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Mirnezami AH, Drami I, Glyn T, Sutton PA, Tiernan J, Behrenbruch C, Guerra G, Waters PS, Woodward N, Applin S, Charles SJ, Rose SA, Denys A, Pape E, van Ramshorst GH, Baker D, Bignall E, Blair I, Davis P, Edwards T, Jackson K, Leendertse PG, Love-Mott E, MacKenzie L, Martens F, Meredith D, Nettleton SE, Trotman MP, van Hecke JJM, Weemaes AMJ, Abecasis N, Angenete E, Aziz O, Bacalbasa N, Barton D, Baseckas G, Beggs A, Brown K, Buchwald P, Burling D, Burns E, Caycedo-Marulanda A, Chang GJ, Coyne PE, Croner RS, Daniels IR, Denost QD, Drozdov E, Eglinton T, Espín-Basany E, Evans MD, Flatmark K, Folkesson J, Frizelle FA, Gallego MA, Gil-Moreno A, Goffredo P, Griffiths B, Gwenaël F, Harris DA, Iversen LH, Kandaswamy GV, Kazi M, Kelly ME, Kokelaar R, Kusters M, Langheinrich MC, Larach T, Lydrup ML, Lyons A, Mann C, McDermott FD, Monson JRT, Neeff H, Negoi I, Ng JL, Nicolaou M, Palmer G, Parnaby C, Pellino G, Peterson AC, Quyn A, Rogers A, Rothbarth J, Abu Saadeh F, Saklani A, Sammour T, Sayyed R, Smart NJ, Smith T, Sorrentino L, Steele SR, Stitzenberg K, Taylor C, Teras J, Thanapal MR, Thorgersen E, Vasquez-Jimenez W, Waller J, Weber K, Wolthuis A, Winter DC, Brangan G, Vimalachandran D, Aalbers AGJ, Abdul Aziz N, Abraham-Nordling M, Akiyoshi T, Alahmadi R, Alberda W, Albert M, Andric M, Angeles M, Antoniou A, Armitage J, Auer R, Austin KK, Aytac E, Baker RP, Bali M, Baransi S, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brunner M, Bui A, Burgess A, Burger JWA, Campain N, Carvalhal S, Castro L, Ceelen W, Chan KKL, Chew MH, Chok AK, Chong P, Christensen HK, Clouston H, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Damjanovic L, Davies M, Davies RJ, Delaney CP, de Wilt JHW, Deutsch C, Dietz D, Domingo S, Dozois EJ, Duff M, Egger E, Enrique-Navascues JM, Espín-Basany E, Eyjólfsdóttir B, Fahy M, Fearnhead NS, Fichtner-Feigl S, Fleming F, Flor B, Foskett K, Funder J, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Giner F, Ginther N, Glover T, Golda T, Gomez CM, Harris C, Hagemans JAW, Hanchanale V, Harji DP, Helbren C, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Holmström A, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Jenkins JT, Jourand K, Kaffenberger S, Kapur S, Kanemitsu Y, Kaufman M, Kelley SR, Keller DS, Kersting S, Ketelaers SHJ, Khan MS, Khaw J, Kim H, Kim HJ, Kiran R, Koh CE, Kok NFM, Kontovounisios C, Kose F, Koutra M, Kraft M, Kristensen HØ, Kumar S, Lago V, Lakkis Z, Lampe B, Larsen SG, Larson DW, Law WL, Laurberg S, Lee PJ, Limbert M, Loria A, Lynch AC, Mackintosh M, Mantyh C, Mathis KL, Margues CFS, Martinez A, Martling A, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, McArthur DR, McCormick JJ, McGrath JS, McPhee A, Maciel J, Malde S, Manfredelli S, Mikalauskas S, Modest D, Morton JR, Mullaney TG, Navarro AS, Neto JWM, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, O’Dwyer ST, Paarnio K, Pappou E, Park J, Patsouras D, Peacock O, Pfeffer F, Piqeur F, Pinson J, Poggioli G, Proud D, Quinn M, Oliver A, Radwan RW, Rajendran N, Rao C, Rasheed S, Rasmussen PC, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Seifert G, Selvasekar C, Shaban M, Shaikh I, Shida D, Simpson A, Skeie-Jensen T, Smart P, Smith JJ, Solbakken AM, Solomon MJ, Sørensen MM, Spasojevic M, Steffens D, Stocchi L, Stylianides NA, Swartling T, Sumrien H, Swartking T, Takala H, Tan EJ, Taylor D, Tejedor P, Tekin A, Tekkis PP, Thaysen HV, Thurairaja R, Toh EL, Tsarkov P, Tolenaar J, Tsukada Y, Tsukamoto S, Tuech JJ, Turner G, Turner WH, Tuynman JB, Valente M, van Rees J, van Zoggel D, Vásquez-Jiménez W, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Wakeman C, Warrier S, Wasmuth HH, Weiser MR, Westney OL, Wheeler JMD, Wild J, Wilson M, Yano H, Yip B, Yip J, Yoo RN, Zappa MA. The empty pelvis syndrome: a core data set from the PelvEx collaborative. Br J Surg 2024; 111:znae042. [PMID: 38456677 PMCID: PMC10921833 DOI: 10.1093/bjs/znae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/15/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Empty pelvis syndrome (EPS) is a significant source of morbidity following pelvic exenteration (PE), but is undefined. EPS outcome reporting and descriptors of radicality of PE are inconsistent; therefore, the best approaches for prevention are unknown. To facilitate future research into EPS, the aim of this study is to define a measurable core outcome set, core descriptor set and written definition for EPS. Consensus on strategies to mitigate EPS was also explored. METHOD Three-stage consensus methodology was used: longlisting with systematic review, healthcare professional event, patient engagement, and Delphi-piloting; shortlisting with two rounds of modified Delphi; and a confirmatory stage using a modified nominal group technique. This included a selection of measurement instruments, and iterative generation of a written EPS definition. RESULTS One hundred and three and 119 participants took part in the modified Delphi and consensus meetings, respectively. This encompassed international patient and healthcare professional representation with multidisciplinary input. Seventy statements were longlisted, seven core outcomes (bowel obstruction, enteroperineal fistula, chronic perineal sinus, infected pelvic collection, bowel obstruction, morbidity from reconstruction, re-intervention, and quality of life), and four core descriptors (magnitude of surgery, radiotherapy-induced damage, methods of reconstruction, and changes in volume of pelvic dead space) reached consensus-where applicable, measurement of these outcomes and descriptors was defined. A written definition for EPS was agreed. CONCLUSIONS EPS is an area of unmet research and clinical need. This study provides an agreed definition and core data set for EPS to facilitate further research.
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West CT, West MA, Mirnezami AH, Drami I, Denys A, Glyn T, Sutton PA, Tiernan J, Behrenbruch C, Guerra G, Waters PS, Woodward N, Applin S, Charles SJ, Rose SA, Pape E, van Ramshorst GH, Aalbers AGJ, Abdul AN, Abecasis N, Abraham-Nordling M, Akiyoshi T, Alahmadi R, Alberda W, Albert M, Andric M, Angeles M, Angenete E, Antoniou A, Armitage J, Auer R, Austin KK, Aytac E, Aziz O, Bacalbasa N, Baker RP, Bali M, Baransi S, Baseckas G, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brown K, Brunner M, Buchwald P, Bui A, Burgess A, Burger JWA, Burling D, Burns E, Campain N, Carvalhal S, Castro L, Caycedo-Marulanda A, Ceelen W, Chan KKL, Chang GJ, Chew MH, Chok AK, Chong P, Christensen HK, Clouston H, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Coyne PE, Croner RS, Damjanovic L, Daniels IR, Davies M, Davies RJ, Delaney CP, de Wilt JHW, Denost QD, Deutsch C, Dietz D, Domingo S, Dozois EJ, Drozdov E, Duff M, Egger E, Eglinton T, Enrique-Navascues JM, Espín-Basany E, Evans MD, Eyjólfsdóttir B, Fahy M, Fearnhead NS, Fichtner-Feigl S, Flatmark K, Fleming F, Flor B, Folkesson J, Foskett K, Frizelle FA, Funder J, Gallego MA, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Gil-Moreno A, Giner F, Ginther N, Glover T, Goffredo P, Golda T, Gomez CM, Griffiths B, Gwenaël F, Harris C, Harris DA, Hagemans JAW, Hanchanale V, Harji DP, Helbren C, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Holmström A, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Iversen LH, Jenkins JT, Jourand K, Kaffenberger S, Kandaswamy GV, Kapur S, Kanemitsu Y, Kaufman M, Kazi M, Kelley SR, Keller DS, Kelly ME, Kersting S, Ketelaers SHJ, Khan MS, Khaw J, Kim H, Kim HJ, Kiran R, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kose F, Koutra M, Kraft M, Kristensen HØ, Kumar S, Kusters M, Lago V, Lakkis Z, Lampe B, Langheinrich MC, Larach T, Larsen SG, Larson DW, Law WL, Laurberg S, Lee PJ, Limbert M, Loria A, Lydrup ML, Lyons A, Lynch AC, Mackintosh M, Mann C, Mantyh C, Mathis KL, Margues CFS, Martinez A, Martling A, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, McArthur DR, McCormick JJ, McDermott FD, McGrath JS, McPhee A, Maciel J, Malde S, Manfredelli S, Mikalauskas S, Modest D, Monson JRT, Morton JR, Mullaney TG, Navarro AS, Neeff H, Negoi I, Neto JWM, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, O’Dwyer ST, Paarnio K, Palmer G, Pappou E, Park J, Patsouras D, Peacock A, Pellino G, Peterson AC, Pfeffer F, Piqeur F, Pinson J, Poggioli G, Proud D, Quinn M, Oliver A, Quyn A, Radwan RW, Rajendran N, Rao C, Rasheed S, Rasmussen PC, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rothbarth J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Saklani A, Sammour T, Sayyed R, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Seifert G, Selvasekar C, Shaban M, Shaikh I, Shida D, Simpson A, Skeie-Jensen T, Smart NJ, Smart P, Smith JJ, Smith T, Solbakken AM, Solomon MJ, Sørensen MM, Spasojevic M, Steele SR, Steffens D, Stitzenberg K, Stocchi L, Stylianides NA, Swartling T, Sumrien H, Swartking T, Takala H, Tan EJ, Taylor C, Taylor D, Tejedor P, Tekin A, Tekkis PP, Teras J, Thanapal MR, Thaysen HV, Thorgersen E, Thurairaja R, Toh EL, Tsarkov P, Tolenaar J, Tsukada Y, Tsukamoto S, Tuech JJ, Turner G, Turner WH, Tuynman JB, Valente M, van Rees J, van Zoggel D, Vásquez-Jiménez W, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Wakeman C, Warrier S, Wasmuth HH, Weber K, Weiser MR, Westney OL, Wheeler JMD, Wild J, Wilson M, Wolthuis A, Yano H, Yip B, Yip J, Yoo RN, Zappa MA, Winter DC. Empty pelvis syndrome: PelvEx Collaborative guideline proposal. Br J Surg 2023; 110:1730-1731. [PMID: 37757457 PMCID: PMC10805575 DOI: 10.1093/bjs/znad301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023]
