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Konrath E, Marhold F, Kindler W, Scheichel F, Popadic B, Blauensteiner K, Calabek-Wohinz B, Freydl E, Weber M, Ristl R, Hainz K, Sherif C, Oberndorfer S. P01.08.A Perioperative Levetiracetam for seizure prophylaxis in seizure naive brain tumor patients with focus on neurocognitive functioning. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.080] [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: 11/14/2022] Open
Abstract
Abstract
Background
In seizure-naive brain tumor patients, the efficacy of perioperative prophylactic antiepileptic drugtreatment remains controversial. In case of administration, the common preferred drug is levetiracetam (LEV) because of its favorable pharmacological profile. Research to date has not sufficiently determined how LEV affects cognition in the short term as it does in the perioperative period. The objective of this prospective study was to examine the neurocognitive functioning of seizure-naive brain tumor patients after receiving LEV perioperatively.
Material and methods
Patients with supratentorial brain tumor undergoing surgery received LEV three days before until seven days after surgery as seizure prophylaxis. Cognitive functioning (NeuroCogFX), LEV plasma-levels, hematotoxicity, side-effects, as well as health-related quality of life (HRQoL, Qolie31), were recorded preoperatively before (Baseline) and after onset of LEV (Pre-Op), 4-6 days postoperatively (Post-Op) and 21 days postoperatively (Follow-Up).
Results
No significant changes in cognitive functioning and HRQoL were seen after onset of preoperative LEV. There was a significant improvement of NeuroCogFX total-score at Follow-Up (p=0.004) compared to Baseline. The overall-score Qolie31 showed simultaneous improvement patterns as cognitive functioning (p< 0.001). The most frequent side effect related to study drug was somnolence (in 24% of patients).
Conclusion
Following LEV therapy, a significant improvement of cognitive functioning, as well as an improvement in HRQoL, were detected postoperatively. This is presumably due to the debulking effect of the surgery. Nevertheless, LEV has no detrimental effect on cognitivefunctioning in the perioperative phase in seizure-naive brain tumor patients.
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Affiliation(s)
- E Konrath
- Klinische Abteilung für Neurologie , St. Pölten , Austria
| | - F Marhold
- Klinische Abteilung für Neurochirurgie , St. Pölten , Austria
| | - W Kindler
- Klinische Abteilung für Neurologie , St. Pölten , Austria
| | - F Scheichel
- Klinische Abteilung für Neurochirurgie , St. Pölten , Austria
| | - B Popadic
- Klinische Abteilung für Neurochirurgie , St. Pölten , Austria
| | | | | | - E Freydl
- Klinische Abteilung für Neurologie , St. Pölten , Austria
| | - M Weber
- Karl Landsteiner Privatuniversität für Gesundheitswissenschaften , Krems , Austria
| | - R Ristl
- Medizinische Universität Wien , Wien , Austria
| | - K Hainz
- Klinische Abteilung für Neurologie , St. Pölten , Austria
| | - C Sherif
- Klinische Abteilung für Neurochirurgie , St. Pölten , Austria
| | - S Oberndorfer
- Klinische Abteilung für Neurologie , St. Pölten , Austria
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Kiesel B, Kerschbaumer J, Prihoda R, Borkovec M, Thakur S, Mercea P, Feucht D, Steindl A, Berghoff AS, Furtner J, Leitner J, Romagna A, Schwartz C, Stefanits H, Marhold F, Rötzer T, Preusser M, Freyschlag C, Widhalm G. P11.55.B Postoperative MRI is able to detect an unexpected residual tumor after surgery of brain metastases: experience from 5 specialized centers. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.244] [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: 11/13/2022] Open
Abstract
Abstract
Background
Brain metastases (BM) constitute the most common central nervous system tumors. The treatment options of BM consist of surgery, radiotherapy, radiosurgery, chemotherapy, and immunotherapy. Regarding surgery in BM, the extent of resection (EOR) represents a crucial factor for patient prognosis. However, first studies using postoperative MRI demonstrated that an unexpected residual tumor after surgery of BM is not uncommon despite these tumors were considered to be well-demarcated. The aim of this study was thus to investigate in a large cohort including multiple neurosurgical centers the EOR following BM resection, potential risk factors for incomplete resection and postsurgical follow-up data.
