation Oncology, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
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Roesch J, Oertel M, Fabian A, Höck M, von der Grün J, Löser A, Süss C, Vinsensia M, Tamaskovics B, Heß S, Waltenberger M, Wegen S, Trommer M, Mäurer M, Medenwald D, Rühle A, Käsmann L, Fleischmann D, Dobiasch S, Hecht M. PH-0054 Re-Irradiation in head & neck cancer - a pooled analysis of 253 individual cases. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07236-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lommen J, Schorn L, Sproll C, Schrader F, Haussmann J, Kubler N, Budach W, Rana M, Tamaskovics B. P-22 Artifact reduction in head and neck CT images using polyetheretherketone (PEEK), polyetherketoneketone (PEKK), polyphenylsulfone (PPSU) and polyether (PE) polymer implants in mandible reconstruction. Oral Oncol 2021. [DOI: 10.1016/s1368-8375(21)00311-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Haussmann J, Budach W, Strnad V, Corradini S, Krug D, Schmidt L, Tamaskovics B, Bölke E, Simiantonakis I, Kammers K, Matuschek C. Comparing Local and Systemic Control between Partial- and Whole-Breast Radiotherapy in Low-Risk Breast Cancer-A Meta-Analysis of Randomized Trials. Cancers (Basel) 2021; 13:2967. [PMID: 34199281 PMCID: PMC8231985 DOI: 10.3390/cancers13122967] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/09/2021] [Accepted: 06/09/2021] [Indexed: 11/16/2022] Open
Abstract
PURPOSE/OBJECTIVE The standard treatment for localized low-risk breast cancer is breast-conserving surgery, followed by adjuvant radiotherapy and appropriate systemic therapy. As the majority of local recurrences occur at the site of the primary tumor, numerous trials have investigated partial-breast irradiation (PBI) instead of whole-breast treatment (WBI) using a multitude of irradiation techniques and fractionation regimens. This meta-analysis addresses the impact on disease-specific endpoints, such as local and regional control, as well as disease-free survival of PBI compared to that of WBI in published randomized trials. MATERIAL AND METHODS We conducted a systematic literature review and searched for randomized trials comparing WBI and PBI in early-stage breast cancer with publication dates after 2009. The meta-analysis was based on the published event rates and the effect sizes for available oncological endpoints of at least two trials reporting on them. We evaluated in-breast tumor recurrences (IBTR), local recurrences at the primary site and elsewhere in the ipsilateral breast, regional recurrences (RR), distant metastasis-free interval (DMFI), disease-free survival (DFS), contralateral breast cancer (CBC), and second primary cancer (SPC). Furthermore, we aimed to assess the impact of different PBI techniques and subgroups on IBTR. We performed all statistical analyses using the inverse variance heterogeneity model to pool effect sizes. RESULTS For the intended meta-analysis, we identified 13 trials (overall 15,561 patients) randomizing between PBI and WBI. IBTR was significantly higher after PBI (OR = 1.66; CI-95%: 1.07-2.58; p = 0.024) with an absolute difference of 1.35%. We detected significant heterogeneity in the analysis of the PBI technique with intraoperative radiotherapy resulting in higher local relapse rates (OR = 3.67; CI-95%: 2.28-5.90; p < 0.001). Other PBI techniques did not show differences to WBI in IBTR. Both strategies were equally effective at the primary tumor site, but PBI resulted in statistically more IBTRs elsewhere in the ipsilateral breast. IBTRs after WBI were more likely to be located at the primary tumor bed, whereas they appeared equally distributed within the breast after PBI. RR was also more frequent after PBI (OR = 1.75; CI-95%: 1.07-2.88; p < 0.001), yet we did not detect any differences in DMFI (OR = 1.08; CI-95%: 0.89-1.30; p = 0.475). DFS was significantly longer in patients treated with WBI (OR = 1.14; CI-95%: 1.02-1.27; p = 0.003). CBC and SPC were not different in the test groups (OR = 0.81; CI-95%: 0.65-1.01; p = 0.067 and OR = 1.09; CI-95%: 0.85-1.40; p = 0.481, respectively). CONCLUSION Limiting the target volume to partial-breast radiotherapy appears to be appropriate when selecting patients with a low risk for local and regional recurrences and using a suitable technique.
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Affiliation(s)
- Jan Haussmann
- Department of Radiation Oncology, Heinrich Heine University, 40225 Dusseldorf, Germany; (J.H.); (W.B.); (L.S.); (B.T.); (I.S.); (C.M.)
| | - Wilfried Budach
- Department of Radiation Oncology, Heinrich Heine University, 40225 Dusseldorf, Germany; (J.H.); (W.B.); (L.S.); (B.T.); (I.S.); (C.M.)
| | - Vratislav Strnad
- Department of Radiation Oncology, University Erlangen, 91054 Erlangen, Germany;
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital LMU (Ludwig Maximillian), 81377 Munich, Germany;
| | - David Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, 24105 Kiel, Germany;
| | - Livia Schmidt
- Department of Radiation Oncology, Heinrich Heine University, 40225 Dusseldorf, Germany; (J.H.); (W.B.); (L.S.); (B.T.); (I.S.); (C.M.)
| | - Balint Tamaskovics
- Department of Radiation Oncology, Heinrich Heine University, 40225 Dusseldorf, Germany; (J.H.); (W.B.); (L.S.); (B.T.); (I.S.); (C.M.)
| | - Edwin Bölke
- Department of Radiation Oncology, Heinrich Heine University, 40225 Dusseldorf, Germany; (J.H.); (W.B.); (L.S.); (B.T.); (I.S.); (C.M.)
| | - Ioannis Simiantonakis
- Department of Radiation Oncology, Heinrich Heine University, 40225 Dusseldorf, Germany; (J.H.); (W.B.); (L.S.); (B.T.); (I.S.); (C.M.)
| | - Kai Kammers
- Division of Biostatistics and Bioinformatics, Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA;
| | - Christiane Matuschek
- Department of Radiation Oncology, Heinrich Heine University, 40225 Dusseldorf, Germany; (J.H.); (W.B.); (L.S.); (B.T.); (I.S.); (C.M.)