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Roser E, Harter P, Zocholl D, Denschlag D, Chekerov R, Wimberger P, Kurzeder C, Hasenburg A, Muallem MZ, Mustea A, Emons G, Zeimet AG, Beck F, Arndt T, Brucker SY, Kommoss S, Heitz F, Welz J, Egger EK, Kalder M, Buderath P, Klar M, Marth C, Ulrich UA, Weigel M, Traub L, Anthuber C, Strauss H, Hanker L, Link T, Kubiak K, Melekian B, Hornung D, Pölcher M, Lampe B, Krauß T, Keilholz U, Flörcken A, Pietzner K, Sehouli J. Treatment strategies in patients with gynecological sarcoma: Results of the prospective intergroup real-world registry for gynecological sarcoma in Germany (REGSA-NOGGO RU1). Int J Gynecol Cancer 2023; 33:223-230. [PMID: 36631151 DOI: 10.1136/ijgc-2022-003800] [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] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Gynecological sarcomas account for 3% of all gynecological malignancies and are associated with a poor prognosis. Due to the rarity and heterogeneity of gynecological sarcomas there is still no consensus on optimal therapeutic strategies. This study's objective was to describe the treatment strategies used in patients with gynecological sarcomas in the primary course of disease. METHODS The German prospective registry for gynecological sarcoma (REGSA) is the largest registry for gynecological sarcomas in Germany, Austria and Switzerland. Primary inclusion criteria for REGSA are histological diagnosis of sarcoma of the female genital tract, sarcoma of the breast or uterine smooth muscle tumors of uncertain malignant potential (STUMP). We evaluated data of the REGSA registry on therapeutic strategies used for primary treatment from August 2015 to February 2021. RESULTS A total of 723 patients from 120 centers were included. Data on therapeutic strategies for primary treatment were available in 605 cases. Overall, 580 (95.9%) patients underwent primary surgery, 472 (81.4%) of whom underwent only hysterectomy. Morcellation was reported in 11.4% (n=54) of all hysterectomies. A total of 42.8% (n=202) had no further surgical interventions, whereas an additional salpingo-ophorectomy was performed in 54% (n=255) of patients. An additional lymphadenectomy was performed in 12.7% (n=60), an omentectomy in 9.5% (n=45) and intestinal resection in 6.1% (n=29) of all patients. Among 448 patients with available information, 21.4% (n=96) received chemo- or targeted therapies, more commonly as single-agent treatment than as drug combinations. Information about anti-hormonal treatment was available for 423 patients, among which 42 (9.9%) received anti-hormonal treatment, 23 (54.8%) of whom with low-grade endometrial stroma sarcomas. For radiotherapy, data of 437 patients were available, among which 29 (6.6%) patients underwent radiotherapy. CONCLUSION Our study showed that treatment of patients with gynecologic sarcomas is heterogeneous. Further trials are needed along with more information on treatment modalities, therapy response and patient-reported outcomes to implement new treatment strategies.
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Affiliation(s)
- Eva Roser
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Medical University, Berlin, Germany
| | - Philipp Harter
- Department of Gynecology and Gynecological Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - Dario Zocholl
- Institute of Biometry and Clinical Epidemiology, Charité-Universitaetsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Dominik Denschlag
- Department of Gynecology, Hochtaunus-Kliniken gGmbH, Bad Homburg, Germany
| | - Radoslav Chekerov
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Medical University, Berlin, Germany
| | - Pauline Wimberger
- Department of Obstetrics and Gynecology, University of Dresden, TU Dresden, Dresden Germany and National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
| | - Christian Kurzeder
- Department of Obstetrics and Gynecology, Universitätsspital Basel, Basel, Switzerland
| | | | - Mustafa-Zelal Muallem
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Medical University, Berlin, Germany
| | - Alexander Mustea
- Department of Gynecology and Gynecological Oncology, Bonn University Hospital, Bonn, Germany
| | - Guenter Emons
- Department of Gynecology and Obstetrics, University Medicine Goettingen, Goettingen, Germany
| | - A G Zeimet
- Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Innsbruck, Austria
| | - Felix Beck
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Medical University, Berlin, Germany
| | - Tjadina Arndt
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Medical University, Berlin, Germany
| | - Sara Y Brucker
- Department of Women's Health, Tübingen University Hospital, Tuebingen, Germany
| | - Stefan Kommoss
- Department of Women's Health, Tübingen University Hospital, Tuebingen, Germany
| | - Florian Heitz
- Department of Gynecology and Gynecological Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - Julia Welz
- Department of Gynecology and Gynecological Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - Eva-Katharina Egger
- Department of Gynecology and Gynecological Oncology, Bonn University Hospital, Bonn, Germany
| | - Matthias Kalder
- Department of Gynecology and Obstetrics, University Clinic Gießen and Marburg, Marburg, Germany
| | - Paul Buderath
- Department of Gynecology and Obstetrics, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Maximilian Klar
- Department of Gynecology and Obstetrics, University Medical Center Freiburg, Freiburg, Germany
| | - Christian Marth
- Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Innsbruck, Austria
| | - Uwe Andreas Ulrich
- Department of Obstetrics and Gynecology, Martin Luther Hospital Berlin, Berlin, Germany
| | - Michael Weigel
- Department of Obstetrics and Gynecology, Leopoldina Krankenhaus Schweinfurt, Schweinfurt, Germany
| | - Lea Traub
- Department of Obstetrics and Gynecology, Technische Universität Munich, Munich, Germany
| | - Christoph Anthuber
- Department of Obstetrics and Gynecology, Klinikum Starnberg, Starnberg, Germany
| | - Hans Strauss
- Department of Obstetrics and Gynecology, University of Halle (Saale), Halle, Germany
| | - Lars Hanker
- Department of Obstetrics and Gynecology, University of Schleswig-Holstein, Luebeck, Germany
| | - Theresa Link
- Department of Obstetrics and Gynecology, University of Dresden, TU Dresden, Dresden Germany and National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
| | - Karol Kubiak
- Department of Obstetrics and Gynecology, St. Franziskus Hospital Münster, Muenster, Germany
| | - Badrig Melekian
- Department of Obstetrics and Gynecology, Marienkliniken Siegen, Siegen, Germany
| | - Daniela Hornung
- Department of Obstetrics and Gynecology, Vidiakliniken, Standort Diakonissenkrankenhaus, Karlsruhe, Germany
| | - Martin Pölcher
- Department of Gynecologic Oncology, Rotkreuzklinikum Munich, Munich, Germany
| | - Bjoern Lampe
- Department of Obstetrics and Gynecology, Florence-Nightingale-Hospital, Kaiserswerther Diakonie, Duesseldorf, Germany
| | - Thomas Krauß
- Department of Obstetrics and Gynecology, Klinikum Passau, Passau, Germany
| | - Ulrich Keilholz
- Charité Comprehensive Cancer Center and German Cancer Consortium, Berlin, Germany
| | - Anne Flörcken
- Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Klaus Pietzner
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Medical University, Berlin, Germany
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Medical University, Berlin, Germany .,Charité Comprehensive Cancer Center and German Cancer Consortium, Berlin, Germany
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Fahy MR, Kelly ME, Aalbers AGJ, Abdul Aziz N, Abecasis N, Abraham-Nordling M, Akiyoshi T, Alberda W, Albert M, Andric M, Angeles MA, Angenete E, Antoniou A, Auer R, Austin KK, Aytac E, Aziz O, Bacalbasa N, Baker RP, Bali M, Baransi S, Baseckas G, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Beynon J, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brunner M, Buchwald P, Bui A, Burgess A, Burger JWA, Burling D, Burns E, Campain N, Carvalhal S, Castro L, Caycedo-Marulanda A, Ceelan W, Chan KKL, Chang GJ, Chang M, Chew MH, Chok AY, Chong P, Clouston H, Codd M, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Coyne PE, Croner RS, Damjanovich L, Daniels IR, Davies M, Delaney CP, de Wilt JHW, Denost Q, Deutsch C, Dietz D, Domingo S, Dozois EJ, Drozdov E, Duff M, Eglinton T, Enriquez-Navascues JM, Espín-Basany E, Evans MD, Eyjólfsdóttir B, Fearnhead NS, Ferron G, Flatmark K, Fleming FJ, Flor B, Folkesson J, Frizelle FA, Funder J, Gallego MA, Gargiulo M, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Gil-Moreno A, Giner F, Ginther DN, Glyn T, Glynn R, Golda T, Griffiths B, Harris DA, Hagemans JAW, Hanchanale V, Harji DP, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Iversen LH, Jenkins JT, Jourand K, Kaffenberger S, Kandaswamy GV, Kapur S, Kanemitsu Y, Kazi M, Kelley SR, Keller DS, Ketelaers SHJ, Khan MS, Kiran RP, Kim H, Kim HJ, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kose F, Koutra M, Kristensen HØ, Kroon HM, Kumar S, Kusters M, Lago V, Lampe B, Lakkis Z, Larach JT, Larkin JO, Larsen SG, Larson DW, Law WL, Lee PJ, Limbert M, Loria A, Lydrup ML, Lyons A, Lynch AC, Maciel J, Manfredelli S, Mann C, Mantyh C, Mathis KL, Marques CFS, Martinez A, Martling A, Mehigan BJ, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, Mikalauskas S, McArthur DR, McCormick JJ, McCormick P, McDermott FD, McGrath JS, Malde S, Mirnezami A, Monson JRT, Navarro AS, Negoi I, Neto JWM, Ng JL, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, Nugent T, Oliver A, O’Dwyer ST, O’Sullivan NJ, Paarnio K, Palmer G, Pappou E, Park J, Patsouras D, Peacock O, Pellino G, Peterson AC, Pinson J, Poggioli G, Proud D, Quinn M, Quyn A, Rajendran N, Radwan RW, Rajendran N, Rao C, Rasheed S, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rothbarth J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Saklani A, Sammour T, Sayyed R, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Selvasekar C, Shaikh I, Simpson A, Skeie-Jensen T, Smart NJ, Smart P, Smith JJ, Solbakken AM, Solomon MJ, Sørensen MM, Sorrentino L, Steele SR, Steffens D, Stitzenberg K, Stocchi L, Stylianides NA, Swartling T, Spasojevic M, Sumrien H, Sutton PA, Swartking T, Takala H, Tan EJ, Taylor C, Tekin A, Tekkis PP, Teras J, Thaysen HV, Thurairaja R, Thorgersen EB, Toh EL, Tsarkov P, Tsukada Y, Tsukamoto S, Tuech JJ, Turner WH, Tuynman JB, Valente M, van Ramshorst GH, van Zoggel D, Vasquez-Jimenez W, Vather R, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Urrejola G, Wakeman C, Warrier SK, Wasmuth HH, Waters PS, Weber K, Weiser MR, Wheeler JMD, Wild J, Williams A, Wilson M, Wolthuis A, Yano H, Yip B, Yip J, Yoo RN, Zappa MA, Winter DC. Minimum standards of pelvic exenterative practice: PelvEx Collaborative guideline. Br J Surg 2022; 109:1251-1263. [PMID: 36170347 DOI: 10.1093/bjs/znac317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/18/2022] [Accepted: 08/18/2022] [Indexed: 12/31/2022]
Abstract
This document outlines the important aspects of caring for patients who have been diagnosed with advanced pelvic cancer. It is primarily aimed at those who are establishing a service that adequately caters to this patient group. The relevant literature has been summarized and an attempt made to simplify the approach to management of these complex cases.
