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Rick O, Gerhardt A, Schilling G. Cancer-Related Cognitive Dysfunction: A Narrative Review for Clinical Practice. Oncol Res Treat 2024; 47:218-223. [PMID: 38471462 DOI: 10.1159/000538277] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 03/06/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Cancer-related cognitive dysfunction (CRCD) is a major functional disorder in patients with cancer. This central nervous dysfunction is found in up to 60% of patients after tumour therapy, often significantly limits the quality of life, and significantly impedes participation in working life. For this reason, diagnosis and treatment of CRCD are of central importance. This narrative review is intended to provide an overview and support for practical clinical care with regard to diagnostics and therapeutic options. SUMMARY In Germany, CRCD has received insufficient attention in clinical practice due to the lack of guidelines for diagnosis and therapy. The pathophysiology is complex and cannot be explained by chemotherapeutic treatment alone. In addition to the tumour disease as such and the tumour therapy, psychological factors such as anxiety and depression as well as sleep disorders also play a significant role. Today, it is known that in addition to age, molecular genetic changes also have an effect on cognitive function. Morphologically, CRCD can be located in the frontal cortex and hippocampus. In addition to easy-to-use screening instruments such as the visual analogue scale, validated questionnaires such as the Questionnaire of Subjectively Experienced Deficits in Attention (FEDA) developed in Germany are also available. These allow the suspected diagnosis to be substantiated and the patient to be referred to further neurological, neuropsychological, or psycho-oncological diagnostics. Within the framework of further neuropsychological diagnostics, the International Cognition and Cancer Task Force (ICCTF) recommends testing learning, memory, processing speed, and executive functions. From the authors' point of view, a step-by-step diagnosis is recommended in order to avoid overdiagnosis. In clinical practice, graduation according to the "Common Terminology Criteria for Adversity Events" (CTCAE Version 5.0) is suitable for assessing the degree of severity. Cognitive training should be behaviourally oriented and include regular practice of cognitive skills to restore attention, psychomotor speed, memory, and executive functions. The best evidence is currently found for web-based training programmes that can be used by the patient at home. There is also evidence for mindfulness training and physical exercises. In particular, the combination of these three therapeutic elements currently seems to be the optimal treatment strategy for CRCD. KEY MESSAGES Cognitive dysfunction should be given much more attention in the clinical care of cancer patients. Diagnostic tools for this purpose and evidence-based therapeutic interventions are available. In the future, networks should be created that allow for better care of patients with CRCD.
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Affiliation(s)
- Oliver Rick
- Klinik Reinhardshöhe, Bad Wildungen, Germany
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Rick O, Hoffmann W, Steimann MA. Oncologic rehabilitation in the COVID-19 pandemic: the situation in clinics. Oncol Res Treat 2022; 45:568-575. [PMID: 35850098 DOI: 10.1159/000525804] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/15/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Oncological rehabilitation is an important pillar in the treatment of cancer patients. Due to the COVID-19 pandemic, this form of therapy is particularly challenged, as it relies heavily on group therapies. The aim of the study was to find out what impact the pandemic has had on oncological rehabilitation so far and how the rehabilitation clinics have dealt with it. METHODS A web-based survey was used to collect data from 14 oncological rehabilitation clinics on the impact of the COVID-19 pandemic on occupancy, staffing trends and hygiene measures for the observation period from 1 March 2020 to 28 February 2021. The data were compared with the same period one year earlier. In addition, the compensatory measures taken with regard to therapy were recorded. RESULTS While only 15272 patients were rehabilitated in the period under review, 21257 patients were rehabilitated in the same period one year earlier. This corresponds to a decrease in occupancy of 28%. Three clinics were affected by temporary closures due to the pandemic. In 39% of the clinics, screening tests for patients had already been started for more than 8 months, while this was also offered to staff in only 23% of the clinics. With regard to changes in the therapeutic offer, more physiotherapeutic small groups with a reduced number of participants were used. This was also used in the area of sports therapy and education offers by 73% and 60% of the clinics respectively. Overall, 92% of the participants assumed an economic recovery at the time of the survey. CONCLUSION Despite a considerable decrease in occupancy in the oncological rehabilitation clinics, the therapies could be changed and carried out in a hygiene-compliant manner. Screening tests were offered at an early stage for patients as well as somewhat delayed for staff. The data show that pandemic-consistently changes in oncological rehabilitation are possible and that supply chains can be maintained.
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Abstract
AIM OF THE STUDY Gradual reintegration has been an established tool for return to work for many years. However, the effect is unclear in patients with oncological diseases. The objective of this study was to determine the significance of gradual reintegration after inpatient medical rehabilitation. METHODS Within the framework of a cohort study, data of 787 patients who underwent medical rehabilitation at Clinic Reinhardshöhe from 06/2012 to 06/2019 were retrospectively analyzed. Patients were routinely contacted 6 months after the end of medical rehabilitation and asked about their occupational situation. The subjective employment prognosis stated by the patient was recorded using the Würzburg Screening Questionnaire. RESULTS 485/787 patients (62%) had undergone gradual reintegration, 302/787 patients (38%) had not. At the time of the follow-up survey, 456/485 patients with gradual reintegration had returned to work, while only 155/302 patients in the group without gradual reintegration had done so (94 vs. 51%; p<0.001). As a positive predictor of return to work, gradual reintegration was found to be by far the strongest factor (OR 20.21; 95% CI 8.605-47.065). CONCLUSION Although this is a retrospective analysis of routine data, gradual reintegration turns out to be a very strong predictor of return to work. Nonuse of stWE is likely influenced by other medical or personal factors not controlled for in our study. This may have led to overestimation of the effect.