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Hecht M, Eckstein M, Rutzner S, von der Grün J, Illmer T, Klautke G, Laban S, Hautmann MG, Brunner T, Tamaskovics B, Hinke A, Frey B, Semrau S, Hartmann A, Balermpas P, Budach W, Gaipl US, Iro H, Gostian AO, Fietkau R. Primary results of the phase II CheckRad-CD8 trial: First-line treatment of locally advanced head and neck squamous cell carcinoma (HNSCC) with double checkpoint blockade and radiotherapy dependent on intratumoral CD8+ T-cell infiltration. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.6007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6007 Background: Inhibition of the PD-1/PD-L1 pathway is efficient in recurrent/metastatic HNSCC. Targeting the immune checkpoint CTLA-4 may be synergistic to radiotherapy. This trial studies feasibility and efficacy of combined PD-L1/CTLA-4 blockade concomitant to induction chemotherapy and radiotherapy. Methods: Patients with previously untreated stage III-IVB (AJCC 8th edition) HNSCC were eligible for this multicenter phase II trial. Treatment consisted of a single cycle of cisplatin 30mg/m² d1-3, docetaxel 75mg/m² d1, durvalumab 1500mg fix dose d5 and tremelimumab 75mg fix dose d5. Patients with at least 20% increase of intratumoral CD8+ immune cell density or pathological complete response (pCR) in the re-biopsy (performed on d22-26) entered radio-immunotherapy (RIT) up to a total dose of 70Gy. Patients received further three cycles of durvalumab/tremelimumab (q4w, two concomitant and one subsequent) followed by eight cycles of durvalumab mono (q4w). Primary endpoint was a feasibility rate of patients entering RIT to receive treatment until at least cycle 6 of immunotherapy of ≥80% (i.e. dose limiting toxicity/DLT ≤20%; exclusion of patients with other reasons than DLT for treatment discontinuation; feasibility unacceptable if ≤65%). The calculated sample size was 57 patients to enter RIT. Main secondary endpoints were progression-free survival (PFS) and overall survival (OS). Results: Between Sep 2018 and Mai 2020, 80 patients were enrolled (one excluded). Median age was 60 years, 33 patients (42%) were current smokers, 43 patients (54%) had oropharyngeal tumors (53% p16 positive), 44 patients (56%) were stage IV. Median follow up was 12.5 months. After induction chemo-immunotherapy 41 patients had pCR and 31 an intratumoral CD8+ immune cell increase. Of 60 patients entering RIT (primary endpoint cohort), 10 received DLT and 4 discontinued for other reasons. The feasibility rate of the RIT cohort until cycle 6 was 82%, meeting the primary endpoint of ≥80% (95% confidence interval (CI), one-sided (lower boundary): 72%). The RIT cohort had a PFS rate at 1 year of 79% (CI 69-90%) and at 2 years of 73% (CI 61-87%) and an OS rate at 1 year of 89% (CI 81-98%) and at 2 years of 86% (CI 77-97%). The entire study cohort had a PFS rate at 1 year of 75% (CI 65-85%) and at 2 years of 68% (CI 58-81%) and an OS rate at 1 year of 86% (CI 78-95%) and at 2 years of 80% (CI 70-91%). Toxicity (treatment-related or un-related) ≥grade 3 appeared in 75 patients (95%) and mainly consisted of dysphagia (53%), leucopenia (48%) and infections (29%). DLT mainly consisted of hepatitis (10%). Conclusions: The trial met the primary endpoint feasibility. CD8+ T cell-based pathological patient selection after induction therapy identifies patients with promising PFS rates after chemotherapy-free RIT. Clinical trial information: nct03426657.
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Affiliation(s)
- Markus Hecht
- Department of Radiation Oncology, Universitatsklinikum Erlangen, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| | - Markus Eckstein
- Institute of Pathology, Universitatsklinikum Erlangen, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| | - Sandra Rutzner
- Department of Radiation Oncology, Universitatsklinikum Erlangen, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| | - Jens von der Grün
- Department of Radiation Oncology, University Hospital Frankfurt, Goethe-Universität Frankfurt, Frankfurt Am Main, Germany
| | - Thomas Illmer
- Medical Oncology Clinic Dresden Freiberg, Dresden, Germany
| | - Gunther Klautke
- Department of Radiation Oncology, Klinikum Chemnitz, Chemnitz, Germany
| | - Simon Laban
- Department of Otolaryngology - Head and Neck Surgery, University Hospital Ulm, Universität Ulm, Ulm, Germany
| | - Matthias G. Hautmann
- Department of Radiation Oncology, University Hospital Regensburg, Universität Regensburg, Regensburg, Germany
| | - Thomas Brunner
- Department of Radiation Oncology, University Hospital Magdeburg, Otto von Guericke Universität Magdeburg, Freiburg, Germany
| | - Balint Tamaskovics
- Department of Radiation Oncology, University Hospital Düsseldorf, Heinrich Heine Universität Düsseldorf, Dusseldorf, Germany
| | - Axel Hinke
- CCRC Cancer Clinical Research Consulting, Düsseldorf, Germany
| | - Benjamin Frey
- Department of Radiation Oncology, Universitatsklinikum Erlangen, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| | - Sabine Semrau
- Department of Radiation Oncology, Universitatsklinikum Erlangen, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, Universitatsklinikum Erlangen, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| | | | - Wilfried Budach
- Department of Radiation Oncology, University Hospital Düsseldorf, Heinrich Heine Universität Düsseldorf, Düsseldorf, Germany
| | - Udo S Gaipl
- Department of Radiation Oncology, Universitatsklinikum Erlangen, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| | - Heinrich Iro
- Department of Otholaryngology - Head and Neck Surgery, Universitatsklinikum Erlangen, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| | - Antoniu-Oreste Gostian
- Department of Otholaryngology - Head and Neck Surgery, Universitatsklinikum Erlangen, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, Universitatsklinikum Erlangen, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