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Harter P, Ataseven B, Burges A, Reuss A, Kommoss S, Sehouli J, Lampe B, Schmalfeldt B, Wimberger P, Witteler R, Buderath P, Herwig U, Bronger H, Emons G, Klar M, Hasenburg A, de Gregorio N, Hilpert F, Du Bois A, Mahner S. Diagnosis of first relapse and its impact on quality of life in patients with advanced ovarian cancer (AGO-OVAR 19/II). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e17609] [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
e17609 Background: Maintenance or improvement of health-related quality of life (QoL) is one of the major goals for patients with advanced ovarian cancer (OC). QoL is influenced by symptoms of disease on the one and beneficial or adverse effects of surgical and systemic treatment on the other side. In addition, QoL is also an important patient centered endpoint in clinical trials to support primary endpoints such as progression-free survival (PFS). This analysis evaluates the impact of the diagnosis of first relapse on QoL. Methods: Patients with primary OC were included before start of treatment. QoL was assessed by the cancer-specific questionnaires EORTC QLQ‐C30 and QLQ‐OV28 and the generic EQ‐5D 3L at baseline and every 3 months thereafter, to describe the influence of treatment and course of disease on QoL. QoL data within 100 days before and after the first relapse were compared (part 2 of NCT02828618). QoL scales were analyzed by repeated measures regression. We report model-based pre- and post-recurrence means and p-values for the difference in means. Results: In total, 269 had a PFS event with a median PFS of 20.3 months. This analysis includes 186 patients; 122 with QoL assessment before and after relapse and 50 and 14 with assessment only before or after relapse. Median age was 62.5 years (range 31 – 90). The number of evaluable answers for each domain ranged between 166 and 172 before recurrence and 135 and 137 after recurrence. Global QoL decreased from 61.4 to 48.4 points (p < 0.001) with the diagnosis of recurrence. The following scales showed a deterioration of at least 10 points: Social functioning (65.7- > 52.6), fatigue (55.8 - > 44.5), appetite loss (22.5 - > 33.4), emotional functioning (65.2 - > 54.9), role functioning (56.5 - > 46.4); (all p < 0.001). EQ-5D 3L visual analogue scale showed a deterioration from 66.4 to 55.0 (p < 0.001). Conclusions: The event of first relapse is associated with a significant and clinically relevant deterioration of global QoL including several subscales. Therefore, prolongation of PFS preserves QoL, which supports the role of PFS as meaningful primary endpoint in ovarian cancer trials. Clinical trial information: NCT02828618.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Uwe Herwig
- Albertinen Krankenhaus, Hamburg, Germany
| | | | | | | | | | | | | | | | - Sven Mahner
- University Hospital LMU Munich, Munich, Germany
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6
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Hilpert F, Burges A, Kraemer B, Oerke B, Sehouli J, Lampe B, Schmalfeldt B, Wimberger P, Witteler R, Buderath P, Herwig U, Bronger H, Mueller A, Reuss A, Peters N, Hanf V, Du Bois A, Harter P, Mahner S, Heitz F. Prospective identification of prognostic factors for patients with early failure of advanced ovarian cancer who undergo primary cytoreductive surgery followed by chemotherapy: The AGO-OVAR 19/FRAGILE study (NCT02828618). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.5556] [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
5556 Background: Standard treatment for advanced ovarian cancer (aOC) includes primary cytoreductive surgery followed by chemotherapy (PDS > CTX). There is strong evidence that this strategy is accompanied by high risk for early failure in some patients (pts) but prospective multicenter data for this specific question are lacking. Methods: 64 AGO-sites prospectively registered pts with suspected aOC and collected following variables prior to start of therapy: age, Charlson Comorbidity Index (CCI), timed up and go test (TUG), ASA and ECOG performance score, weight, height, estimated ascites, albumin, creatinine, hemoglobin, leucocytes, platelets, CA125, patient reported outcome measures according to EORTC QLQ-C30 and OV28, hospital anxiety and depression score (HADS), physician-assessed suspected FIGO IV stage, abdominal pain requiring treatment, abdominal bloating, dyspnea and required palliative paracentesis (ascites, pleural effusions). Treatment followed according to investigator’s decision. Primary objective was to predict the unfavorable event of death or progression within 10 months after primary diagnosis. We applied univariate and multiple logistic regression with stepwise variable selection after multiple imputation of missing data in order to identify relevant predictors. Results: 223 pts with aOC FIGO IIIB to IVB and PDS were analyzed. Median age was 63 years (range 31-86). 52 (23.3%) pts experienced progression or death within 10 months from time of enrolment. In univariate regression, age (odds ratio (OR) 1.612 per 10 years), ASA (III vs I/II: OR 3.217), TUG (OR 1.087), body height (OR 0.541 per 10cm), ECOG (1 vs 0 OR 2.326, 2-3 vs 0 OR 4.102), estimated ascites ( > 500cc vs. none OR 2.811), paracentesis (OR 1.991), platelets (upper limit of normal (ULN) vs norm or < lower limit of normal (LLN) OR 1.998), albumin ( < LLN vs norm or > ULN OR 2.053), creatinine ( > ULN vs norm OR 3.969) and baseline QoL single-item subscales appetite loss (“very much” vs “not at all” OR 2.611), constipation (“quite a bit” vs “not at all” OR 4.903), and multi-item subscales global health status (OR 0.982 per 1 point) and nausea/vomiting (OR 1.013 per 1 point) were significant (p < 0.05). Multiple logistic regression identified age (OR 1.459 per 10 years), ASA (III vs I/II: OR 2.427), constipation (“quite a bit” vs “not at all” OR 3.786) and global health (OR: 0.985 per 1 point) as independent predictors of progression or death within 10 months after primary diagnosis (p < 0.05). Conclusions: A significant proportion of aOC pts undergoing PDS > CTX are at high-risk for early failure. The finding of independent risk factors including self-ratings of QoL at time of diagnosis should be confirmed and tested against other models to facilitate a more tailored treatment of high-risk pts and design of future trials in aOC. Clinical trial information: NCT02828618.
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Affiliation(s)
| | | | | | - Britta Oerke
- Biostatistics, Coordinating Center for Clinical Trials, Philipps-University of Marburg, Marburg, Germany
| | | | | | | | | | | | | | - Uwe Herwig
- Albertinen Krankenhaus, Hamburg, Germany
| | | | | | | | - Norbert Peters
- Klinikum Hochsauerland, Karolinen-Hospital Huesten, Arnsberg-Huesten, Germany
| | | | | | - Philipp Harter
- AGO Study Group & Evang. Kliniken Essen-Mitte, Essen, Germany
| | - Sven Mahner
- University Hospital LMU Munich, Munich, Germany
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7
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Luengas-Wuerzinger V, Rawert F, CLAßEN-VON Spee S, Baransi S, Schuler E, Carrizo K, Mallmann P, Lampe B. Role of the Cardiophrenic Lymph Node Status After Neoadjuvant Chemotherapy in Primary Advanced Ovarian Cancer. Anticancer Res 2021; 41:5025-5031. [PMID: 34593451 DOI: 10.21873/anticanres.15317] [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: 08/24/2021] [Revised: 09/05/2021] [Accepted: 09/06/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM This study investigated the cardiophrenic lymph node (CPLN) status before and after neoadjuvant chemotherapy (NACT), as its presence seems to have a rather prognostic significance in patients with advanced ovarian cancer. PATIENTS AND METHODS The baseline computed tomography scans of 66 patients with advanced ovarian cancer primary treated with NACT between March 2015 and June 2020 were reviewed. A CPLN enlargement was defined as ≥5 mm. RESULTS 44% (n=29) of the patients had enlarged CPLNs; 10.7% (n=3) showed a complete response, 71.4% (n=20) a partial response, and 17.9% (n=5) a stable disease after NACT. There was no significant difference between the response to NACT measured according to the status of CPLN compared to other biomarkers in the CPLN group. CONCLUSION Patients with CPLN enlargement have a tendency to an impaired prognosis. The response of CPLN to NACT was comparable to the response of established biomarkers, adding a monitoring function to the CPLN.