Material and Methods
In the current retrospective study conducted at 5 specialized neurosurgical centers in Austria, we included patients with BM resection and available postoperative MRI. The EOR following BM resection was determined by postoperative MRI (complete vs incomplete resection). Additionally, the data on the intraoperative judgement of the EOR of the performing neurosurgeon were collected. Moreover, potential factors for incomplete resection including tumor localization, tumor volume, primary tumor, pattern of contrast media enhancement on imaging and tumor eloquence were investigated. Finally, the rate of local progression of BM after initial surgery was analyzed in the follow-up period and overall survival data were collected.
Results
Altogether, 548 patients with 649 surgically treated BM were included. According to postoperative MRI, complete resection was achieved in 407 (66%) of 649 BM and incomplete resection in 176 (29%) of 649 BM. Misjudgment of the EOR by the neurosurgeon was found in 25% of cases and resulted in an unexpected residual tumor which was evident on postoperative MRI in 122 (22%) BM. Preoperative tumor volume was significantly larger in incompletely resected BM. Moreover, local progression was significantly more common in cases with incompletely resected BM and was also associated with shorter overall survival.
Conclusion
Our data of this study including multiple centers indicate that postoperative MRI is capable to detect a relatively high rate of unexpected residual tumors following resection of BM. Since local progression was more common in BM with residual tumors and this was associated with shorter survival, special attention should be paid to achieve a complete tumor resection.
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Affiliation(s)
- B Kiesel
- Medical University Vienna , Vienna , Austria
| | | | - R Prihoda
- Universitätsklinikum St. Pölten , St. Pölten , Austria
| | - M Borkovec
- Medical University Vienna , Vienna , Austria
| | - S Thakur
- University Hospital Salzburg , Salzburg , Austria
| | - P Mercea
- Medical University Vienna , Vienna , Austria
| | - D Feucht
- Medical University Vienna , Vienna , Austria
| | - A Steindl
- Medical University Vienna , Vienna , Austria
| | | | - J Furtner
- Medical University Vienna , Vienna , Austria
| | - J Leitner
- Medical University Vienna , Vienna , Austria
| | - A Romagna
- University Hospital Salzburg , Salzburg , Austria
| | - C Schwartz
- University Hospital Salzburg , Salzburg , Austria
| | - H Stefanits
- Kepler Universitätsklinikum , Linz , Austria
| | - F Marhold
- Universitätsklinikum St. Pölten , St. Pölten , Austria
| | - T Rötzer
- Medical University Vienna , Vienna , Austria
| | - M Preusser
- Medical University Vienna , Vienna , Austria
| | | | - G Widhalm
- Medical University Vienna , Vienna , Austria
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Ladisich B, Schwartz C, Trinka E, Weisz N, Sherif C, Marhold F, Demarchi G, Rampp S. P 21 Functional connectivity and network topology in brain tumors: A prospective, pilot-, MEG- study. Clin Neurophysiol 2022. [DOI: 10.1016/j.clinph.2022.01.052] [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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Mercea P, Kiesel B, Mischkulnig M, Millesi M, Berghoff A, Wöhrer A, Wolfsberger S, Ungersböck K, Knosp E, Preusser M, Marhold F, Widhalm G. Analysis of 5-ALA induced fluorescence in brain metastases and surrounding brain tissue. Photodiagnosis Photodyn Ther 2017. [DOI: 10.1016/j.pdpdt.2017.01.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Tinchon A, Calabek B, Andreas B, Riedlberger U, Minear G, Reinhard B, Liegl G, Freydl E, Marhold F, Oberndorfer S. P08.49 The value of neurocognitive testing in multimodal response assessment in patients with glioblastoma multiforme. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.182] [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: 11/12/2022] Open