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Haussmann J, Budach W, Corradini S, Tamaskovics B, Boelke E, Djiepmo-Njanang F, Kammers K, Matuschek C. PH-0596: Whole breast irradiation in comparison to endocrine therapy in early stage breast cancer. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00618-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Fischer JC, Zänker K, van Griensven M, Schneider M, Kindgen-Milles D, Knoefel WT, Lichtenberg A, Tamaskovics B, Djiepmo-Njanang FJ, Budach W, Corradini S, Ganswindt U, Häussinger D, Feldt T, Schelzig H, Bojar H, Peiper M, Bölke E, Haussmann J, Matuschek C. Correction to: The role of passive immunization in the age of SARS-CoV-2: an update. Eur J Med Res 2020; 25:53. [PMID: 33126916 PMCID: PMC7596629 DOI: 10.1186/s40001-020-00449-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Johannes C Fischer
- Institute for Transplant Diagnostics and Cell Therapeutics, Heinrich Heine University, Düsseldorf, Germany
| | - Kurt Zänker
- The Nanjing Han & Zaenker Cancer Institute, Nanjing and Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing Tech University, Jiangsu, China
| | - Martijn van Griensven
- MERLN Institute for Technology-Inspired Regenerative Medicine, Department cBITE, Maastricht University, Maastricht, The Netherlands
| | - Marion Schneider
- Department of Experimental Anesthesiology, University of Ulm, Ulm, Germany
| | - Detlef Kindgen-Milles
- Department of Anesthesiology and Intensive Care Medicine, Heinrich Heine University, Düsseldorf, Germany
| | | | - Artur Lichtenberg
- Department of Cardiac Surgery, Heinrich Heine University, Düsseldorf, Germany
| | - Balint Tamaskovics
- Department of Radiation Oncology, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | | | - Wilfried Budach
- Department of Radiation Oncology, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Ute Ganswindt
- Department of Radiation Oncology, Innsbruck, Austria
| | - Dieter Häussinger
- Clinic of Gastroenterology, Hepatology und Infectious Diseases, Heinrich Heine University, Düsseldorf, Germany
| | - Torsten Feldt
- Clinic of Gastroenterology, Hepatology und Infectious Diseases, Heinrich Heine University, Düsseldorf, Germany
| | - Hubert Schelzig
- Department of Vascular Surgery, Heinrich Heine University, Düsseldorf, Germany
| | - Hans Bojar
- NEXTGEN ONCOLOGY GROUP, Düsseldorf, Germany
| | | | - Edwin Bölke
- Department of Radiation Oncology, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Jan Haussmann
- Department of Radiation Oncology, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Christiane Matuschek
- Department of Radiation Oncology, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
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Matuschek C, Budach W, Bojar H, Fehm T, Nestle-Krämling C, Corradini S, Fastner G, Seidel C, Krug D, Tamaskovics B, Bölke E, Kühn T, Haussmann J. Präoperative Strahlentherapie (PRT) und Systemtherapie beim Mammakarzinom – welche Faktoren beeinflussen das Gesamtüberleben (OS)? Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- C Matuschek
- Universitätsklinikum Düsseldorf, Klinik für Strahlentherapie und Radioonkologie
| | - W Budach
- Universitätsklinikum Düsseldorf, Klinik für Strahlentherapie und Radioonkologie
| | | | - T Fehm
- Universitätsfrauenklinik Düsseldorf, Frauenklinik
| | | | - S Corradini
- Ludwig-Maximilians-Universität München, Klinik für Strahlentherapie und Radioonkologie
| | - G Fastner
- Universitätsklinik Salzburg, Klinik für Strahlentherapie und Radioonkologie
| | - C Seidel
- Universitätsklinik Leipzig, Klinik für Strahlentherapie und Radioonkologie
| | - D Krug
- Universiätsklinik Schleswig-Holstein, Campus Kiel, Klinik für Strahlentherapie und Radioonkologie
| | - B Tamaskovics
- Universitätsklinikum Düsseldorf, Klinik für Strahlentherapie und Radioonkologie
| | - E Bölke
- Universitätsklinikum Düsseldorf, Klinik für Strahlentherapie und Radioonkologie
| | - T Kühn
- Klinikum Esslingen, Frauenklinik
| | - J Haussmann
- Universitätsklinikum Düsseldorf, Klinik für Strahlentherapie und Radioonkologie
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21
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Matuschek C, Fischer JC, Combs SE, Fietkau R, Corradini S, Zänker K, Bölke E, Djiepmo-Njanang FJ, Tamaskovics B, Fischer JE, Stuschke M, Pöttgen C, Förster R, Zwahlen DR, Papachristofilou A, Ganswindt U, Pelka R, Schneider EM, Feldt T, Jensen BEO, Häussinger D, Knoefel WT, Kindgen-Milles D, Pedoto A, Grebe O, van Griensven M, Budach W, Haussmann J. Measures of infection prevention and incidence of SARS-CoV-2 infections in cancer patients undergoing radiotherapy in Germany, Austria and Switzerland. Strahlenther Onkol 2020; 196:1068-1079. [PMID: 32914236 PMCID: PMC7483062 DOI: 10.1007/s00066-020-01681-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/12/2020] [Indexed: 02/07/2023]
Abstract
Purpose COVID-19 infection has manifested as a major threat to both patients and healthcare providers around the world. Radiation oncology institutions (ROI) deliver a major component of cancer treatment, with protocols that might span over several weeks, with the result of increasing susceptibility to COVID-19 infection and presenting with a more severe clinical course when compared with the general population. The aim of this manuscript is to investigate the impact of ROI protocols and performance on daily practice in the high-risk cancer patients during this pandemic. Methods We addressed the incidence of positive COVID-19 cases in both patients and health care workers (HCW), in addition to the protective measures adopted in ROIs in Germany, Austria and Switzerland using a specific questionnaire. Results The results of the questionnaire showed that a noteworthy number of ROIs were able to complete treatment in SARS-CoV‑2 positive cancer patients, with only a short interruption. The ROIs reported a significant decrease in patient volume that was not impacted by the circumambient disease incidence, the type of ROI or the occurrence of positive cases. Of the ROIs 16.5% also reported infected HCWs. About half of the ROIs (50.5%) adopted a screening program for patients whereas only 23.3% also screened their HCWs. The range of protective measures included the creation of working groups, instituting home office work and protection with face masks. Regarding the therapeutic options offered, curative procedures were performed with either unchanged or moderately decreased schedules, whereas palliative or benign radiotherapy procedures were more often shortened. Most ROIs postponed or cancelled radiation treatment for benign indications (88.1%). The occurrence of SARS-CoV‑2 infections did not affect the treatment options for curative procedures. Non-university-based ROIs seemed to be more willing to change their treatment options for curative and palliative cases than university-based ROIs. Conclusion Most ROIs reported a deep impact of SARS-CoV‑2 infections on their work routine. Modification and prioritization of treatment regimens and the application of protective measures preserved a well-functioning radiation oncology service and patient care. Electronic supplementary material The online version of this article (10.1007/s00066-020-01681-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christiane Matuschek