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Affiliation(s)
| | - Friederike Rawert
- Florence-Nightingale Hospital, Department of Gynaecology and Obstetrics, Düsseldorf, Germany
| | - Sabrina CLAßEN-VON Spee
- Florence-Nightingale Hospital, Department of Gynaecology and Obstetrics, Düsseldorf, Germany
| | - Saher Baransi
- Florence-Nightingale Hospital, Department of Gynaecology and Obstetrics, Düsseldorf, Germany
| | - Esther Schuler
- Florence-Nightingale Hospital, Department of Gynaecology and Obstetrics, Düsseldorf, Germany
| | - Katharina Carrizo
- Florence-Nightingale Hospital, Department of Gynaecology and Obstetrics, Düsseldorf, Germany
| | - Peter Mallmann
- University Hospital of Cologne, Department of Obstetrics and Gynaecology, Cologne, Germany
| | - Bjoern Lampe
- Florence-Nightingale Hospital, Department of Gynaecology and Obstetrics, Düsseldorf, Germany
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8
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Harter P, Sehouli J, Meier W, Reuss A, Hillemanns P, Hasenburg A, Hilpert F, Denschlag D, Burges A, Hanker L, Lampe B, Canzler U, Gropp-Meier M, du Bois A. Randomized phase III study to evaluate the impact of secondary cytoreductive surgery in recurrent ovarian cancer – final analysis of AGO DESKTOP III/ENGOT- ov20. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717176] [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)
| | | | | | | | | | | | | | | | | | | | - B Lampe
- Florence-Nightingale Krankenhaus
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9
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Hasenburg A, Sehouli J, Lampe B, Reuss A, Schmalfeld B, Belau AK, Bossart M, Mahner S, Hillemanns P, Petry U, du Bois A, Herwig U, Hilpert F, Gropp-Meier M, Hanf V, Greimel E, Wagner U, Harter P. LION-PAW (lymphadenectomy in ovarian neoplasm) sexual function assessment: a prospective sub-study of the LION trial. Int J Gynecol Cancer 2020; 30:1548-1553. [PMID: 32938723 DOI: 10.1136/ijgc-2020-001551] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 04/29/2020] [Revised: 08/12/2020] [Accepted: 08/14/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND There is limited information about the impact of radical surgery including pelvic and para-aortic lymphadenectomy and subsequent platinum-based chemotherapy on sexuality in patients with advanced ovarian cancer. OBJECTIVE To evaluate the impact of radical surgery including pelvic and para-aortic lymphadenectomy and subsequent platinum-based chemotherapy on sexuality in patients with advanced ovarian cancer as a sub-protocol of the prospectively randomized LION trial. METHODS The Sexual Activity Questionnaire was applied to assess sexual function according to its sub-scales activity, pleasure, and discomfort. The 'orgasm' sub-scale from the Female Sexual Function Index was also added. The questionnaire was administered in combination with the EORTC QLQ-C30 questionnaire at baseline prior surgery, after 6, 12, and 24 months. The primary endpoint was changes in sexual function. RESULTS Overall, 495 patients received the questionnaires. 254 (51%) responded at baseline. Of these, 55 (22%) patients were sexually active, 182 (72%) were sexually inactive, and for 17 (7%) patients' data were not available. There was a total of 55/495 (11%) patients at 6 months, 139 (28%) patients at 12 months, and 81 (16%) patients at 24 months. Median age was 60.5 years (range 21.4-75.8). At baseline, sexually active responders were significantly younger (median age 51.5 years,) than sexually inactive responders (median age 61.8 years) and tended to have a better performance status. Discomfort evaluated as dryness of the vagina and pain during sexual intercourse was significantly worse at 12 months than at baseline (p<0.001); however, the surgical variable, lymphadenectomy, did not have any impact on this. The orgasm sub-scale showed diverging results with a deterioration from baseline to 12 months in the lymphadenectomy group compared with the no-lymphadenectomy group (p=0.02). CONCLUSION The majority of patients were sexually inactive; however, in those who were sexually active, pain during intercourse was worse at 12 months. In addition, the orgasm sub-scale demonstrated worse results in patients who underwent complete lymphadenectomy. The study suggests that surgery in the retroperitoneal space may influence sexual function.
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Affiliation(s)
- Annette Hasenburg
- Department of Obstetrics and Gynecology, University Medical Center, Mainz, Germany
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, New Hampshire, USA
| | - Bjoern Lampe
- Department of Gynecology and Obstetrics, Kaiserswerther Diakonie, Duesseldorf, Germany
| | - Alexander Reuss
- Coordinating Centre for Clinical Trials, Philipps-Universität Marburg, Marburg, Germany
| | - Barbara Schmalfeld
- Department of Gynecology and Obstetrics, University Hospital Ludwig-Maximilians-University Munich, München, Bayern, Germany.,Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Antje Kristina Belau
- Department of Gynecology and Obstetrics, University of Greifswald, Greifswald, Germany
| | - Michaela Bossart
- Department of Gynecology and Obstetrics, University Medical Center Freiburg, Freiburg, Germany
| | - Sven Mahner
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Gynecology and Obstetrics, University Hospital, LMU Munich, München, Germany
| | - Peter Hillemanns
- Department of Gynecology and Obstetrics, Medizinische Hochschule, Hannover, Germany
| | - Ulrich Petry
- Department of Gynecology and Obstetrics, Klinikum Wolfsburg, Wolfsburg, Niedersachsen, Germany
| | - Andreas du Bois
- Department of Gynecology and Gynecological Oncology, KEM, Kliniken Essen Mitte, Essen, Germany
| | - Uwe Herwig
- Department of Gynecology and Obstetrics, Albertinen-Hospital Hamburg, Hamburg, Germany
| | - Felix Hilpert
- Department of Gynecology and Obstetrics, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel, Germany.,Mammazentrum Hamburg, Krankenhaus Jerusalem, Hamburg, Germany
| | - Martina Gropp-Meier
- Department of Gynecology and Obstetrics, St. Elisabethenhospital, Ravensburg, Baden-Württemberg, Germany
| | - Volker Hanf
- Department of Gynecology and Obstetrics, Klinikum Fürth, Fürth, Bayern, Germany
| | - Elfriede Greimel
- Clinical Psychology Unit, Medical University Graz, Graz, Steiermark, Austria
| | - Uwe Wagner
- Department of Gynecology and Obstetrics, University of Gießen and Marburg GmbH Site Marburg, Marburg, Germany
| | - Philipp Harter
- Department of Gynecology and Gynecological Oncology, KEM, Kliniken Essen Mitte, Essen, Germany
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10
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Herold N, Wappenschmidt B, Markiefka-Schömig B, Driesen J, Keupp K, Kröber S, Hahnen E, Carrizo K, Lampe B, Schmutzler R, Rhiem K. SMARCA4- Risikogen für das kleinzellige Ovarialkarzinome des hyperkalzämischen Typs (SCCOHT). Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671041] [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: 10/28/2022] Open
Affiliation(s)
- N Herold
- Zentrum familiärer Brust- und Eierstockkrebs, Center for Integrated Oncology (CIO) Universitätsklinik Köln, Köln, Deutschland
| | - B Wappenschmidt
- Zentrum familiärer Brust- und Eierstockkrebs, Center for Integrated Oncology (CIO) Universitätsklinik Köln, Köln, Deutschland
| | | | - J Driesen
- Zentrum familiärer Brust- und Eierstockkrebs, Center for Integrated Oncology (CIO) Universitätsklinik Köln, Köln, Deutschland
| | - K Keupp
- Zentrum familiärer Brust- und Eierstockkrebs, Center for Integrated Oncology (CIO) Universitätsklinik Köln, Köln, Deutschland
| | - S Kröber
- Zentrum familiärer Brust- und Eierstockkrebs, Center for Integrated Oncology (CIO) Universitätsklinik Köln, Köln, Deutschland
| | - E Hahnen
- Zentrum familiärer Brust- und Eierstockkrebs, Center for Integrated Oncology (CIO) Universitätsklinik Köln, Köln, Deutschland
| | - K Carrizo
- Kaiserswerther Diakonie/Florence Nightingale Krankenhaus, Düsseldorf, Deutschland
| | - B Lampe
- Kaiserswerther Diakonie/Florence Nightingale Krankenhaus, Düsseldorf, Deutschland
| | - R Schmutzler
- Zentrum familiärer Brust- und Eierstockkrebs, Center for Integrated Oncology (CIO) Universitätsklinik Köln, Köln, Deutschland
| | - K Rhiem
- Zentrum familiärer Brust- und Eierstockkrebs, Center for Integrated Oncology (CIO) Universitätsklinik Köln, Köln, Deutschland
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11
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Hasenburg A, Sehouli J, Lampe B, Reuss A, Schmalfeldt B, Belau A, Bossart M, Mahner S, Hillemanns P, Petry KU, du Bois A, Herwig U, Hilpert F, Gropp-Meier M, Hanf V, Janni W, Schindelhauer A, Kimmig R, Greimel E, Wagner U, Harter P. LION-PAW – Lymphonodectomy (LNE) in Ovarian Neoplasm – Pleasure Ability of Women Prospektive Substudie der multizentrischen AGO LION Studie. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671032] [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: 10/28/2022] Open
Affiliation(s)
- A Hasenburg
- Universitätsmedizin Mainz, Klinik und Poliklinik für Geburtshilfe und Frauengesundheit, Mainz, Deutschland