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Rick O, Reuß-Borst M, Dauelsberg T, Hass HG, König V, Caspari R, Götz-Keil G, Pfitzner J, Kerschgens C, Fliessbach K, Hoppe C. [Role of Clinical, Sociomedical and Psychological Factors on Return to Work of Patients with Breast Cancer 6 Months after Rehabilitation]. REHABILITATION 2021; 60:253-262. [PMID: 33477192 DOI: 10.1055/a-1288-5824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIM OF THE STUDY The majority of patients with non-metastatic breast cancer return to work after tumor therapy. A rate of up to 80% is given in national and international studies, which can vary considerably depending on the study population and the various social systems. However, it is unclear how many patients are reintegrated into work after medical rehabilitation and which clinical, sociodemographic and psychological factors play a role. METHODS In a multicentre study, clinical and sociodemographic data were collected from breast cancer patients at the beginning of their medical rehabilitation. Subjectively experienced deficits in attention performance (FEDA), depressive symptoms (PHQ-9) and health-related quality of life (EORTC QLQ-C30) were recorded using standardized questionnaires. The cognitive performance was also examined using a computer-based test battery (NeuroCog FX). A follow-up survey was carried out 6-9 months after medical rehabilitation. The subjective assessment of one's own cognitive performance (FEDA) was recorded again at this time. RESULTS 396 of the originally 476 patients were included in the study. In the follow-up survey, 323/396 patients (82%) were again employed. In a regression model, sociodemographic factors proved to be particularly predictive with regard to occupational reintegration: employment at the time of the tumor diagnosis, job preserved after medical rehabilitation, employee status and gradual reintegration according to the Hamburg model (Nagelkerke R2=0.685). This model could not be improved by adding psychological variables. The subjective patient information in all questionnaires was highly correlated (r>0.57; p<0.001). CONCLUSION The vast majority of breast cancer patients return to work after medical rehabilitation. Socio-demographic factors play a crucial role in this. The regression model developed here, including the employment status, professional orientation and gradual reintegration, is of predictive importance and can be used in medical rehabilitation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Klaus Fliessbach
- Klinik für Neurodegenerative Erkrankungen und Gerontopsychiatrie, Universitätsklinik Bonn
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Kliesch S, Schmidt S, Wilborn D, Aigner C, Albrecht W, Bedke J, Beintker M, Beyersdorff D, Bokemeyer C, Busch J, Classen J, de Wit M, Dieckmann KP, Diemer T, Dieing A, Gockel M, Göckel-Beining B, Hakenberg OW, Heidenreich A, Heinzelbecker J, Herkommer K, Hermanns T, Kaufmann S, Kornmann M, Kotzerke J, Krege S, Kristiansen G, Lorch A, Müller AC, Oechsle K, Ohloff T, Oing C, Otto U, Pfister D, Pichler R, Recken H, Rick O, Rudolph Y, Ruf C, Schirren J, Schmelz H, Schmidberger H, Schrader M, Schweyer S, Seeling S, Souchon R, Winter C, Wittekind C, Zengerling F, Zermann DH, Zillmann R, Albers P. Management of Germ Cell Tumours of the Testes in Adult Patients: German Clinical Practice Guideline, PART II - Recommendations for the Treatment of Advanced, Recurrent, and Refractory Disease and Extragonadal and Sex Cord/Stromal Tumours and for the Management of Follow-Up, Toxicity, Quality of Life, Palliative Care, and Supportive Therapy. Urol Int 2021; 105:181-191. [PMID: 33486494 DOI: 10.1159/000511245] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 07/23/2020] [Accepted: 08/20/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES We developed the first German evidence- and consensus-based clinical guideline on diagnosis, treatment, and follow-up of germ cell tumours (GCT) of the testes in adult patients. We present the guideline content in 2 separate publications. The present second part summarizes therecommendations for the treatment of advanced disease stages and for the management of follow-up and late effects. MATERIALS AND METHODS An interdisciplinary panel of 42 experts including 1 patient representative developed the guideline content. Clinical recommendations and statements were based on scientific evidence and expert consensus. For this purpose, evidence tables for several review questions, which were based on systematic literature searches (last search in March 2018), were provided. Thirty-one experts, who were entitled to vote, rated the final clinical recommendations and statements. RESULTS Here we present the treatment recommendations separately for patients with metastatic seminoma and non-seminomatous GCT (stages IIA/B and IIC/III), for restaging and treatment of residual masses, and for relapsed and refractory disease stages. The recommendations also cover extragonadal and sex cord/stromal tumours, the management of follow-up and toxicity, quality-of-life aspects, palliative care, and supportive therapy. CONCLUSION Physicians and other medical service providers who are involved in the diagnostics, treatment, and follow-up of GCT (all stages, outpatient and inpatient care as well as rehabilitation) are the users of the present guideline. The guideline also comprises quality indicators for measuring the implementation of the guideline recommendations in routine clinical care; these data will be presented in a future publication.