- Medical Faculty, Department of Radiation Oncology, Heinrich Heine University, Duesseldorf, Germany
| | - Johannes C Fischer
- Institute for Transplant Diagnostics and Cell Therapeutics, Heinrich Heine University, Düsseldorf, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Technical University of Munich, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum Munich, Munich, Germany.,Partner Site Munich, Deutsches Konsortium für Translationale Krebsforschung (DKTK), Munich, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, University of Erlangen, Erlangen, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | | | - Edwin Bölke
- Medical Faculty, Department of Radiation Oncology, Heinrich Heine University, Duesseldorf, Germany.
| | | | - Balint Tamaskovics
- Medical Faculty, Department of Radiation Oncology, Heinrich Heine University, Duesseldorf, Germany
| | | | - Martin Stuschke
- Department of Radiation Oncology, University Essen, Essen, Germany
| | | | - Robert Förster
- Institute of Radiation Oncology, Cantonal Hospital Winterthur, University of Zurich, Zurich, Switzerland
| | - Daniel R Zwahlen
- Institute of Radiation Oncology, Cantonal Hospital Winterthur, University of Zurich, Zurich, Switzerland
| | | | - Ute Ganswindt
- Department of Radiation Oncology, Medical University Innsbruck, Innsbruck, Austria
| | - Rainer Pelka
- Institute for Applied Statistics, Unterföhring/Munich, Germany
| | - E Marion Schneider
- Division of Experimental Anesthesiology, University Hospital Ulm, Ulm, Germany
| | - Torsten Feldt
- Department of Gastroenterology, Hepatology and Infectious Diseases, Heinrich Heine University, Duesseldorf, Germany
| | - Björn Erik Ole Jensen
- Department of Gastroenterology, Hepatology and Infectious Diseases, Heinrich Heine University, Duesseldorf, Germany
| | - Dieter Häussinger
- Department of Gastroenterology, Hepatology and Infectious Diseases, Heinrich Heine University, Duesseldorf, Germany
| | - Wolfram Trudo Knoefel
- Department for General Visceral and Pediatric Surgery, Heinrich Heine University, Dusseldorf, Germany
| | - Detlef Kindgen-Milles
- Department of Intensive Care Medicine, Heinrich Heine University, Dusseldorf, Germany
| | - Alessia Pedoto
- Department of Anesthesiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Olaf Grebe
- Department for Cardiology, Rhythmology and Intensive Care Medicine, Evangelic Hospital, Dusseldorf, Germany
| | - Martijn van Griensven
- MERLN Institute for Technology-Inspired Regenerative Medicine, Department cBITE, Maastricht University, Maastricht, The Netherlands
| | - Wilfried Budach
- Medical Faculty, Department of Radiation Oncology, Heinrich Heine University, Duesseldorf, Germany
| | - Jan Haussmann
- Medical Faculty, Department of Radiation Oncology, Heinrich Heine University, Duesseldorf, Germany
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Haussmann J, Corradini S, Njanang FD, Boelke E, Budach W, Tamaskovics B, Kammers K, Matuschek C. 105: Is Whole Breast Irradiation Better Than Endocrine Therapy in Early Stage Breast Cancer? A Network Meta-Analysis of Published Randomized Trials. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(20)30997-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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23
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Matuschek C, Moll F, Fangerau H, Fischer JC, Zänker K, van Griensven M, Schneider M, Kindgen-Milles D, Knoefel WT, Lichtenberg A, Tamaskovics B, Djiepmo-Njanang FJ, Budach W, Corradini S, Häussinger D, Feldt T, Jensen B, Pelka R, Orth K, Peiper M, Grebe O, Maas K, Gerber PA, Pedoto A, Bölke E, Haussmann J. Face masks: benefits and risks during the COVID-19 crisis. Eur J Med Res 2020; 25:32. [PMID: 32787926 PMCID: PMC7422455 DOI: 10.1186/s40001-020-00430-5] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/21/2020] [Indexed: 12/22/2022] Open
Abstract
Background The German government has made it mandatory to wear respiratory masks covering mouth and nose (MNC) as an effective strategy to fight SARS-CoV-2 infections. In many countries, this directive has been extended on shopping malls or public transportation. The aim of this paper is to critically analyze the statutory regulation to wear protective masks during the COVID-19 crisis from a medical standpoint. Methods We performed an extensive query of the most recent publications addressing the prevention of viral infections including the use of face masks in the community as a method to prevent the spread of the infection. We addressed the issues of practicability, professional use, and acceptability based on the community and the environment where the user resided. Results Upon our critical review of the available literature, we found only weak evidence for wearing a face mask as an efficient hygienic tool to prevent the spread of a viral infection. However, the use of MNC seems to be linked to relevant protection during close contact scenarios by limiting pathogen-containing aerosol and liquid droplet dissemination. Importantly, we found evidence for significant respiratory compromise in patients with severe obstructive pulmonary disease, secondary to the development of hypercapnia. This could also happen in patients with lung infections, with or without SARS-CoV-2. Conclusion Epidemiologists currently emphasize that wearing MNC will effectively interrupt airborne infections in the community. The government and the politicians have followed these recommendations and used them to both advise and, in some cases, mandate the general population to wear MNC in public locations. Overall, the results seem to suggest that there are some clinically relevant scenarios where the use of MNC necessitates more defined recommendations. Our critical evaluation of the literature both highlights the protective effects of certain types of face masks in defined risk groups, and emphasizes their potential risks.