| | - J Sehouli
- Charité, Campus Virchow Klinikum, Berlin, Deutschland
| | - B Lampe
- Kaiserswerther Diakonie/Florence Nightingale Krankenhaus, Düsseldorf, Deutschland
| | - A Reuss
- Philipps-University of Marburg, Coordinating Center for Clinical Trials, Marburg, Deutschland
| | - B Schmalfeldt
- Klinikum rechts der Isar; Technical University of Munich, München, Deutschland
- University Medical Center Hamburg-Eppendorf, Dept. of Gynecology and Gynecologic Oncology, Hamburg, Deutschland
| | - A Belau
- University of Greifswald, Clinic and Policlinic for Gynecology and Obstetrics, Greifswald, Deutschland
| | - M Bossart
- Universitätsklinik Freiburg, Universitätsfrauenklinik, Freiburg, Deutschland
| | - S Mahner
- University Medical Center Hamburg-Eppendorf, Dept. of Gynecology and Gynecologic Oncology, Hamburg, Deutschland
- Universitätsfrauenklinik LMU München, Geburtshilfe und Frauenheilkunde, München, Deutschland
| | - P Hillemanns
- Medizinische Hochschule Hannover, Klinik für Frauenheilkunde und Geburtshilfe, Hannover, Deutschland
| | - KU Petry
- Klinikum Wolfsburg, Frauenklinik, Wolfsburg, Deutschland
| | - A du Bois
- Kliniken Essen-Mitte (KEM) Evang. Huyssens-Stiftung/Knappschaft GmbH, Klinik für Gynäkologie und gyn. Onkologie, Essen, Deutschland
| | - U Herwig
- Albertinen-Hospital Hamburg, Research Center Gynecology, Hamburg, Deutschland
| | - F Hilpert
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - M Gropp-Meier
- Oberschwabenklinik, Krankenhaus St. Elisabeth, Ravensburg, Deutschland
| | - V Hanf
- Klinikum Fürth, Frauenklinik, Fürth, Deutschland
| | - W Janni
- University of Ulm, Department of Gynecology, Ulm, Deutschland
| | - A Schindelhauer
- Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | - R Kimmig
- Universitätsklinikum Essen, Frauenklinik, Essen, Deutschland
| | - E Greimel
- Medical University Graz, Department of Obstetrics and Gynecology, Graz, Österreich
| | - U Wagner
- University of Gießen and Marburg GmbH Site Marburg, Klinik für Gynäkologie, Gyn. Endokrinologie und Onkologie, Marburg, Deutschland
| | - P Harter
- Kliniken Essen-Mitte (KEM) Evang. Huyssens-Stiftung/Knappschaft GmbH, Klinik für Gynäkologie und gyn. Onkologie, Essen, Deutschland
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12
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Hami LT, Lampe B, Mallmann P, Forner DM. The Impact of Age on the Prognosis of Vulvar Cancer. Oncol Res Treat 2018; 41:520-524. [DOI: 10.1159/000488800] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 03/27/2018] [Indexed: 11/19/2022]
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13
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Mahner S, Heitz F, Burges A, Reuss A, Kraemer B, Schmalfeldt B, Sehouli J, Lampe B, Schnelzer A, Wimberger P, Fotopoulou C, Guyon F, Lecuru F, Querleu D, Greggi S, Colombo N, Aletti GD, Harter P, Du Bois A. TRUST: Trial of radical upfront surgical therapy in advanced ovarian cancer (ENGOT ov33 / AGO‐OVAR OP7). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.tps5602] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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
TPS5602 Background: Primary cytoreductive surgery (PDS) followed by chemotherapy has been considered as standard management for advanced ovarian cancer patients (pts) over decades. An alternative approach of interval debulking surgery (IDS) following neoadjuvant chemotherapy (NACT) was subsequently reported by two randomized phase III trials (EORTC‐GCG, CHORUS). Owing to important limitations of these studies, especially regarding surgical quality, optimal timing of surgical therapy in advanced ovarian cancer is still unclear. Methods: TRUST is an international open, randomized, controlled multicenter trial investigating overall survival (OS; primary endpoint) after PDS vs NACT and subsequent IDS in pts with FIGO stage IIIB‐IVB ovarian, tubal, and peritoneal carcinoma. Secondary objectives are safety of complete tumor resection, progression‐free survival and quality of life (QoL) as well as surgical morbidity. In order to guarantee adequate surgical quality, participating centers need to fulfill specific quality assurance criteria (e.g. ≥50% complete resection rate in upfront surgery for FIGO IIIB-IV pts, ≥36 debulking-surgeries/year) and agree to independent audits by TRUST Quality committee delegates. A 1:1 randomization to PDS or NACT followed by IDS stratified by center and age‐ECOG combination (ECOG 0 and age ≤65 years vs ECOG > 0 or age > 65 years) is performed. Pts in the PDS arm will undergo surgery followed by 6 cycles of platinum-based chemotherapy, whereas pts in the IDS arm will be treated with 3 cycles of NACT after histologic confirmation of the disease, followed by IDS and subsequently 3 cycles of platinum-based chemotherapy. Intention of surgery for both groups will be complete tumor resection as per guideline recommendations. Health related QoL will be assessed using the EORTC QLQ‐C30, QLQ‐OV28, and EQ‐5D‐3L questionnaires. For sample size planning, we considered a prolongation of median OS from 45 months in the IDS arm to 60 months in the PDS arm (HR 0.75) as clinically relevant. 380 events are needed to obtain a power of 80% in two‐sided log-rank test with significance level of 0.05. The primary analysis will be done in the ITT‐population of 686 randomized pts. By Feb 3 2017, 46 pts were randomized. Clinical trial information: NCT02828618.
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Affiliation(s)
- Sven Mahner
- Department for Gynecology and Obstetrics, University of Munich, Munich, Germany
| | - Florian Heitz
- Department of Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - Alexander Burges
- AGO and Department of Gynecology, University Hospital Munich-Großhadern, Munich, Germany
| | - Alexander Reuss
- AGO and Coordinating Center for Clinical Trials, Marburg, Germany
| | - Bernhard Kraemer
- University of Tuebingen, Department of Gynecology and Obstetrics, Tübingen, Germany
| | - Barbara Schmalfeldt
- AGO and Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jalid Sehouli
- AGO and Charité Campus Virchow-Klinikum, Berlin, Germany
| | - Bjoern Lampe
- Florence Nightingale Hospital, Düsseldorf, Germany
| | - Andreas Schnelzer
- Department of Gynecology, Klinikum rechts der Isar der Technischen Universität, Munich, Germany
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | | | | | - Fabrice Lecuru
- GINECO and European Georges Pompidou Hospital, Paris, France
| | - Denis Querleu
- Institut Claudius Regaud, IUCT-Oncopole, CRCT, Inserm, Toulouse, France
| | | | - Nicoletta Colombo
- University of Milano-Bicocca and Istituto Europeo di Oncologia, Milan, Italy
| | | | - Philipp Harter
- Departments of Gynecology and Gynecologic Oncology, Kliniken Essen Mitte, Essen, Germany
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14
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Hami LT, Forner DM, Lampe B, Mallmann P. Untersuchung von Tumorcharakteristika und Prognosekriterien beim Vulvakarzinom unter besonderer Berücksichtigung des Lebensalters. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592998] [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: 10/20/2022] Open
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Rhiem K, Richters L, Hahnen E, Lampe B, Rezai M, Göhring UJ, Schumacher C, Kümmel S, Ataseven B, Schmutzler R. Benchmarking der Checkliste zur Erfassung einer erblichen Belastung für Brust- und/oder Eierstockkrebs. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592829] [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: 10/20/2022] Open
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Forner DM, Dakhil R, Lampe B. Quality of life and sexual function after surgery in early stage vulvar cancer. Eur J Surg Oncol 2014; 41:40-5. [PMID: 25468750 DOI: 10.1016/j.ejso.2014.10.050] [Citation(s) in RCA: 20] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 10/13/2014] [Accepted: 10/17/2014] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES AND METHODS Vulvar carcinomas are rare genital malignancies. In a retrospective study on 21 patients factors influencing the quality of life and sexual function were investigated. All patients were interviewed according to the Female Sexual Function Index questionnaire (FSFI) and the Short Form 12(®) questionnaire (SF12). RESULTS We identified 21 patients that had been operated for vulvar carcinoma FIGO stage I or IIIa in the years 2006-2008. Patients that had adjuvant radiotherapy were excluded. 14 patients had been treated by a wide excision, the other 7 by a vulvectomy. 10 patients had undergone a total inguinal lymphadenectomy, 5 patients a sentinel node biopsy. In a multivariate analysis lymphadenectomy was the only factor influencing the patients' sexual function: Patients without lymphadenectomy or with sentinel node biopsy scored better in terms of sexual function, neither age nor the extend of the surgery resulted in a significant difference. CONCLUSION The lymphadenectomy has a negative influence on the patients' sexual function after surgical treatment for vulvar carcinoma. The indication for lymphadenectomy should hence be seen critically.