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Affiliation(s)
- Sabine Kliesch
- Centre of Reproductive Medicine and Andrology, Department of Clinical and Surgical Andrology, University Hospital Münster, Münster, Germany
| | - Stefanie Schmidt
- UroEvidence, Deutsche Gesellschaft für Urologie, Berlin, Germany
| | - Doris Wilborn
- UroEvidence, Deutsche Gesellschaft für Urologie, Berlin, Germany
| | - Clemens Aigner
- Ruhrlandklinik, University Hospital Essen, Essen, Germany
| | - Walter Albrecht
- Department of Urology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
| | - Jens Bedke
- Department of Urology, University Hospital Tübingen, Tübingen, Germany
| | | | - Dirk Beyersdorff
- Clinic and Polyclinic for Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Bokemeyer
- II. Medical Clinic and Polyclinic, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jonas Busch
- Department of Urology, Charité University Hospital, Berlin, Germany
| | - Johannes Classen
- Department of Radiotherapy, Radiological Oncology, and Palliative Medicine, St. Vincentius-Kliniken, Karlsruhe, Germany
| | - Maike de Wit
- Clinic for Internal Medicine - Hematology, Oncology, and Palliative Medicine, Vivantes Clinic Neukölln, Berlin, Germany
| | | | - Thorsten Diemer
- Clinic and Polyclinic for Urology, Pediatric Urology, and Andrology, University Hospital Gießen, Gießen, Germany
| | - Anette Dieing
- Clinic for Internal Medicine - Hematology and Oncology, Vivantes Clinics Am Urban, Berlin, Germany
| | | | | | - Oliver W Hakenberg
- Urological Clinic and Polyclinic, University Hospital Rostock, Rostock, Germany
| | - Axel Heidenreich
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | | | - Kathleen Herkommer
- Urological Clinic and Polyclinic of the Technical University of Munich, Munich, Germany
| | - Thomas Hermanns
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sascha Kaufmann
- Department for Radiooncology, University Hospital Tübingen, Tübingen, Germany
| | - Marko Kornmann
- Clinic for General and Visceral Surgery, University Hospital Ulm, Ulm, Germany
| | | | - Susanne Krege
- KEM, Protestant Hospital Essen-Mitte, Clinic for Urology, Pediatric Urology and Urological Oncology, Essen, Germany
| | | | - Anja Lorch
- Department of Urology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | - Karin Oechsle
- II. Medical Clinic and Polyclinic, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Timur Ohloff
- German Foundation for Young Adults with Cancer, Berlin, Germany
| | - Christoph Oing
- II. Medical Clinic and Polyclinic, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrich Otto
- Urological Competence Centre for Rehabilitation, Bad Wildungen, Germany
| | - David Pfister
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | - Renate Pichler
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Heinrich Recken
- Hamburger Fern-Hochschule Studienzentrum Essen, Essen, Germany
| | - Oliver Rick
- Klinik Reinhardshöhe GmbH, Bad Wildungen, Germany
| | | | - Christian Ruf
- Department of Urology, Bundeswehrkrankenhaus, Ulm, Germany
| | | | - Hans Schmelz
- Department of Urology, Bundeswehrkrankenhaus, Koblenz, Germany
| | - Heinz Schmidberger
- Clinic and Polyclinic for Radiooncology and Radiotherapy, University Hospital Mainz, Mainz, Germany
| | | | | | | | - Rainer Souchon
- Department for Radiooncology, University Hospital Tübingen, Tübingen, Germany
| | | | | | | | - D H Zermann
- Vogtland-Klinik Bad Elster, Bad Elster, Germany
| | | | - Peter Albers
- Department of Urology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany,
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Kliesch S, Schmidt S, Wilborn D, Aigner C, Albrecht W, Bedke J, Beintker M, Beyersdorff D, Bokemeyer C, Busch J, Classen J, de Wit M, Dieckmann KP, Diemer T, Dieing A, Gockel M, Göckel-Beining B, Hakenberg OW, Heidenreich A, Heinzelbecker J, Herkommer K, Hermanns T, Kaufmann S, Kornmann M, Kotzerke J, Krege S, Kristiansen G, Lorch A, Müller AC, Oechsle K, Ohloff T, Oing C, Otto U, Pfister D, Pichler R, Recken H, Rick O, Rudolph Y, Ruf C, Schirren J, Schmelz H, Schmidberger H, Schrader M, Schweyer S, Seeling S, Souchon R, Winter C, Wittekind C, Zengerling F, Zermann DH, Zillmann R, Albers P. Management of Germ Cell Tumours of the Testis in Adult Patients. German Clinical Practice Guideline Part I: Epidemiology, Classification, Diagnosis, Prognosis, Fertility Preservation, and Treatment Recommendations for Localized Stages. Urol Int 2021; 105:169-180. [PMID: 33412555 DOI: 10.1159/000510407] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/23/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION This is the first German evidence- and consensus-based clinical guideline on diagnosis, treatment, and follow-up on germ cell tumours (GCTs) of the testis in adult patients. We present the guideline content in two publications. Part I covers the topic's background, methods, epidemiology, classification systems, diagnostics, prognosis, and treatment recommendations for the localized stages. METHODS An interdisciplinary panel of 42 experts including 1 patient representative developed the guideline content. Clinical recommendations and statements were based on scientific evidence and expert consensus. For this purpose, evidence tables for several review questions, which were based on systematic literature searches (last search was in March 2018) were provided. Thirty-one experts entitled to vote, rated the final clinical recommendations and statements. RESULTS We provide 161 clinical recommendations and statements. We present information on the quality of cancer care and epidemiology and give recommendations for staging and classification as well as for diagnostic procedures. The diagnostic recommendations encompass measures for assessing the primary tumour as well as procedures for the detection of metastases. One chapter addresses prognostic factors. In part I, we separately present the treatment recommendations for germ cell neoplasia in situ, and the organ-confined stages (clinical stage I) of both seminoma and nonseminoma. CONCLUSION Although GCT is a rare tumour entity with excellent survival rates for the localized stages, its management requires an interdisciplinary approach, including several clinical experts. Quality of care is highly related to institutional expertise and can be reassured by established online-based second-opinion boards. There are very few studies on diagnostics with good level of evidence. Treatment of metastatic GCTs must be tailored to the risk according to the International Germ Cell Cancer Collaboration Group classification after careful diagnostic evaluation. An interdisciplinary approach as well as the referral of selected patients to centres with proven experience can help achieve favourable clinical outcomes.