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Affiliation(s)
- Christiane Matuschek
- Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany
| | - Friedrich Moll
- Department of the History, Philosophy and Ethics of Medicine, Heinrich Heine University, Medical Faculty, Dusseldorf, Germany
| | - Heiner Fangerau
- Department of the History, Philosophy and Ethics of Medicine, Heinrich Heine University, Medical Faculty, Dusseldorf, Germany
| | - Johannes C Fischer
- Institute for Transplant Diagnostics and Cell Therapeutics, Heinrich Heine University, Dusseldorf, Germany
| | - Kurt Zänker
- Center for Biomedical Education and Research (ZBAF), University Witten/Herdecke, Witten, Germany
| | - Martijn van Griensven
- Department cBITE, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, The Netherlands
| | - Marion Schneider
- Department of Experimental Anesthesiology, University of Ulm, Ulm, Germany
| | - Detlef Kindgen-Milles
- Department of Anesthesiology and Intensive Care Medicine, Heinrich Heine University, Dusseldorf, Germany
| | - Wolfram Trudo Knoefel
- Department for General Visceral and Pediatric Surgery, Heinrich Heine University, Dusseldorf, Germany
| | - Artur Lichtenberg
- Department for Cardiac Surgery, Heinrich Heine University, Dusseldorf, Germany
| | - Balint Tamaskovics
- Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany
| | | | - Wilfried Budach
- Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Germany
| | - Dieter Häussinger
- Department of Gastroenterology, Hepatology and Infectious Diseases, Heinrich Heine University, Dusseldorf, Germany
| | - Torsten Feldt
- Department of Gastroenterology, Hepatology and Infectious Diseases, Heinrich Heine University, Dusseldorf, Germany
| | - Björn Jensen
- Department of Gastroenterology, Hepatology and Infectious Diseases, Heinrich Heine University, Dusseldorf, Germany
| | - Rainer Pelka
- Institute for Applied Statistics, Munich, Germany
| | - Klaus Orth
- University of Hannover, Hannover, Germany
| | | | - Olaf Grebe
- Department for Cardiology, Rhythmology and Intensive Care Medicine, Evangelic Hospital, Dusseldorf, Germany
| | - Kitti Maas
- Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany
| | | | - Alessia Pedoto
- Department of Anesthesiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Edwin Bölke
- Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany.
| | - Jan Haussmann
- Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany
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Haussmann J, Tamaskovics B, Budach W, Bölke E, Corradini S, Djiepmo-Njanang FJ, Matuschek C. Teil- und Ganzbrustbestrahlung beim Mammakarzinom im Frühstadium. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1714522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
Affiliation(s)
- J Haussmann
- Heinrich Heine Universität, Klinik für Strahlentherapie und Radiologische Onkologie
| | - B Tamaskovics
- Heinrich Heine Universität, Klinik für Strahlentherapie und Radiologische Onkologie
| | - W Budach
- Heinrich Heine Universität, Klinik für Strahlentherapie und Radiologische Onkologie
| | - E Bölke
- Universitätsklinikum Düsseldorf, Klinik für Strahlentherapie und radiologische Onkologie
| | | | - F-J Djiepmo-Njanang
- Heinrich Heine Universität, Klinik für Strahlentherapie und Radiologische Onkologie
| | - C Matuschek
- Universitätsklinikum Düsseldorf, Klinik für Strahlentherapie und radiologische Onkologie
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Hecht M, Gostian AO, Eckstein M, Rutzner S, von der Grün J, Illmer T, Hautmann MG, Brunner T, Laban S, Klautke G, Tamaskovics B, Hinke A, Frey B, Semrau S, Hartmann A, Roedel C, Budach W, Gaipl US, Iro H, Fietkau R. A multicenter phase II trial of the combination cisplatin/ docetaxel/durvalumab/tremelimumab as single-cycle induction treatment in locally advanced HNSCC (CheckRad-CD8 trial). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.6519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6519 Background: PD-1/PD-L1 inhibitors are efficient in head and neck squamous cell cancer (HNSCC). Combination with anti-CTLA4 agents may enhance anti-tumor activity compared to anti-PD-1/PD-L1 monotherapy in different tumor types. In the CheckRad-CD8 trial the typical induction treatment consisting of Cisplatin/Docetaxel was combined with Durvalumab/Tremelimumab. Patients with pathological complete response (pCR) in the re-biopsy after induction treatment or at least 20% increase of intratumoral CD8 density in the re-biopsy compared to baseline entered radioimmunotherapy with concomitant Durvalumab/Tremelimumab. Methods: In this prospective multicenter phase II trial, patients with HNSCC stage III-IVB received a single cycle of Cisplatin 30mg/m² d1-3, Docetaxel 75mg/m² d1, Durvalumab 1500mg fix dose d5 and Tremelimumab 75mg fix dose d5. Objectives of this interim analysis were to quantify the effect of the induction treatment on intratumoral CD8 density and the pCR rate and to generate safety data. Results: Between Sep 2018 and Dec 2019, 57 patients were enrolled. Median age was 59 years, 22 patients (37%) were current smokers, 27 patients (47%) had oropharyngeal tumors (52% p16 positive). The median pre-treatment intratumoral CD8 density was 335 CD8+ cells/mm². After induction treatment 27 patients (47%) had a pCR in the re-biopsy and further 25 patients (44%) had a relevant increase of intratumoral CD8+ cells (median increase by factor 3.0). Response according to RECIST criteria was CR in 1 (2%), PR in 19 (33%) and SD in 20 patients (35%) (17 patients not evaluable). Adverse events (AE) grade 3-4 appeared in 39 patients (68%) and mainly consisted of leucopenia (43%) and infections (28%). 6 patients (11%) developed grade 3-4 immune-related AEs. In multivariable analysis the intratumoral CD8 density was the only independently significant predictor of pCR (odds ratio 1.0013 per cell/mm², 95%-CI 1.00023-1.0023, p=0.017). 42 patients (74%) continued with Durvalumab/ Tremelimumab concomitant to radiotherapy. Conclusions: Single cycle induction treatment with Cisplatin/Docetaxel/Durvalumab/Tremelimumab is feasible and achieves a high pCR rate. CD8 density may have a predictive role for further treatment planning in locally advanced HNSCC. Clinical trial information: NCT03426657 .