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Affiliation(s)
- D M Forner
- Sana Klinikum Remscheid, Burger Str. 211, Remscheid D-42859, Germany.
| | - R Dakhil
- Kaiserswerther Diakonie, Florence Nightingale Hospital, Kreuzbergstraße 79, Dusseldorf D-40489, Germany
| | - B Lampe
- Kaiserswerther Diakonie, Florence Nightingale Hospital, Kreuzbergstraße 79, Dusseldorf D-40489, Germany
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Wolter A, Diedrichson J, Scholz T, Lampe B, Liebau J. Subkutane Mastektomie und simultane Hysterektomie/Adnexektomie - Interdisziplinäres operatives Management bei Frau-zu-Mann-Transsexualismus. HANDCHIR MIKROCHIR P 2013. [DOI: 10.1055/s-0033-1341628] [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: 10/26/2022] Open
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Gröning T, Ramsauer B, Vetter K, Lampe B. Übertragung in klinikinterne Fortbildungsveranstaltung möglich. GYN TO GO – 2. Kursjahr mit kostenfreien Live-Onlinefortbildungen. Geburtshilfe Frauenheilkd 2012. [DOI: 10.1055/s-0032-1324930] [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: 10/27/2022] Open
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Forner DM, Lampe B. Exenteration as a primary treatment for locally advanced cervical cancer: long-term results and prognostic factors. Am J Obstet Gynecol 2011; 205:148.e1-6. [PMID: 21640963 DOI: 10.1016/j.ajog.2011.03.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 02/04/2011] [Accepted: 03/29/2011] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Whereas pelvic exenteration is an established therapy for the treatment of recurrent cervical carcinoma, it is not often performed for primary locally advanced cervical cancer (LACC). STUDY DESIGN This retrospective study analyzed survival data and prognostic factors of 35 patients with LACC who were treated by pelvic exenteration. RESULTS After surgery, 33 patients (97%) were macroscopically free of tumor. In 20 patients, pelvic lymph nodes (LN) were involved, and in 6 of these, metastatic tissue had reached the paraaortal nodes. Overall, the patients' mean 5 year survival was 43%, and the median survival time was 30 months; these values ranged from 15% to 70% and from 15 to 44 months, respectively, depending on LN involvement (P=.006). Pelvic LN involvement was the only significant factor for overall survival found in the multivariate analysis (P=.02). CONCLUSION In LACC with free LNs and no distant metastases, pelvic exenteration has good long-term results.
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Forner DM, Meyer A, Lampe B. Preoperative assessment of complete tumour resection by magnetic resonance imaging in patients undergoing pelvic exenteration. Eur J Obstet Gynecol Reprod Biol 2010; 148:182-5. [DOI: 10.1016/j.ejogrb.2009.10.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Revised: 08/17/2009] [Accepted: 10/19/2009] [Indexed: 12/17/2022]
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Forner DM, Lampe B. Pelvic Cyst: Renal or Ovarian? J Minim Invasive Gynecol 2009; 16:682-6. [DOI: 10.1016/j.jmig.2009.07.011] [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] [Received: 05/12/2009] [Revised: 07/21/2009] [Accepted: 07/23/2009] [Indexed: 11/25/2022]
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Gröning T, Hilscher M, Grecu O, Lampe B. Großflächige Vesico-Uterinfistel als Komplikation nach Spontanpartus – Ein Fallbericht. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1222977] [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: 10/20/2022]
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Forner DM, Lümmen S, Lampe B. Primärmanifestation eines Non Hodgkin Lymphom der Cervix uteri. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1089164] [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: 10/18/2022] Open
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Forner DM, Lampe B. Ovarialcyste in der Postmenopause – Nierencyste als seltene Differentialdiagnose. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1089051] [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] Open
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Lieber AC, Forner DM, Lampe B, Liebau J. Onkoplastische Deckung bei Vulvatumoren unterschiedlicher Genese und Lokalisation. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1089313] [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] Open
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Forner DM, Lampe B. Prädiktiver Wert des MRT zum Erreichen lokoregionärer Tumorfreiheit vor multiviszeralen Eingriffen. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1089150] [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] Open
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Forner DM, Lampe B. Darmresektionen im Rahmen der operativen Therapie des Ovarialkarzinomes. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-983665] [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] Open
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Lampe B, Thiel A, Poggenborg J, Schuster A, Vollmar S, Hesselmann A, Haupt WF. Development of a single pulse transcranial magnetic stimulation protocol for individual localization of brain regions for semantic processing. KLIN NEUROPHYSIOL 2006. [DOI: 10.1055/s-2006-939215] [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: 10/20/2022]
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Lampe B, Egger H, Forner DM. Funktionelle Organrekonstruktion in der gynäkologischen Onkologie. Geburtshilfe Frauenheilkd 2005. [DOI: 10.1055/s-2005-837562] [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: 10/25/2022] Open
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Mau W, Gülich M, Gutenbrunner C, Lampe B, Morfeld M, Schwarzkopf SR, Smolenski UC. Lernziele im Querschnittsbereich Rehabilitation, Physikalische Medizin und Naturheilverfahren nach der 9. Revision der Approbationsordnung für Ärzte. REHABILITATION 2004; 43:337-47. [PMID: 15565535 DOI: 10.1055/s-2004-828349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In October 2003 the 9 (th) revision of the Federal Medical Training Regulations (Approbationsordnung) came into effect. The new compulsory interdisciplinary subject "Rehabilitation, Physical Medicine, Naturopathic Treatment" offers the opportunity to teach all students in comprehensive concepts of Rehabilitation such as the International Classification of Functioning, Disability and Health (ICF) of the WHO and the new book 9 of the German Social Code (SGB 9), as well as Physical Medicine and Naturopathic Treatment. Since the content of this new subject has not been defined up to date a joint task force of the German Society of Rehabilitation Science and the German Society of Physical Medicine and Rehabilitation was founded in order to recommend teaching standards. As part of these teaching standards educational objectives are introduced in this article. They should guide the persons in charge of teaching the subject in the medical faculties. In some areas the students should acquire profound abilities and skills in addition to knowledge. The medical faculties may focus on different educational targets according to their individual teaching profile.
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Affiliation(s)
- W Mau
- Institut für Rehabilitationsmedizin, Martin-Luther-Universität Halle-Wittenberg.
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Altgassen C, Lantzsch T, Mende T, Kölbl H, Stöcklein R, Wischnik A, Abou-Dahkn M, Strecker J, Pourfard J, Meerpohl HG, Fleisch M, Dall P, Bender HG, Lampe B, Trifyllis N, Mahnert U, Hoyme UB, Tulusan AH, Bühner M, Otte C, Neis K, Böhmer G, Petry KU, Kühn T, Passeka A, Urbanzyk H, Schmatloch S, Dimpfl T, Ackermann S, Malur S, Beckmann MW, Müller B, Greinke C, Dürst M, Schneider A. HPV-Detektion in Sentinellymphknoten bei Patientinnen mit Zervixkarzinom. Geburtshilfe Frauenheilkd 2003. [DOI: 10.1055/s-2003-815255] [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: 10/20/2022] Open
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Janni W, Shabani N, Dimpfl T, Starflinger I, Rjosk D, Peschers U, Bergauer F, Lampe B, Genz T. Matched pair analysis of survival after chest-wall recurrence compared to mammary recurrence: a long-term follow up. J Cancer Res Clin Oncol 2001; 127:455-62. [PMID: 11469684 DOI: 10.1007/s004320100238] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Local recurrence remains a major concern after primary treatment of breast cancer and has a major impact on subsequent survival. While most studies report a poorer survival rate in patients with a local recurrence after mastectomy than after breast conservation, it remains controversial whether different risk profiles at the time of primary diagnosis may account for this difference. METHOD Matched pair analysis of 134 patients with newly diagnosed locoregional recurrence of breast cancer without evidence of systemic disease. Matching criteria included the primary surgical treatment, tumor size, nodal status, and age. The significance of various prognostic parameters at the time of primary diagnosis and at the time of recurrence were evaluated, by univariate and multivariate analyses, with respect to survival after recurrence. The median follow-up was 8.4 years. RESULTS Risk factors at the time of presentation, such as tumor size and lymph node status, were comparable between both groups. Local recurrence occurred on an average 9 months earlier in patients after mastectomy (P = 0.08). Univariate analysis showed that lymph node status (P = 0.0001) and disease-free interval from primary treatment to local recurrence (P = 0.0002) were the most significant single prognostic factors for subsequent survival after local recurrence. The primary surgical treatment modality was shown to be of marginal statistical influence (only P = 0.05). CONCLUSION Local recurrence after mastectomy seems to be associated with worse survival than after breast-conserving therapy. Early onset of chest-wall recurrence, moreover, represents the highest independent risk for cancer-associated death.
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Affiliation(s)
- W Janni
- Department of Gynecology and Obstetrics, Klinikum Innenstadt, Ludwig-Maximilians-Universität Muenchen, Germany.
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Janni W, Dimpfl T, Rjosk D, Strobl B, Bergauer F, Sommer H, Lampe B, Genz T. Prognose des Lokalrezidives beim nodalnegativen Mammakarzinom in Abhängigkeit von der Primäroperation - Langzeitergebnisse einer Matched-Pair-Analyse*. Geburtshilfe Frauenheilkd 2001. [DOI: 10.1055/s-2001-11161] [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: 10/17/2022] Open
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Janni W, Dimpfl T, Braun S, Knobbe A, Peschers U, Rjosk D, Lampe B, Genz T. Radiotherapy of the chest wall following mastectomy for early-stage breast cancer: impact on local recurrence and overall survival. Int J Radiat Oncol Biol Phys 2000; 48:967-75. [PMID: 11072152 DOI: 10.1016/s0360-3016(00)00743-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Recent studies have renewed an old controversy about the efficacy of adjuvant radiotherapy following mastectomy for breast cancer. Radiotherapy is usually recommended for advanced disease, but whether or not to use it in pT1-T2 pN0 situations is still being debated. This study was designed to clarify whether or not routine radiotherapy of the chest wall following mastectomy reduces the risk of local recurrence and if it influences the overall survival rate. METHODS Retrospective analysis of patients treated with mastectomy for pT1-T2 pN0 tumors and no systemic treatment. Patients treated with radiotherapy of the chest wall following mastectomy (Group A) are compared with those treated with mastectomy alone (Group B). RESULTS A total of 918 patients underwent mastectomy. Patients who received adjuvant radiotherapy after mastectomy (n = 114) had a significantly lower risk for local recurrence. Ten years after the primary diagnosis, 98.1% of the patients with radiotherapy were disease free compared to 86.4% of the patients without radiotherapy. The average time interval from primary diagnosis until local recurrence was 8.9 years in Group A and 2.8 years in Group B. The Cox regression analysis including radiotherapy, tumor size and tumor grading found the highest risk for local recurrence for patients without radiotherapy (p < 0.0004). In terms of overall survival however, the Kaplan-Meier analysis showed no difference between the two groups (p = 0.8787) and the Cox regression analysis failed to show any impact on overall survival. CONCLUSION With observation spanning over 35 years, this study shows that adjuvant radiotherapy of the chest wall following mastectomy reduces the risk for local recurrence in node-negative patients with pT1-T2 tumors but has no impact on the overall survival rate.