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Affiliation(s)
- Sabine Kliesch
- Centre of Reproductive Medicine and Andrology, Department of Clinical and Surgical Andrology, University Hospital Münster, Münster, Germany,
| | | | - Doris Wilborn
- UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Germany
| | - Clemens Aigner
- Ruhrlandklinik at University Hospital Essen, Essen, Germany
| | - Walter Albrecht
- Department of Urology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
| | - Jens Bedke
- Department of Urology, University Hospital Tübingen, Tübingen, Germany
| | | | - Dirk Beyersdorff
- Clinic and Polyclinic for Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Bokemeyer
- II. Medical Clinic and Polyclinic, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jonas Busch
- Department of Urology, Charité University Hospital, Berlin, Germany
| | - Johannes Classen
- Department of Radiotherapy, Radiological Oncology and Palliative Medicine, St. Vincentius-Kliniken, Karlsruhe, Germany
| | - Maike de Wit
- Clinic for Internal Medicine - Hematology, Oncology and Palliative Medicine, Vivantes Clinic Neukölln, Berlin, Germany
| | | | - Thorsten Diemer
- Clinic and Polyclinic for Urology, Pediatric Urology and Andrology, University Hospital Gießen, Gießen, Germany
| | - Anette Dieing
- Clinic for Internal Medicine - Hematology and Oncology, Vivantes Clinics Am Urban, Berlin, Germany
| | | | | | - Oliver W Hakenberg
- Urological Clinic and Polyclinic, University Hospital Rostock, Rostock, Germany
| | - Axel Heidenreich
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | | | - Kathleen Herkommer
- Urological Clinic and Polyclinic of the Technical University of Munich, Munich, Germany
| | - Thomas Hermanns
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sascha Kaufmann
- Department for Radiooncology, University Hospital Tübingen, Tübingen, Germany
| | - Marko Kornmann
- Clinic for General and Visceral Surgery, University Hospital Ulm, Ulm, Germany
| | - Jörg Kotzerke
- Klinik und Poliklinik für Nuklearmedizin, University Hospital Dresden, Dresden, Germany
| | - Susanne Krege
- KEM, Protestant Hospital Essen-Mitte, Clinic for Urology, Pediatric Urology and Urological Oncology, Essen, Germany
| | | | - Anja Lorch
- Department of Urology, University Hospital Düsseldorf, Düsseldorf, Germany
| | | | - Karin Oechsle
- II. Medical Clinic and Polyclinic, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Timur Ohloff
- Advisor, German Foundation for Young Adults with Cancer, Berlin, Germany
| | - Christoph Oing
- II. Medical Clinic and Polyclinic, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrich Otto
- Urological Competence Centre for Rehabilitation, Bad Wildungen, Germany
| | - David Pfister
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | - Renate Pichler
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Heinrich Recken
- HFH, Hamburger Fern-Hochschule Studienzentrum Essen (Distance Learning University, Essen Study Centre), Essen, Germany
| | - Oliver Rick
- Klinik Reinhardshöhe GmbH, Bad Wildungen, Germany
| | | | - Christian Ruf
- Department of Urology, Bundeswehrkrankenhaus (German Federal Armed Forces Hospital), Ulm, Germany
| | | | - Hans Schmelz
- Department of Urology, Bundeswehrkrankenhaus (German Federal Armed Forces Hospital), Koblenz, Germany
| | - Heinz Schmidberger
- Clinic and Polyclinic for Radiooncology and Radiotherapy, University Hospital Mainz, Mainz, Germany
| | | | | | | | - Rainer Souchon
- Department for Radiooncology, University Hospital Tübingen, Tübingen, Germany
| | | | | | | | | | | | - Peter Albers
- Department of Urology, University Hospital Düsseldorf, Düsseldorf, Germany
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Rick O. Rehabilitation in Zeiten von COVID-19. InFo Hämatol Onkol 2020. [PMCID: PMC7474306 DOI: 10.1007/s15004-020-8216-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Wöckel A, Festl J, Stüber T, Brust K, Krockenberger M, Heuschmann PU, Jírů-Hillmann S, Albert US, Budach W, Follmann M, Janni W, Kopp I, Kreienberg R, Kühn T, Langer T, Nothacker M, Scharl A, Schreer I, Link H, Engel J, Fehm T, Weis J, Welt A, Steckelberg A, Feyer P, König K, Hahne A, Baumgartner T, Kreipe HH, Knoefel WT, Denkinger M, Brucker S, Lüftner D, Kubisch C, Gerlach C, Lebeau A, Siedentopf F, Petersen C, Bartsch HH, Schulz-Wendtland R, Hahn M, Hanf V, Müller-Schimpfle M, Henscher U, Roncarati R, Katalinic A, Heitmann C, Honegger C, Paradies K, Bjelic-Radisic V, Degenhardt F, Wenz F, Rick O, Hölzel D, Zaiss M, Kemper G, Budach V, Denkert C, Gerber B, Tesch H, Hirsmüller S, Sinn HP, Dunst J, Münstedt K, Bick U, Fallenberg E, Tholen R, Hung R, Baumann F, Beckmann MW, Blohmer J, Fasching P, Lux MP, Harbeck N, Hadji P, Hauner H, Heywang-Köbrunner S, Huober J, Hübner J, Jackisch C, Loibl S, Lück HJ, von Minckwitz G, Möbus V, Müller V, Nöthlings U, Schmidt M, Schmutzler R, Schneeweiss A, Schütz F, Stickeler E, Thomssen C, Untch M, Wesselmann S, Bücker A, Buck A, Stangl S. Interdisciplinary Screening, Diagnosis, Therapy and Follow-up of Breast Cancer. Guideline of the DGGG and the DKG (S3-Level, AWMF Registry Number 032/045OL, December 2017) - Part 2 with Recommendations for the Therapy of Primary, Recurrent and Advanced Breast Cancer. Geburtshilfe Frauenheilkd 2018; 78:1056-1088. [PMID: 30581198 PMCID: PMC6261741 DOI: 10.1055/a-0646-4630] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 06/20/2018] [Indexed: 12/29/2022] Open
Abstract
Purpose The aim of this official guideline coordinated and published by the German Society for Gynecology and Obstetrics (DGGG) and the German Cancer Society (DKG) was to optimize the screening, diagnosis, therapy and follow-up care of breast cancer. Method The process of updating the S3 guideline published in 2012 was based on the adaptation of identified source guidelines. They were combined with reviews of evidence compiled using PICO (Patients/Interventions/Control/Outcome) questions and with the results of a systematic search of literature databases followed by the selection and evaluation of the identified literature. The interdisciplinary working groups took the identified materials as their starting point and used them to develop suggestions for recommendations and statements, which were then modified and graded in a structured consensus process procedure. Recommendations Part 2 of this short version of the guideline presents recommendations for the therapy of primary, recurrent and metastatic breast cancer. Loco-regional therapies are de-escalated in the current guideline. In addition to reducing the safety margins for surgical procedures, the guideline also recommends reducing the radicality of axillary surgery. The choice and extent of systemic therapy depends on the respective tumor biology. New substances are becoming available, particularly to treat metastatic breast cancer.