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Affiliation(s)
- Markus Hecht
- Department of Radiation Oncology, Universitatsklinikum Erlangen, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| | - Antoniu-Oreste Gostian
- Department of Otholaryngology - Head and Neck Surgery, Universitatsklinikum Erlangen, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| | - Markus Eckstein
- Institute of Pathology, Universitatsklinikum Erlangen, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| | - Sandra Rutzner
- Department of Radiation Oncology, Universitatsklinikum Erlangen, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| | - Jens von der Grün
- Department of Radiation Oncology, University Hospital Frankfurt, Goethe-Universität Frankfurt, Frankfurt Am Main, Germany
| | - Thomas Illmer
- Medical Oncology Clinic Dresden Freiberg, Dresden, Germany
| | - Matthias G. Hautmann
- Department of Radiation Oncology, University Hospital Regensburg, Universität Regensburg, Regensburg, Germany
| | - Thomas Brunner
- Department of Radiation Oncology, University Hospital Magdeburg, Otto von Guericke Universität Magdeburg, Freiburg, Germany
| | - Simon Laban
- Department of Otolaryngology - Head and Neck Surgery, University Hospital Ulm, Universität Ulm, Ulm, Germany
| | - Gunther Klautke
- Department of Radiation Oncology, Klinikum Chemnitz, Chemnitz, Germany
| | - Balint Tamaskovics
- Department of Radiation Oncology, University Hospital Düsseldorf, Heinrich Heine Universität Düsseldorf, Dusseldorf, Germany
| | - Axel Hinke
- CCRC Cancer Clinical Research Consulting, Düsseldorf, Germany
| | - Benjamin Frey
- Department of Radiation Oncology, Universitatsklinikum Erlangen, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| | - Sabine Semrau
- Department of Radiation Oncology, Universitatsklinikum Erlangen, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, Universitatsklinikum Erlangen, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| | - Claus Roedel
- Department of Radiation Oncology, University Hospital Frankfurt, Goethe-Universität Frankfurt, Frankfurt, Germany
| | - Wilfried Budach
- Department of Radiation Oncology, University Hospital Düsseldorf, Heinrich Heine Universität Düsseldorf, Düsseldorf, Germany
| | - Udo S Gaipl
- Department of Radiation Oncology, Universitatsklinikum Erlangen, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| | - Heinrich Iro
- Department of Otholaryngology - Head and Neck Surgery, Universitatsklinikum Erlangen, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, Universitatsklinikum Erlangen, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
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Haussmann J, Budach W, Boelke E, Tamaskovics B, Djiepmo Njanang FJ, Corradini S, Kammers K, Wessalowski R, Matuschek C. Comparison of different systemic therapeutic regimes in resectable high-risk soft tissue sarcoma: Results of a network meta-analysis. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.11549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11549 Background: The treatment of high-risk soft tissue sarcoma of the trunk or the extremities consists of surgical resection with risk-adapted radiation therapy. Further treatment options which can significantly improve local and systemic tumor control including chemotherapy are not well established. Due to the heterogeneity of disease different systemic approaches as well as their application during different time points have been attempted. Methods: We conducted a literature search for randomized clinical trials in the treatment of localized, resectable high-risk soft tissue sarcoma comparing different treatment modalities according to the PRISMA guidelines. We extracted published hazard ratios and number of events for the endpoints of overall and disease-free survival (OS; DFS) as well as local and distant recurrence-free interval (LRFI; DRFI). The different modalities were compared in a network meta-analysis against the defined standard treatment surgery ± radiotherapy using the inverse-variance heterogeneity model (ivhet) with the help of the Microsoft Excel add-in Meta-XL V5.3. Results: The literature search identified 25 studies including 3489 patients. The network analysis showed that adjuvant chemotherapy (adjCTx) results in a significant improvement in overall survival (HR = 0.86; CI-95%: 0.75-0.97; p = 0.017) compared to the standard treatment of surgery ± radiatherapy alone. Combined treatment with regional hyperthermia and neoadjuvant chemotherapy (HTx+nadjCTx) also improves OS (HR = 0.45; CI-95%: 0.20-1.00; p = 0.049). Preoperative chemotherapy alone (nadjCTx) as well as perioperative chemotherapy (periopCTx) resulted both in non-statistically significant improvements in OS (HR = 0.61; CI-95%: 0.29-1.29; p = 0.195) and (HR = 0.48; CI-95%: 0.15-1.55; p = 0.218). Histology-tailored neoadjuvant chemotherapy (tNaCTx) also showed no effect on overall survival (HR = 1.08; CI-95%: 0.45-2.61; p = 0.868). The analysis of DFS, LRFI and DRFI disclosed a similar pattern between the different treatment regimens. Conclusions: The addition of cytotoxic chemotherapy in resectable high-risk soft tissue sarcomas provides a measurable benefit in overall survival. Shifting of systemic therapy to the neoadjuvant setting and combination with regional hyperthermia might be favored. Predictive clinical and molecular markers are needed to evaluate and limit potentional risks prospectively going forward.