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Affiliation(s)
- W Janni
- I. Frauenklinik, Ludwig-Maximilians-Universtitaet, Maistr. 11, D- 80337, Muenchen, Germany.
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Abstract
Tumor proliferation is of important prognostic significance for several neoplasms. The very few previous studies on this parameter in vulvar carcinoma have shown contradictory results. The aim of this study was to determine the prognostic significance of tumor proliferation in vulvar carcinoma. Paraffin-embedded tissue of 74 squamous cell carcinomas of the vulva was immunostained for MIB-1, detecting Ki-67, and analyzed for staining patterns and the percentage of positive cells. There were three general staining patterns: a diffuse distribution (diffuse type), a localized staining at the infiltrating tumor border (infiltrating type), and a localized staining in basal parts of infiltrating tumor cell aggregates (basal type). The percentage of positive cells was not correlated with morphologic or clinical parameters, nor was it correlated with disease-free and overall survival. MIB-1 staining types were correlated with tumor type and grading. Tumors of diffuse and infiltrating type seemed to have more frequent lymph node metastasis (p = 0.053) and shorter disease-free survival (p = 0.076). In these tumors, overall survival time was reduced significantly (p = 0.02). In multivariate analysis, MIB-1 staining types were the most important factor for overall survival with an odds ratio of 4.73. In conclusion, distribution and not the percentage of proliferating cells is of prognostic significance in squamous cell carcinoma of the vulva.
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Affiliation(s)
- P Hantschmann
- I. Frauenklinik des Klinikum Innenstadt der LMU-München, F R Germany
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Lampe B, Hantschmann P, Dimpfl T. Prognostic relevance of immunohistology, tumor size and vascular space involvement in axillary node negative breast cancer. Arch Gynecol Obstet 1998; 261:139-46. [PMID: 9651658 DOI: 10.1007/s004040050213] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Adjuvant treatment for patients with axillary node negative (ANN) breast cancer is controversial because operation alone gives a 70% cure rate. Features which predict recurrence are needed and we therefore evaluated the predictive value of tumor diameter and vascular involvement as well as of estrogen receptors (ER), progesterone receptors (PR), p53, MIB-1, c-erb and PCNA demonstrated by immunohistological staining in 178 patients with ANN breast cancer. Although ER status, tumor diameter and vascular space involvement were significantly correlated to the development of recurrence, their sensitivity, specificity and predictive value were too low to give them clinical value.
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Affiliation(s)
- B Lampe
- I. Frauenklinik, Klinikum Innenstadt, Ludwigs-Maximilians-Universität, München, Germany
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Lampe B, Kürzl R, Dimpfl T, Fawzi H. Accuracy of preoperative histology and macroscopic assessment of cervical involvement in endometrial carcinoma. Eur J Obstet Gynecol Reprod Biol 1997; 74:205-9. [PMID: 9306120 DOI: 10.1016/s0301-2115(97)00106-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To compare the diagnostic accuracy between the preoperatively and macroscopically established determination of cervical involvement in endometrial carcinoma. STUDY DESIGN During the period 1987 to 1991, 154 patients with endometrial cancer were evaluated in a retrospective blind manner with the objective of assessing the diagnostic accuracy of the preoperative (prehysterectomy curettage) and the macroscopic (sectioned surgical specimen) determination of th involvement of the cervix. The results were compared with histological findings of the hysterectomy specimen (gold standard). RESULTS Preoperative pre-hysterectomy curettage established a sensitivity of 38% and a specificity of 91% whereas the macroscopic findings (gross appearance) confirmed a sensitivity of 50% and a specificity of 95%. A prevalence of 17% for cervical involvement was found. In patients with cervical involvement diagnosed on pre-hysterectomy curettage, a positive predictive value of 45% and negative predictive value of 88% were established. A positive predictive value of 68% and a negative predictive value of 90% resulted from the judgement of the cervical gross appearance. CONCLUSIONS We conclude that the cervical involvement of endometrial carcinoma diagnosed on pre-hysterectomy tissue is less predictive than the judgement of the intraoperative gross appearance of the cervix.
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Affiliation(s)
- B Lampe
- I. Frauenklinik Universität München, Germany
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Abstract
Collagen XIV, a fibril-associated collagen with interrupted triple helices, is expressed in differentiated soft connective tissues and in cartilage. However, a cellular receptor for this protein has not been identified. Here we show that human placental collagen XIV, isolated by a mild and simple two-step method, serves as adhesive protein for a variety of mesenchymal and some epithelial cells. Cell adhesion could be inhibited by preincubation of the collagen XIV substrate with heparin or with the chondroitin/dermatan sulfate proteoglycan decorin and by pretreatment of cells with chondroitinase ABC or heparinase III, suggesting a cell membrane proteoglycan as receptor. Affinity chromatography of 125I-labeled fibroblast cell surface proteins on collagen XIV-Sepharose yielded a chondroitin/dermatan sulfate proteoglycan with a molecular mass of 97-105 kDa after chondroitinase ABC digestion and of 60-70 kDa after further treatment with N-glycosidase F. The eluates contained also some high-molecular-weight material that was susceptible to digestion with heparinase but no detectable integrins. Immunoprecipitation with a specific monoclonal antibody identified the prominent chondroitin/dermatan sulfate proteoglycan as a member of the CD44 family. The interaction between collagen XIV and cells appears to be finely tuned, since matrix-associated glycosaminoglycans, and particularly proteoglycans like decorin, could compete with cells for the binding site(s) on collagen XIV under physiological conditions.
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Affiliation(s)
- T Ehnis
- Klinikum Benjamin Franklin, Department of Gastroenterology, Free University of Berlin, Hindenburgdamm 30, Berlin, D-12200, Germany
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Abstract
BACKGROUND This study was performed to identify pathologic and clinical features that best correlate with lymph node metastasis and disease free survival among patients with Stage I and II cervical cancer treated by radical hysterectomy. METHODS Three hundred-seventy patients with complete clinical information and pathologic material, including cone and cervical biopsies, were selected for analysis. Of these patients, 301 with clinical stages I and II disease were the subject of this paper. The results of patients with microinvasive carcinoma of the cervix, as defined by the Society of Gynecologic Oncologists (depth of invasion < or = 3 mm and no lymph node vascular space invasion), were reported previously and excluded from this analysis. Patients with small cell carcinoma of the cervix were found to have a very poor prognosis (disease free 5-year survival of 36%) and were also excluded from this analysis (Sevin BU, Nadji M, Metkoch MW, Lu Y, Averette HE. Unpublished data, 1995). Variables studied were patient age, weight, race, marital status, and economic status; tumor size; depth of invasion; lymph node-vascular space involvement; cell type; tumor grade; lymph node metastasis; and number of lymph nodes removed. The influence of these variables on survival was examined by univariate analysis with use of Cox's regression model and the log rank test for comparison of survival curves. RESULTS Factors that predict disease free survival, ranked by degree of significance, were depth of invasion, tumor size, lymph node-vascular space invasion, number of positive nodes, tumor volume, clinical stage, and tumor extension to the vagina or surgical margins. CONCLUSIONS Radical hysterectomy and bilateral lymphadenectomy is standard therapy for patients with Stage IB and IIA carcinoma of the cervix. A variety of surgically defined risk factors predict 5-year disease free survival, and many of these factors are related. Identification of independent risk factors requires a multivariate analysis of data.
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Affiliation(s)
- B U Sevin
- Department of Obstetrics and Gynecology, University of Miami School of Medicine, Florida 33136, USA
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Abstract
The aim of this study was to determine the sensitivity and the specificity of tumor typing in the prehysterectomy curettage in order to assess the diagnostic accuracy in patients with endometrial cancer. Tumor typing was performed on complete prehysterectomy curettages of 154 patients with endometrial cancer treated during 1987-1991. The results were compared with the histologic findings of the hysterectomy specimen as the gold standard. Patients with no carcinoma demonstrable postoperatively in the removed uterus were excluded from the study. Tumor typing on prehysterectomy curettage revealed only a moderate sensitivity of 46-64%. In contrast, the specificity was > 90% for all histologic subtypes with the exception of the endometrioid tumor type (68%). The histologic subtypes (papillary, adenocarcinoma with squamous differentiation, mucinous, serous papillary, clear cell) achieved similar high predictive values despite a much lower prevalence due to the high values of specificity. Tumor typing of endometrial carcinoma based upon the findings of the prehysterectomy curettage reveals different reliabilities depending on the tumor type.