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Affiliation(s)
- Achim Wöckel
- Universitätsfrauenklinik Würzburg, Universität Würzburg, Würzburg, Germany
| | - Jasmin Festl
- Universitätsfrauenklinik Würzburg, Universität Würzburg, Würzburg, Germany
| | - Tanja Stüber
- Universitätsfrauenklinik Würzburg, Universität Würzburg, Würzburg, Germany
| | - Katharina Brust
- Universitätsfrauenklinik Würzburg, Universität Würzburg, Würzburg, Germany
| | | | - Peter U. Heuschmann
- Institut für Klinische Epidemiologie und Biometrie (IKE-B), Universität Würzburg, Würzburg, Germany
| | - Steffi Jírů-Hillmann
- Institut für Klinische Epidemiologie und Biometrie (IKE-B), Universität Würzburg, Würzburg, Germany
| | | | - Wilfried Budach
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | | | - Ina Kopp
- AWMF-Institut für Medizinisches Wissensmanagement, Marburg, Germany
| | | | - Thorsten Kühn
- Frauenklinik, Klinikum Esslingen, Esslingen, Germany
| | - Thomas Langer
- Office des Leitlinienprogrammes Onkologie, Berlin, Germany
| | - Monika Nothacker
- AWMF-Institut für Medizinisches Wissensmanagement, Marburg, Germany
| | - Anton Scharl
- Frauenklinik, Klinikum St. Marien Amberg, Amberg, Germany
| | | | - Hartmut Link
- Praxis für Hämatologie und Onkologie, Kaiserslautern, Germany
| | - Jutta Engel
- Tumorregister München, Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität München, München, Germany
| | - Tanja Fehm
- Universitätsfrauenklinik Düsseldorf, Düsseldorf, Germany
| | - Joachim Weis
- Stiftungsprofessur Selbsthilfeforschung, Tumorzentrum/CCC Freiburg, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Anja Welt
- Innere Klinik (Tumorforschung), Westdeutsches Tumorzentrum, Universitätsklinikum Essen, Essen, Germany
| | | | - Petra Feyer
- Klinik für Strahlentherapie und Radioonkologie, Vivantes Klinikum, Neukölln Berlin, Germany
| | - Klaus König
- Berufsverband der Frauenärzte, Steinbach, Germany
| | | | | | - Hans H. Kreipe
- Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Wolfram Trudo Knoefel
- Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Michael Denkinger
- AGAPLESION Bethesda Klinik, Geriatrie der Universität Ulm, Ulm, Germany
| | - Sara Brucker
- Universitätsfrauenklinik Tübingen, Tübingen, Germany
| | - Diana Lüftner
- Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Campus Benjamin Franklin, Universitätsklinikum Charité, Berlin, Germany
| | - Christian Kubisch
- Institut für Humangenetik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Christina Gerlach
- III. Medizinische Klinik und Poliklinik, uct, Interdisziplinäre Abteilung für Palliativmedizin, Universitätsmedizin der Johannes Gutenberg Universität, Mainz, Germany
| | - Annette Lebeau
- Institut für Pathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Cordula Petersen
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Markus Hahn
- Universitätsfrauenklinik Tübingen, Tübingen, Germany
| | - Volker Hanf
- Frauenklinik Nathanstift, Klinikum Fürth, Fürth, Germany
| | | | | | - Renza Roncarati
- Frauenselbsthilfe nach Krebs – Bundesverband e. V., Bonn, Germany
| | - Alexander Katalinic
- Institut für Sozialmedizin und Epidemiologie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Christoph Heitmann
- Ästhetisch plastische und rekonstruktive Chirurgie, Camparihaus München, München, Germany
| | | | - Kerstin Paradies
- Konferenz Onkologischer Kranken- und Kinderkrankenpflege, Hamburg, Germany
| | - Vesna Bjelic-Radisic
- Universitätsfrauenklinik, Abteilung für Gynäkologie, Medizinische Universität Graz, Graz, Austria
| | - Friedrich Degenhardt
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
| | - Frederik Wenz
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Mannheim, Mannheim, Germany
| | - Oliver Rick
- Klinik Reinhardshöhe Bad Wildungen, Bad Wildungen, Germany
| | - Dieter Hölzel
- Tumorregister München, Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität München, München, Germany
| | - Matthias Zaiss
- Praxis für interdisziplinäre Onkologie & Hämatologie, Freiburg, Germany
| | | | - Volker Budach
- Klinik für Radioonkologie und Strahlentherapie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Carsten Denkert
- Institut für Pathologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Gerber
- Universitätsfrauenklinik am Klinikum Südstadt, Rostock, Germany
| | - Hans Tesch
- Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany
| | | | - Hans-Peter Sinn
- Pathologisches Institut, Universität Heidelberg, Heidelberg, Germany
| | - Jürgen Dunst
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Karsten Münstedt
- Frauenklinik Offenburg, Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Germany
| | - Ulrich Bick
- Klinik für Radiologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Eva Fallenberg
- Klinik für Radiologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Reina Tholen
- Deutscher Verband für Physiotherapie, Referat Bildung und Wissenschaft, Köln, Germany
| | - Roswita Hung
- Frauenselbsthilfe nach Krebs, Wolfsburg, Germany
| | - Freerk Baumann
- Centrum für Integrierte Onkologie Köln, Uniklinik Köln, Köln, Germany
| | - Matthias W. Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Jens Blohmer