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Woehrer A, Hackl M, Waldhör T, Weis S, Pichler J, Olschowski A, Buchroithner J, Maier H, Stockhammer G, Thomé C, Haybaeck J, Payer F, von Campe G, Kiefer A, Würtz F, Vince GH, Sedivy R, Oberndorfer S, Marhold F, Bordihn K, Stiglbauer W, Gruber-Mösenbacher U, Bauer R, Feichtinger J, Reiner-Concin A, Grisold W, Marosi C, Preusser M, Dieckmann K, Slavc I, Gatterbauer B, Widhalm G, Haberler C, Hainfellner JA. Relative survival of patients with non-malignant central nervous system tumours: a descriptive study by the Austrian Brain Tumour Registry. Br J Cancer 2014; 110:286-96. [PMID: 24253501 PMCID: PMC3899758 DOI: 10.1038/bjc.2013.714] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 10/04/2013] [Accepted: 10/21/2013] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Unlike malignant primary central nervous system (CNS) tumours outcome data on non-malignant CNS tumours are scarce. For patients diagnosed from 1996 to 2002 5-year relative survival of only 85.0% has been reported. We investigated this rate in a contemporary patient cohort to update information on survival. METHODS We followed a cohort of 3983 cases within the Austrian Brain Tumour Registry. All patients were newly diagnosed from 2005 to 2010 with a histologically confirmed non-malignant CNS tumour. Vital status, cause of death, and population life tables were obtained by 31 December 2011 to calculate relative survival. RESULTS Overall 5-year relative survival was 96.1% (95% CI 95.1-97.1%), being significantly lower in tumours of borderline (90.2%, 87.2-92.7%) than benign behaviour (97.4%, 96.3-98.3%). Benign tumour survival ranged from 86.8 for neurofibroma to 99.7% for Schwannoma; for borderline tumours survival rates varied from 83.2 for haemangiopericytoma to 98.4% for myxopapillary ependymoma. Cause of death was directly attributed to the CNS tumour in 39.6%, followed by other cancer (20.4%) and cardiovascular disease (15.8%). CONCLUSION The overall excess mortality in patients with non-malignant CNS tumours is 5.5%, indicating a significant improvement in survival over the last decade. Still, the remaining adverse impact on survival underpins the importance of systematic registration of these tumours.
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Affiliation(s)
- A Woehrer
- Institute of Neurology, Medical University of Vienna, Währinger Gürtel 18–20, A-1097 Vienna, Austria
| | - M Hackl
- Austrian National Cancer Registry, Statistics Austria, Guglgasse 13, A-1110 Vienna, Austria
| | - T Waldhör
- Center for Public Health, Department of Epidemiology, Medical University of Vienna, Währinger Gürtel 18–20, A-1097 Vienna, Austria
| | - S Weis
- Department of Pathology and Neuropathology, State Neuropsychiatric Hospital Wagner-Jauregg, Linz, Wagner-Jauregg-Weg 15, A-4020 Linz, Austria
| | - J Pichler
- Internal Medicine and Neurooncology, State Neuropsychiatric Hospital Wagner-Jauregg, Wagner-Jauregg-Weg 15, A-4020 Linz, Austria
| | - A Olschowski
- Department of Neurosurgery, State Neuropsychiatric Hospital Wagner-Jauregg, Wagner-Jauregg-Weg 15, A-4020 Linz, Austria
| | - J Buchroithner
- Department of Neurosurgery, State Neuropsychiatric Hospital Wagner-Jauregg, Wagner-Jauregg-Weg 15, A-4020 Linz, Austria
| | - H Maier
- Department of Neuropathology, Institute of Pathology, Medical University of Innsbruck, Christoph-Probst-Platz Innrain 52, A-6020 Innsbruck, Austria
| | - G Stockhammer
- Department of Neurology, Medical University of Innsbruck, Christoph-Probst-Platz Innrain 52, A-6020 Innsbruck, Austria
| | - C Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Christoph-Probst-Platz Innrain 52, A-6020 Innsbruck, Austria
| | - J Haybaeck
- Department of Neuropathology, Institute of Pathology, Medical University of Graz, Auenbruggerplatz 25, A-8036 Graz, Austria
| | - F Payer
- Division of General Neurology and Division of Neuroradiology, Medical University of Graz, Auenbruggerplatz 25, A-8036 Graz, Austria
| | - G von Campe
- Department of Neurosurgery, Medical University of Graz, Auenbruggerplatz 25, A-8036 Graz, Austria
| | - A Kiefer
- Institute of Pathology, State Hospital Klagenfurt, St Veiter Strasse 47, A-9020 Klagenfurt, Austria
| | - F Würtz
- Institute of Pathology, State Hospital Klagenfurt, St Veiter Strasse 47, A-9020 Klagenfurt, Austria
| | - G H Vince
- Department of Neurosurgery, State Hospital Klagenfurt, St Veiter Strasse 47, A-9020 Klagenfurt, Austria
| | - R Sedivy
- Department of Clinical Pathology, General Hospital St Pölten, Probst-Führer-Strasse 4, A-3100 St Pölten, Austria
| | - S Oberndorfer
- Department of Neurology, General Hospital St Pölten, Probst-Führer-Strasse 4, A-3100 St Pölten, Austria
| | - F Marhold