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Affiliation(s)
- B Lampe
- I Frauenklinik, Universität München, Germany
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Abstract
BACKGROUND Recent reports indicate that certain pre- and intraoperatively determined risk factors are predictive of pelvic lymph node metastases from endometrial cancer, allowing selective pelvic lymph node dissection. The objective of this study was to evaluate the accuracy of pre-, pre-/intra- and postoperatively determined tumor characteristics. METHODS The study is based on 100 patients treated from 1987-1991 with total abdominal hysterectomy and bilateral salpingo-oophorectomy. In all patients thorough pelvic lymphadenectomies were performed (no sampling). These patients were evaluated according to different macroscopic and histologic tumor characteristics retrospectively in a blind fashion (the lymph node status was later determined separately). Multivariate analysis was applied and the results were compared using receiver operator characteristic curves. In 15 of 100 patients, pelvic lymph node metastases could be histologically demonstrated. RESULTS Multivariate analysis of 22 tumor characteristics identified the following as being independent in relation to pelvic lymph node metastases: preoperatively determined characteristics: serous papillary tumor type, invasion of myometrium, and histologic grade (Christopherson); pre-/intraoperatively: serous papillary type, histologic grade (Christopherson), and cervical involvement; and postoperatively: lymphangiosis carcinomatosa and hemangiosis carcinomatosa. Receiver operator characteristic curves show that for pelvic node metastases the postoperatively determined histologic findings are more predictive than all other factors that can be evaluated pre- and/or intraoperatively. CONCLUSION Pre- and intraoperative tumor characteristics can determine the individual risk for pelvic lymph node involvement, but additional studies addressing the therapeutic value of pelvic lymphadenectomy would be necessary to define a probability threshold for lymphadenectomy in a decision analysis.
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Affiliation(s)
- B Lampe
- I. Frauenklinik Universität, München, Germany
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Lampe B, Nitsche C, Kürzl R. Zuverlässigkeit der Tumortypisierung des Endometriumkarzinoms am Abrasionsgewebe. Arch Gynecol Obstet 1993. [DOI: 10.1007/bf02266268] [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: 11/29/2022]
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Genz T, Dimpfl T, Lampe B. Komplikationen nach brusterhaltender Karzinomchirurgie — Ergebnisse einer Langzeitbeobachtung. Arch Gynecol Obstet 1993. [DOI: 10.1007/bf02266217] [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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Maassen V, Lampe B, Debus-Thiede G, Kindermann G. [Neuroendocrine cancer of the uterine cervix: an especially aggressive form of cancer with clinical, diagnostic and therapeutic characteristics]. Geburtshilfe Frauenheilkd 1993; 53:448-54. [PMID: 8396541 DOI: 10.1055/s-2007-1022912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The compilation of neuroendocrine carcinomas of the cervix uteri comprises a rare group of carcinomas characterised by particularly aggressive behaviour. These carcinomas can be described and differentiated from similar carcinomas with different biological behaviour by light microscopy and immunohistochemical investigations. We present three patients with neuroendocrine carcinoma of the cervix, stage I b, all of them operated according to Wertheim's operation with pelvic lymphadenectomy and in one case paraaortal lymphadenectomy. In all three cases we found a clinical manifestation of hematogenic metastases. Since we are not aware of any reports on this form of carcinoma in German literature, we would emphasise the importance of diagnostic differentiation between neuroendocrine carcinomas of the cervix and other similar carcinomas of this localisation, in particular since this form of carcinoma requires specific therapeutic procedures.
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Affiliation(s)
- V Maassen
- I. Frauenklinik, Universität München
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Maassen V, Lampe B, Untch M, Mikorey S, Hepp H, Kindermann G. [Adenocarcinoma and adenosis of the vagina. On the histogenesis, diagnosis and therapy of a rare genital neoplasms]. Geburtshilfe Frauenheilkd 1993; 53:308-13. [PMID: 8514101 DOI: 10.1055/s-2007-1022888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
In the United States, vaginal adenosis and clear-cell carcinoma of the vagina were frequently observed in young women, who had been exposed to the synthetic estrogen diethyl-stilbestrol (DES) during their embryonic development. In Germany, obviously, no such exposure occurred. Clearly, such diseases also develop without the context of intrauterine exposure to certain substances. Our own case of such a partly exophytic, partly endophytic adeno-carcinoma of the vagina with multifocal vaginal adenosis, demonstrates the histogenesis, symptoms, diagnostic procedures and therapy of this rare disease. Since young women during their reproductive years are mostly affected, the possibility of fertility-conserving surgery is discussed despite the current practice of radical cancer surgery (with and without radiation). In the 25-year-old patient, we conducted a colpectomy whilst leaving the uterus and ovaries, and replaced the vaginal defect by a sigmoid transplant anastomosed to the cervix. The patient has regular menstrual cycles, should, however, not become pregnant for 1 to 2 years for oncological reasons.
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Affiliation(s)
- V Maassen
- I. Frauenklinik Klinikum Innenstadt, Universität München
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Genz T, Lampe B, Dimpfl T. [Prognostic factors in node-negative breast cancer]. Gynakol Geburtshilfliche Rundsch 1993; 33 Suppl 1:238. [PMID: 8118289 DOI: 10.1159/000272238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- T Genz
- I. Univers.-Frauenklinik München
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Abstract
BACKGROUND Microinvasive carcinoma of the cervix (MIC) has been poorly defined in the past and is still a focus of persistent controversy. In 1985, the International Federation of Gynecology and Obstetrics (FIGO) defined Stage IA as "preclinical invasive carcinoma, diagnosed by microscopy only," subdividing it into Stage IA1 or "minimal microscopic stromal invasion," and Stage IA2 or "tumor with invasive component 5 mm or less in depth taken from the base of the epithelium and 7 mm or less in horizontal spread." In 1974, the Society of Gynecologic Oncologists (SGO) defined MIC as any lesion with a depth of invasion of 3 mm or less from the base of the epithelium, without lymphatic or vascular space invasion. METHODS To assess the risk of lymph node metastasis and treatment failures, pathologic material and clinical data on 370 patients with Stage I carcinoma of the cervix, who were treated by radical hysterectomy and pelvic-aortic node dissection, were reviewed. Histopathologic analysis of tumors was based on a uniform format, including measurement of the maximum depth of invasion, the width and length of the horizontal tumor spread, invasive growth pattern, cell type, tumor grade, and lymphatic or vascular space involvement. RESULTS Of the 370 patients, 110 had a depth of invasion of 5 mm or less. Of these, 54 patients fulfilled the SGO definition of MIC; 42, the new FIGO Stage IA2 definition; and 27, both definitions. None of the patients with MIC, as defined by either the SGO or the new FIGO Stage IA2, had lymph node metastases or tumor recurrence. These data support the conclusion that MIC, defined by either the SGO or FIGO definitions, have a low risk for lymph node metastasis or recurrent carcinoma. A review of the literature indicated a recurrence rate for Stage IA2 of 4.2%. In addition to depth of invasion, lymph vascular space invasion is a better predictor of lymph node metastasis and recurrence than the surface dimension. CONCLUSIONS The authors recommend adoption of the SGO definition of MIC. Patients with a depth of invasion of 3 mm or less without lymph vascular space invasion safely can be treated conservatively.
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Affiliation(s)
- B U Sevin
- Department of Obstetrics and Gynecology, University of Miami School of Medicine, Florida 33101
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Lampe B, Genz T, Maassen V, Mikorey S, Klosterhalfen T. Correlation of c-erbB-2 protein expression with histologic grade, lymph node involvement and steroid receptor status in human breast tumors. Arch Gynecol Obstet 1992; 251:45-50. [PMID: 1347986 DOI: 10.1007/bf02718277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The association of c-erbB-2 gene amplification product (p185) with histologic tumor type in 100 patients with primary breast cancer was determined. In 49 patients with infiltrating ductal carcinoma p185 detection was correlated with histologic findings (tumor grade, lymphnode status, receptor status). Strong positive staining for p185 protein was found in 10 patients (20%) with infiltrating ductal breast carcinoma and correlated with complete negative estrogen/progesterone receptor status and with histologic grade G3. There was neither an association with lymphnode involvement nor was there any to negative estrogen and progesterone receptor status alone. At present, we cannot say whether or not there is a correlation between the degree of c-erbB-2 gene amplification and prognosis. Follow-up studies are necessary to determine whether c-erbB-2 gene amplification allows definition of a specific subset of women who could benefit from adjuvant therapy.
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Affiliation(s)
- B Lampe
- I. Frauenklinik der Universität München, FRG
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Abstract
7 cases of serous-papillary adenocarcinoma of the endometrium (UPSC) were found in a retrospective study of 80 patients which were treated at the Department of Gynaecology of the University of Munich from August 1987 to December 1989 because of endometrial adenocarcinoma. Characteristic histologic findings and prognostic factors of the UPSC were examined by means of large scale sections of the completely worked-up uteri and compared with the usual adenocarcinoma of the endometrioid type (UEC). Despite only minimal myometrial infiltration in some cases, lymphangiosis carcinomatosa was almost always present (6/7) and more than 50% of patients showed evidence of blood vessel involvement. In all patients with pelvic lymph node dissection metastases were found. According to our results in line with the literature, UPSC is a highly malignant and morphologically distinct variant of endometrial adenocarcinoma without promising treatment to date.
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Affiliation(s)
- B Lampe
- I. Frauenklinik, Universität München
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Ganjei P, Giraldo KA, Lampe B, Nadji M. Vulvar Paget's disease. Is immunocytochemistry helpful in assessing the surgical margins? J Reprod Med 1990; 35:1002-4. [PMID: 1703577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
From January 1977 to December 1988, 19 patients with biopsy-proven Paget's disease of the vulva underwent simple or radical vulvectomy at the University of Miami/Jackson Memorial Medical Center. All vulvectomy specimens were evaluated immunocytochemically for the expression of carcinoembryonic antigen (CEA), epithelial membrane antigen (EMA) and low-molecular-weight keratins 8 and 18 (LMK), both in areas containing neoplastic cells and in histologically negative surgical margins. Neoplastic Paget's cells stained positively for CEA in all cases; they were positive for EMA and LMK in 18 and 17 cases, respectively. In all eight cases with underlying in situ or invasive carcinomas, CEA, EMA and LMK were localized in the underlying tumors as well. None of the histologically proven negative margins reacted for CEA, EMA or LMK on immunocytochemistry. CEA appears to be a valuable immunocytochemical marker for extramammary Paget's disease; EMA and LMK are also expressed by the majority of such cases. None of these markers, however, is of added value in identifying Paget's cells in surgical margins if those margins appear negative on routine hematoxylin-and-eosin staining.
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Affiliation(s)
- P Ganjei
- Department of Pathology, University of Miami/Jackson Memorial Medical Center, Florida
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