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Affiliation(s)
| | - Wilfried Budach
- Department of Radiation Oncology, University Hospital Düsseldorf, Heinrich Heine Universität Düsseldorf, Düsseldorf, Germany
| | | | - Balint Tamaskovics
- Department of Radiation Oncology, University Hospital Düsseldorf, Heinrich Heine Universität Düsseldorf, Dusseldorf, Germany
| | | | | | - Kai Kammers
- Division of Biostatistics and Bioinformatics, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
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Fischer JC, Zänker K, van Griensven M, Schneider M, Kindgen-Milles D, Knoefel WT, Lichtenberg A, Tamaskovics B, Djiepmo-Njanang FJ, Budach W, Corradini S, Ganswindt U, Häussinger D, Feldt T, Schelzig H, Bojar H, Peiper M, Bölke E, Haussmann J, Matuschek C. The role of passive immunization in the age of SARS-CoV-2: an update. Eur J Med Res 2020; 25:16. [PMID: 32404189 PMCID: PMC7220618 DOI: 10.1186/s40001-020-00414-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/30/2020] [Indexed: 12/20/2022] Open
Abstract
The rapid spread of the corona virus pandemic is an existential problem for many people in numerous countries. So far, there is no effective vaccine protection or proven therapy available against the SARS-CoV-2 virus. In this review, we describe the role of passive immunization in times of the corona virus. Passive immunization could be a bridging technology to improve the immune defense of critically ill patients until better approaches with effective medications are available.
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Affiliation(s)
- Johannes C Fischer
- Institute for Transplant Diagnostics and Cell Therapeutics, Heinrich Heine University, Düsseldorf, Germany
| | - Kurt Zänker
- The Nanjing Han & Zaenker Cancer Institute, Nanjing and Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing Tech University, Jiangsu, China
| | - Martijn van Griensven
- MERLN Institute for Technology-Inspired Regenerative Medicine, Department cBITE, Maastricht University, Maastricht, The Netherlands
| | - Marion Schneider
- Department of Experimental Anesthesiology, University of Ulm, Ulm, Germany
| | - Detlef Kindgen-Milles
- Department of Anesthesiology and Intensive Care Medicine, Heinrich Heine University, Düsseldorf, Germany
| | | | - Artur Lichtenberg
- Department of Cardiac Surgery, Heinrich Heine University, Düsseldorf, Germany
| | - Balint Tamaskovics
- Department of Radiation Oncology, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | | | - Wilfried Budach
- Department of Radiation Oncology, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Ute Ganswindt
- Department of Radiation Oncology, Innsbruck, Austria
| | - Dieter Häussinger
- Clinic of Gastroenterology, Hepatology und Infectious Diseases, Heinrich Heine University, Düsseldorf, Germany
| | - Torsten Feldt
- Clinic of Gastroenterology, Hepatology und Infectious Diseases, Heinrich Heine University, Düsseldorf, Germany
| | - Hubert Schelzig
- Department of Vascular Surgery, Heinrich Heine University, Düsseldorf, Germany
| | - Hans Bojar
- NEXTGEN ONCOLOGY GROUP, Düsseldorf, Germany
| | | | - Edwin Bölke
- Department of Radiation Oncology, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Jan Haussmann
- Department of Radiation Oncology, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Christiane Matuschek
- Department of Radiation Oncology, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
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Hecht M, Gostian AO, Eckstein M, Rutzner S, von der Grün J, Illmer T, Hautmann M, Brunner T, Laban S, Klautke G, Tamaskovics B, Frey B, Hartmann A, Rödel C, Budach W, Gaipl U, Iro H, Fietkau R. Single cycle induction treatment with cisplatin/docetaxel plus durvalumab/tremelimumab in stage III-IVB head and neck squamous cell cancer (CheckRad-CD8 trial). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz252.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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29
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Matuschek C, Tamaskovics B, Boelke E, Haussmann J, Djiepmo F, Pokhylevych H, Schomer D, Kumar V, Hayman A. The Role of Venous Anatomy for Treating Glioblastoma. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Haussmann J, Budach W, Tamaskovics B, Bölke E, Corradini S, Djiepmo-Njanang FJ, Kammers K, Matuschek C. Which target volume should be considered when irradiating the regional nodes in breast cancer? Results of a network-meta-analysis. Radiat Oncol 2019; 14:102. [PMID: 31186015 PMCID: PMC6558843 DOI: 10.1186/s13014-019-1280-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 04/22/2019] [Indexed: 01/11/2023] Open
Abstract
Purpose/objective(s) Radiation treatment to the regional nodes results in an improvement in survival in breast cancer according to a meta-analysis of randomized trials. However, different volumes were targeted in these studies: breast or chestwall only (WBI/CWI), inclusion of the medial supraclavicular region and axillary apex (MS + WBI/CWI) or additional inclusion of the internal mammary chain (IM + MS + WBI/CWI). The benefit of treating the medial supraclavicular region and axillary apex compared to tangential breast or chestwall irradiation only remains unclear. Materials/methods A literature search was conducted identifying trials for adjuvant radiation volumes in nodal irradiation after breast surgery and axillary treatment. Events and effect sizes were extracted from the publications for the endpoints of overall survival (OS), breast cancer-specific survival (BCSS), disease-free survival (DFS), distant metastasis-free survival (DMFS) and loco-regional control (LRC). A network meta-analysis was performed using MetaXL V5.3 with the inverse variance heterogeneity model. Results We found two randomized studies (n = 5836) comparing comprehensive