- Klinik für Gynäkologie incl. Brustzentrum, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Fasching
- Frauenklinik, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Michael P. Lux
- Frauenklinik, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Nadia Harbeck
- Brustzentrum, Frauenklinik, Universität München (LMU), München, Germany
| | - Peyman Hadji
- Klinik für Gynäkologie und Geburtshilfe, Krankenhaus Nordwest, Frankfurt, Germany
| | - Hans Hauner
- Lehrstuhl für Ernährungsmedizin, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | | | | | - Jutta Hübner
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Christian Jackisch
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach, Offenbach, Germany
| | | | | | | | - Volker Möbus
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Frankfurt Höchst, Frankfurt, Germany
| | - Volkmar Müller
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Ute Nöthlings
- Institut für Ernährungs- und Lebensmittelwissenschaften, Rheinische Friedrich-Wilhelms Universität Bonn, Bonn, Germany
| | - Marcus Schmidt
- Klinik und Poliklinik für Geburtshilfe und Frauengesundheit, Universitätsmedizin der Johannes Gutenberg-Universität Mai, Germany nz, Mainz
| | - Rita Schmutzler
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum Köln, Köln, Germany
| | - Andreas Schneeweiss
- Nationales Centrum für Tumorerkrankungen, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Florian Schütz
- Nationales Centrum für Tumorerkrankungen, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Elmar Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Uniklinik RWTH Aachen, Aachen, Germany
| | | | - Michael Untch
- Klinik für Geburtshilfe und Gynäkologie, Helios Klinikum Berlin-Buch, Berlin, Germany
| | | | - Arno Bücker
- Klinik für Diagnostische und Interventionelle Radiologie am UKS, Universität des Saarlandes, Homburg, Germany
| | - Andreas Buck
- Nuklearmedizinische Klinik und Poliklinik des Universitätsklinikums Würzburg, Würzburg, Germany
| | - Stephanie Stangl
- Institut für Klinische Epidemiologie und Biometrie (IKE-B), Universität Würzburg, Würzburg, Germany
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Wöckel A, Festl J, Stüber T, Brust K, Stangl S, Heuschmann PU, Albert US, Budach W, Follmann M, Janni W, Kopp I, Kreienberg R, Kühn T, Langer T, Nothacker M, Scharl A, Schreer I, Link H, Engel J, Fehm T, Weis J, Welt A, Steckelberg A, Feyer P, König K, Hahne A, Kreipe HH, Knoefel WT, Denkinger M, Brucker S, Lüftner D, Kubisch C, Gerlach C, Lebeau A, Siedentopf F, Petersen C, Bartsch HH, Schulz-Wendtland R, Hahn M, Hanf V, Müller-Schimpfle M, Henscher U, Roncarati R, Katalinic A, Heitmann C, Honegger C, Paradies K, Bjelic-Radisic V, Degenhardt F, Wenz F, Rick O, Hölzel D, Zaiss M, Kemper G, Budach V, Denkert C, Gerber B, Tesch H, Hirsmüller S, Sinn HP, Dunst J, Münstedt K, Bick U, Fallenberg E, Tholen R, Hung R, Baumann F, Beckmann MW, Blohmer J, Fasching PA, Lux MP, Harbeck N, Hadji P, Hauner H, Heywang-Köbrunner S, Huober J, Hübner J, Jackisch C, Loibl S, Lück HJ, von Minckwitz G, Möbus V, Müller V, Nöthlings U, Schmidt M, Schmutzler R, Schneeweiss A, Schütz F, Stickeler E, Thomssen C, Untch M, Wesselmann S, Bücker A, Krockenberger M. Interdisciplinary Screening, Diagnosis, Therapy and Follow-up of Breast Cancer. Guideline of the DGGG and the DKG (S3-Level, AWMF Registry Number 032/045OL, December 2017) - Part 1 with Recommendations for the Screening, Diagnosis and Therapy of Breast Cancer. Geburtshilfe Frauenheilkd 2018; 78:927-948. [PMID: 30369626 PMCID: PMC6202580 DOI: 10.1055/a-0646-4522] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 06/20/2018] [Indexed: 01/04/2023] Open
Abstract
Purpose The aim of this official guideline coordinated and published by the German Society for Gynecology and Obstetrics (DGGG) and the German Cancer Society (DKG) was to optimize the screening, diagnosis, therapy and follow-up care of breast cancer. Methods The process of updating the S3 guideline dating from 2012 was based on the adaptation of identified source guidelines which were combined with reviews of evidence compiled using PICO (Patients/Interventions/Control/Outcome) questions and the results of a systematic search of literature databases and the selection and evaluation of the identified literature. The interdisciplinary working groups took the identified materials as their starting point to develop recommendations and statements which were modified and graded in a structured consensus procedure. Recommendations Part 1 of this short version of the guideline presents recommendations for the screening, diagnosis and follow-up care of breast cancer. The importance of mammography for screening is confirmed in this updated version of the guideline and forms the basis for all screening. In addition to the conventional methods used to diagnose breast cancer, computed tomography (CT) is recommended for staging in women with a higher risk of recurrence. The follow-up concept includes suggested intervals between physical, ultrasound and mammography examinations, additional high-tech diagnostic procedures, and the determination of tumor markers for the evaluation of metastatic disease.