- Department of Neurosurgery, General Hospital St Pölten, Probst-Führer-Strasse 4, A-3100 St Pölten, Austria
| | - K Bordihn
- Department of Neurosurgery, Christian Doppler Clinic, Paracelsus Private Medical University, Strubergasse 21, A-5020 Salzburg, Austria
| | - W Stiglbauer
- Institute of Pathology, General Hospital Wiener Neustadt, Corvinusring 3–5, A-2700 Wiener Neustadt, Austria
| | - U Gruber-Mösenbacher
- Department of Pathology, Feldkirch State Hospital, Carinagasse 47, A-6807 Feldkirch, Austria
| | - R Bauer
- Department of Neurosurgery, Feldkirch State Hospital, Carinagasse 47, A-6807 Feldkirch, Austria
| | - J Feichtinger
- Department of Pathology, Krankenanstalt Rudolfstiftung, Juchgasse 25, A-1030 Vienna, Austria
| | - A Reiner-Concin
- Institute of Pathology, Danube Hospital, Langobardenstrasse 122, A-1220 Vienna, Austria
| | - W Grisold
- Department of Neurology, KFJ-Hospital Vienna, Kundratstrasse 3, A-1100 Vienna, Austria
| | - C Marosi
- Department of Medicine I, Medical University of Vienna, Währinger Gürtel 18–20, A-1097 Vienna, Austria
| | - M Preusser
- Department of Medicine I, Medical University of Vienna, Währinger Gürtel 18–20, A-1097 Vienna, Austria
| | - K Dieckmann
- Department of Radiation Oncology, Medical University of Vienna, Währinger Gürtel 18–20, A-1097 Vienna, Austria
| | - I Slavc
- Department of Paediatrics, Medical University of Vienna, Währinger Gürtel 18–20, A-1097 Vienna, Austria
| | - B Gatterbauer
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18–20, A-1097 Vienna, Austria
| | - G Widhalm
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18–20, A-1097 Vienna, Austria
| | - C Haberler
- Institute of Neurology, Medical University of Vienna, Währinger Gürtel 18–20, A-1097 Vienna, Austria
| | - J A Hainfellner
- Institute of Neurology, Medical University of Vienna, Währinger Gürtel 18–20, A-1097 Vienna, Austria
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Knosp E, Wolfsberger S, Marhold F. Endoscopic Trans-sphenoidal Surgery in the Sellar and Parassellar Region. Skull Base 2007. [DOI: 10.1055/s-2007-983983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pirker R, Krajnik G, Mohn-Staudner A, Thaler J, Greil R, Schmeikal S, Marhold F, Deutsch J, Malayeri R, Huber H. Vinorelbine/gemcitabine in advanced non-small-cell lung cancer. Lung Cancer 2000. [DOI: 10.1016/s0169-5002(00)80149-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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9
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Krajnik G, Mohn-Staudner A, Thaler J, Greil R, Schmeikal S, Marhold F, Deutsch J, Preiss P, Malayeri R, Schäfer-Prokop C, Wein W, Huber H, Pirker R. Vinorelbine-gemcitabine in advanced non-small-cell lung cancer (NSCLC): an AASLC phase II trial. Austrian Association for the Study of Lung Cancer. Ann Oncol 2000; 11:993-8. [PMID: 11038036 DOI: 10.1023/a:1008370704612] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [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: 11/12/2022] Open
Abstract
PURPOSE The purpose of the present phase 11 trial was to determine the efficacy and toxicity of vinorelbine-gemcitabine in patients with advanced non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS From December 1997 to February 1999, 78 chemotherapy-naive patients (median age 60 years, Karnofsky performance status of 100, 90, 80 and 70 present in 5%, 41%, 36% and 18% of the patients, respectively) with stage IIIB (17%) or IV (83%) NSCLC (65% adenocarcinomas, 22% squamous-cell carcinomas, 10% large-cell carcinomas, 3% mixed-cell carcinomas) received 25 mg/m2 vinorelbine and 1200 mg/m2 gemcitabine on days 1, 8 and 15 of a four-week cycle. RESULTS In an intent-to-treat analysis, partial responses were seen in 19% of the patients. The median duration of response was 4.4 months. The median survival time was seven months and the one-year survival rate was 32%. Myelosuppression was the main side effect with WHO grade 3/4 neutropenia and thrombocytopenia in 35% and 11% of the patients, respectively. Other side effects were usually mild to moderate. CONCLUSIONS Vinorelbine-gemcitabine is active, well tolerated and easy to administer on an outpatient basis in advanced NSCLC. Thus a randomized comparison of this combination with platinum-based protocols is warranted in patients with advanced NSCLC.