nodal irradiation to sole breast treatment as well as one randomized (n = 1407) and one prospective cohort study (n = 3377) analysing the additional treatment of the internal mammary chain against sole local and supraclavicular and axillary apex radiation. Compared to WBI/CWI alone the treatment of IM + MS + WBI/CWI (HR = 0.88; CI:0.78-0.99; p = 0.036) results in improved OS unlike MS + WBI/CWI (HR = 0.99; CI:0.86-1.14; p = 0,89). These results are confirmed in BCSS: IM + MS + WBI/CWI (HR = 0.82; CI:0.72-0.92; p = 0.002) and MS + WBI/CWI (HR = 0.96; CI:0.79-1.18; p = 0.69). PFS is significantly improved with the treatment of MS + WBI/CWI (OR = 0.83; CI:0.71-0.97; p = 0.019). Both nodal treatment volumes improve LRC (MS + WBI/CWI OR = 0.74; CI:0.62-0.87; p = 0.004 and IM + MS + WBI/CWI OR = 0.60; CI:0.43-0.86; p < 0,001). Yet only the internal mammary nodes provide a benefit in DMFS (MS + WBI/CWI HR = 0.97; CI:0.81-1.16; p = 0.74 and IM + MS + WBI/CWI HR = 0.84; CI:0.75-0.94; p = 0.002). Conclusion Expanding the radiation field to the axillary apex and supraclavicular nodes after axillary node dissection reduced loco-regional recurrences without improvement in overall and cancer-specific survival. A prolongation in survival due to regional nodal irradiation is achieved when the internal mammary chain is included. This derives from a reduction in distant metastasis.
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Affiliation(s)
- Jan Haussmann
- Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany
| | - Wilfried Budach
- Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany
| | - Balint Tamaskovics
- Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany
| | - Edwin Bölke
- Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany.
| | - Stefanie Corradini
- Department of Radiation Oncology, LMU University of Munich, Munich, Germany
| | | | - Kai Kammers
- Division of Biostatistics and Bioinformatics, Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christiane Matuschek
- Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany
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Matuschek C, Nestle-Kraemling C, Wollandt S, Speer V, Boelke E, Roth SL, Audretsch W, Tamaskovics B, Lammering G, DjiepmoNjanang FJ, Budach W, Haussmann J. Quality of life after preoperative radio-/chemotherapy in locally advanced breast cancer patients. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e12083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e12083 Background: Preoperative radiotherapy and chemoradiotherapy (PRT/PCRT) represents an increasingly used clinical strategy in different tumor sites. However, concerns regarding a possible unfavorable influence on the clinical outcome still exist. The aim of the current study was to examine the long-term global health status in our series of LABC patients treated with PRT/PCRT followed by breast-conserving surgery (BCS) or mastectomy (ME). Methods: Of the 315 patients treated with PRT/PCRT in the years 1991 and 1999, 203 patients were still alive at long-term follow up of mean 17.7 years (range 14-21). Thirty-seven patients were lost to follow up and 58 patients refused to be contacted, which resulted in 107 patients (64 patients after BCS and 43 after mastectomy) being available and willing to undergo further clinical assessment. PRT/PCRT consisted of external beam radiation therapy (EBRT) with 50 Gy (5 × 2 Gy/week) to the breast and the supra-/ infraclavicular lymph nodes combined with a consecutive electron boost or (in case of BCS) a 10-Gy interstitial brachytherapy boost with Ir-192 prior to EBRT. Overall, chemotherapy was administered either prior to RT or concomitantly in the majority of patients. Quality of life (QoL) was assessed by EORTC QLQ-C30 questionnaires for overall QoL and EORTC QLQ-BR23 for breast-specific QoL. Results are reported using functional scales (body image, sexual functioning, sexual enjoyment, and future perspective) and symptom-related items (systemic therapy side effects, breast symptoms, arm symptoms, and upset by hair loss). The results were compared to a published reference cohort of n=2028 healthy adults (16-92 years), including n=1139 women (age 16-92 years). EORTC QLQ-C30 functional scales were also analyzed between different subgroups including an age-matched analysis with a two sided paired t-test. Results: In comparison with this healthy control group of 1139 women, we did not detect any significant differences for the functional scales measured by physical function, emotional well-being, cognitive, and social function as well as the symptom scales: fatigue, nausea, vomiting, pain, diarrhea and financial difficulties for both groups. However, significant inferior scores were found in the present study group regarding obstipation (p=0.013), loss of appetite (0.038), sleeping disorder (p=0.01) and dyspnoe (p=0.01). Conclusions: Taken together, retrospective as well as prospective data underline the feasibility of preoperative radiotherapy in breast cancer.
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Matuschek C, Tamaskovics B, Budach W, Haussmann J, Boelke E, Djiepmo F, Fehm T, Ruckhaeberle E, Fleisch M, Roth S. EP-1281 New aspects regarding the treatment of multicentric compared to unifocal breast cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31701-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Haussmann J, Boelke E, Tamaskovics B, Kammers K, DjiepmoNjanang FJ, Budach W, Matuschek C. Adjuvant radio chemotherapy for gastric cancer: Is chemotherapy alone better than combined radio chemotherapy? Results of a meta-analysis. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e16030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Kai Kammers
- John Hopkins Bloomberg School of Public Health Department of Biostatistics, Baltimore, MD
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