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Affiliation(s)
- Achim Wöckel
- Universitätsfrauenklinik Würzburg, Universität Würzburg, Würzburg, Germany
| | - Jasmin Festl
- Universitätsfrauenklinik Würzburg, Universität Würzburg, Würzburg, Germany
| | - Tanja Stüber
- Universitätsfrauenklinik Würzburg, Universität Würzburg, Würzburg, Germany
| | - Katharina Brust
- Universitätsfrauenklinik Würzburg, Universität Würzburg, Würzburg, Germany
| | - Stephanie Stangl
- Institut für Klinische Epidemiologie und Biometrie (IKE-B), Universität Würzburg, Würzburg, Germany
| | - Peter U. Heuschmann
- Institut für Klinische Epidemiologie und Biometrie (IKE-B), Universität Würzburg, Würzburg, Germany
| | | | - Wilfried Budach
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | | | - Ina Kopp
- AWMF-Institut für Medizinisches Wissensmanagement, Marburg, Germany
| | | | - Thorsten Kühn
- Frauenklinik, Klinikum Esslingen, Esslingen, Germany
| | - Thomas Langer
- Office des Leitlinienprogrammes Onkologie, Berlin, Germany
| | - Monika Nothacker
- AWMF-Institut für Medizinisches Wissensmanagement, Marburg, Germany
| | - Anton Scharl
- Frauenklinik, Klinikum St. Marien Amberg, Amberg, Germany
| | | | - Hartmut Link
- Praxis für Hämatologie und Onkologie, Kaiserslautern, Germany
| | - Jutta Engel
- Tumorregister München, Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität München, München, Germany
| | - Tanja Fehm
- Universitätsfrauenklinik Düsseldorf, Düsseldorf, Germany
| | - Joachim Weis
- Stiftungsprofessur Selbsthilfeforschung, Tumorzentrum/CCC Freiburg, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Anja Welt
- Innere Klinik (Tumorforschung), Westdeutsches Tumorzentrum, Universitätsklinikum Essen, Essen, Germany
| | | | - Petra Feyer
- Klinik für Strahlentherapie und Radioonkologie, Vivantes Klinikum, Neukölln Berlin, Germany
| | - Klaus König
- Berufsverband der Frauenärzte, Steinbach, Germany
| | | | - Hans H. Kreipe
- Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Wolfram Trudo Knoefel
- Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Michael Denkinger
- AGAPLESION Bethesda Klinik, Geriatrie der Universität Ulm, Ulm, Germany
| | - Sara Brucker
- Universitätsfrauenklinik Tübingen, Tübingen, Germany
| | - Diana Lüftner
- Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Campus Benjamin Franklin, Universitätsklinikum Charité, Berlin, Germany
| | - Christian Kubisch
- Institut für Humangenetik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Christina Gerlach
- III. Medizinische Klinik und Poliklinik, uct, Interdisziplinäre Abteilung für Palliativmedizin, Universitätsmedizin der Johannes Gutenberg Universität, Mainz, Germany
| | - Annette Lebeau
- Institut für Pathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Cordula Petersen
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Markus Hahn
- Universitätsfrauenklinik Tübingen, Tübingen, Germany
| | - Volker Hanf
- Frauenklinik Nathanstift, Klinikum Fürth, Fürth, Germany
| | | | | | - Renza Roncarati
- Frauenselbsthilfe nach Krebs – Bundesverband e. V., Bonn, Germany
| | - Alexander Katalinic
- Institut für Sozialmedizin und Epidemiologie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Christoph Heitmann
- Ästhetisch plastische und rekonstruktive Chirurgie, Camparihaus München, München, Germany
| | | | - Kerstin Paradies
- Konferenz Onkologischer Kranken- und Kinderkrankenpflege, Hamburg, Germany
| | - Vesna Bjelic-Radisic
- Universitätsfrauenklinik, Abteilung für Gynäkologie, Medizinische Universität Graz, Graz, Austria
| | - Friedrich Degenhardt
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
| | - Frederik Wenz
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Mannheim, Mannheim, Germany
| | - Oliver Rick
- Klinik Reinhardshöhe Bad Wildungen, Bad Wildungen, Germany
| | - Dieter Hölzel
- Tumorregister München, Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität München, München, Germany
| | - Matthias Zaiss
- Praxis für interdisziplinäre Onkologie & Hämatologie, Freiburg, Germany
| | | | - Volker Budach
- Klinik für Radioonkologie und Strahlentherapie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Carsten Denkert
- Institut für Pathologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Gerber
- Universitätsfrauenklinik am Klinikum Südstadt, Rostock, Germany
| | - Hans Tesch
- Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany
| | | | - Hans-Peter Sinn
- Pathologisches Institut, Universität Heidelberg, Heidelberg, Germany
| | - Jürgen Dunst
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Karsten Münstedt
- Frauenklinik Offenburg, Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Germany
| | - Ulrich Bick
- Klinik für Radiologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Eva Fallenberg
- Klinik für Radiologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Reina Tholen
- Deutscher Verband für Physiotherapie, Referat Bildung und Wissenschaft, Köln, Germany
| | - Roswita Hung
- Frauenselbsthilfe nach Krebs, Wolfsburg, Germany
| | - Freerk Baumann
- Centrum für Integrierte Onkologie Köln, Uniklinik Köln, Köln, Germany
| | - Matthias W. Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Jens Blohmer
- Klinik für Gynäkologie incl. Brustzentrum, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Peter A. Fasching
- Frauenklinik, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Michael P. Lux
- Frauenklinik, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Nadia Harbeck
- Brustzentrum, Frauenklinik, Universität München (LMU), München, Germany
| | - Peyman Hadji
- Klinik für Gynäkologie und Geburtshilfe, Krankenhaus Nordwest, Frankfurt, Germany
| | - Hans Hauner
- Lehrstuhl für Ernährungsmedizin, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | | | | | - Jutta Hübner
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Christian Jackisch
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach, Offenbach, Germany
| | | | | | | | - Volker Möbus
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Frankfurt Höchst, Frankfurt, Germany
| | - Volkmar Müller
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Ute Nöthlings
- Institut für Ernährungs- und Lebensmittelwissenschaften, Rheinische Friedrich-Wilhelms Universität Bonn, Bonn, Germany
| | - Marcus Schmidt
- Klinik und Poliklinik für Geburtshilfe und Frauengesundheit, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Rita Schmutzler
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum Köln, Köln, Germany
| | - Andreas Schneeweiss
- Nationales Centrum für Tumorerkrankungen, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Florian Schütz
- Nationales Centrum für Tumorerkrankungen, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Elmar Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Uniklinik RWTH Aachen, Aachen, Germany
| | | | - Michael Untch
- Klinik für Geburtshilfe und Gynäkologie, Helios Klinikum Berlin-Buch, Berlin, Germany
| | | | - Arno Bücker
- Klinik für Diagnostische und Interventionelle Radiologie am UKS, Universität des Saarlandes, Homburg, Germany