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Affiliation(s)
- G Krajnik
- Department of Internal Medicine, University of Vienna, Austria
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Pirker R, Krajnik G, Mohn-Staudner A, Thaler J, Greil R, Schmeikal S, Marhold F, Deutsch J, Preiss P, Wein W, Malayeri R, Huber H. Vinorelbine/Gemcitabine in advanced non-small-cell lung cancer. Lung Cancer 1999. [DOI: 10.1016/s0169-5002(99)90744-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Krajnik G, Wein W, Greil R, Marhold F, Mohn-Staudner A, Kummer F, Malayeri R, Zöchbauer-Müller S, Huber H, Pirker R. Vinorelbine/gemcitabine in advanced non-small cell lung cancer (NSCLC): a phase I trial. Eur J Cancer 1998; 34:1977-80. [PMID: 10023326 DOI: 10.1016/s0959-8049(98)00235-4] [Citation(s) in RCA: 21] [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: 10/18/2022]
Abstract
Vinorelbine and gemcitabine are both active as single agents in advanced non-small cell lung cancer (NSCLC). Because of their different mechanisms of action, good tolerability and possible administration on an out-patient basis, vinorelbine/gemcitabine should be an interesting combination for palliative chemotherapy. Thus, we initiated a phase I dose-escalation trial in order to determine the maximum tolerated doses of vinorelbine/gemcitabine that can be administered without haematopoietic growth factors, the dose-limiting toxicities and the most frequent side-effects of this novel combination. 40 chemotherapy-naïve patients with advanced NSCLC were treated with different doses of vinorelbine/gemcitabine on days 1, 8 and 15, and this treatment cycle was repeated on day 29. Vinorelbine and gemcitabine were escalated from 10 to 30 mg/m2 and 600 to 1200 mg/m2, respectively. A total of 63 treatment cycles were administered and 27 patients received at least two treatment cycles. Dose-limiting toxicities were leucopenia plus thrombocytopenia (2 patients) and mucositis (1 patient). The maximum tolerated dose was established at 25 mg/m2 vinorelbine combined with 1200 mg/m2 gemcitabine. Frequent side-effects were leucopenia, anaemia, nausea/vomiting, flu-like symptoms, skin rashes and elevation of liver enzymes. The recommended phase II doses are 20-25 mg/m2 vinorelbine combined with 1000-1200 mg/m2 gemcitabine on days 1, 8 and 15, but myelosuppression will have to be carefully monitored.
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Affiliation(s)
- G Krajnik
- Austrian Association for the Study of Lung Cancer (AASLC), Department for Internal Medicine I, University of Vienna Medical School, Austria
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Krajnik G, Wein W, Greil R, Marhold F, Mohn-Staudner A, Kummer F, Malayeri R, Zoechbauer-Mueller S, Huber H, Pirker R. Vinorelbine/gemcitabine in advanced non-small-cell lung cancer: a phase I trial. Lung Cancer 1998. [DOI: 10.1016/s0169-5002(98)90070-8] [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]
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