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Rick O, Reuß-Borst M, Dauelsberg T, Hass HG, König V, Caspari R, Götz-Keil G, Pfitzner J, Kerschgens C, Fliessbach K, Hoppe C. NeuroCog FX study: A multicenter cohort study on cognitive dysfunction in patients with early breast cancer. Psychooncology 2018; 27:2016-2022. [DOI: 10.1002/pon.4763] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 05/06/2018] [Accepted: 05/07/2018] [Indexed: 01/14/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Klaus Fliessbach
- Clinic for Neurodegenerative Disease and Geriatric Psychiatry; University of Bonn Medical Centre; Bonn Germany
| | - Christian Hoppe
- Department of Epileptology; University of Bonn Medical Centre; Bonn Germany
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Schmielau J, Rick O, Reuss-Borst M, Kalusche-Bontemps EM, Steimann M. Rehabilitation of Cancer Survivors with Long-Term Toxicities. Oncol Res Treat 2017; 40:764-771. [DOI: 10.1159/000485187] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/13/2017] [Indexed: 12/22/2022]
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Rick O, Dauelsberg T, Kalusche-Bontemps EM. Oncological Rehabilitation. Oncol Res Treat 2017; 40:772-777. [DOI: 10.1159/000481709] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/22/2017] [Indexed: 01/06/2023]
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Rick O, Langer T. Oncological Rehabilitation and Cancer Survivorship. Oncol Res Treat 2017; 40:744. [DOI: 10.1159/000485188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 11/13/2017] [Indexed: 12/16/2022]
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Rick O, Reuß-Borst M, Dauelsberg T, Hass H, König V, Caspari R, Götz-Keil G, Pfitzner J, Kerschgens C, Fliessbach K, Hoppe C. NeuroCog-FX study: A multicenter cohort study on cognitive dysfunction in patients with early breast cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx388.041] [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: 11/14/2022] Open
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Schwella N, Kingreen D, Heuft H, Oettle H, Rick O, Serke S, Huhn D, Siegert W. Peripheral Blood Progenitor Cell
Collection during Hematopoietic
Recovery following Autologous Blood
Progenitor Cell Transplantation. Vox Sang 2017. [DOI: 10.1159/000461974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Rick O, Reuß-Borst M, Dauelsberg T, Hass H, König V, Caspari R, Götz-Keil G, Pfitzner J, Kerschgens C, Fliessbach K, Hoppe C. NeuroCog-FX study: A multicenter cohort study on cognitive dysfunction in patients with early breast cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.10061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
10061 Background: Many breast cancer patients complain about cognitive dysfunction (CD) with mnestic and attentional deficits. These complaints persist even after completion of therapy in approximately one third of the patients and affects both social life and working capacity. The exact nature and genesis of CD in breast cancer patients is still not fully understood and risk factors are not yet described. Methods: To determine CD and risk factors, we used the computer-based neuropsychological test NeuroCog-FX during a three weeks oncological rehabilitation in breast cancer patients. Eight subtests addressed attention, working memory, verbal and figural memory, and language. Test duration was < 30 minutes. A cognitive deficit was diagnosed if at least one subtest was clearly below average (score < M - 1.5 SD) of the normative age group. The data on cognitive function were correlated with the level of depression (PHQ-9 test), QoL (EORTC QLQ-30) and clinical parameters (nodal status, chemo-/radiotherapy and endocrine therapy). Results: From February 2013 to December 2014 a total of 476 patients were recruited in 9 oncological rehabilitation centers in Germany. NeuroCog-FX was used to examine 439 patients. Median age was 50 years (range: 24-62 years); 93% of patients had early tumor stage (T0-T2) and 67% were node-negative. Sixty-one percent of the patients received chemotherapy while 84% of the subjects underwent radiotherapy. CD was found in 59% and a moderate to severe depression in 38% of the patients. The severity of depression was correlated with slower reaction times and reduced verbal memory performance. These two cognitive parameters were also associated with a reduced global health status and a reduced physical function score on the EORTC-QLQ30 questionnaire suggesting an impact of cognitive deficits on quality of life. Cognitive function was not associated with type of treatment or node status. Conclusions: In this large and homogeneous cohort of breast cancer patients, CD has been shown in most of the subjects using a valid test method. CD was associated with depression and reduced quality of life. Neither tumor therapy nor other clinical parameters had a significant impact on development of CD.
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Affiliation(s)
- Oliver Rick
- Klinik Reinhardshoehe, Bad Wildungen, Germany
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Rick O, von Hehn U, Mikus E, Dertinger H, Geiger G. Magnetic field therapy in patients with cytostatics-induced polyneuropathy: A prospective randomized placebo-controlled phase-III study. Bioelectromagnetics 2016; 38:85-94. [PMID: 27657350 PMCID: PMC5248614 DOI: 10.1002/bem.22005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 08/20/2016] [Indexed: 01/05/2023]
Abstract
No causal treatment for chemotherapy‐induced peripheral neuropathy (CIPN) is known. Therefore, there is an urgent need to develop a therapy for CIPN. Only scarce clinical data are available concerning magnetic field therapy (MFT) in this context. We conducted a unicentric, randomized, double‐blind, placebo‐controlled phase‐III trial of an MFT device versus placebo. In this study, we randomized 44 patients with CIPN to two treatment groups, where 21 patients were treated with MFT (Group 1) and 23 patients received placebo (Group 2). We evaluated the efficacy of MFT at baseline (T1), after 3 weeks of study treatment (T2), and after 3 months of study treatment (T3). The primary endpoint was nerve conduction velocity (NCV), while secondary endpoints were the Common Toxicity Criteria (CTCAE) score and the Pain Detect End Score at T3. Seventeen of the patients in Group 1 and 14 patients in Group 2 completed the respective study treatment. The primary endpoint, significant improvement of NCV at T3, was achieved by MFT (P = 0.015), particularly for sensory neurotoxicity of the peroneal nerve. Also, in respect to the secondary endpoints, significant improvement (P = 0.04) was achieved in terms of the patients’ subjectively perceived neurotoxicity (CTCAE score), but not of neuropathic pain (P = 0.11). From data in the randomized study presented here, a positive effect on the reduction of neurotoxicity can be assumed for the MFT device. Patients with sensory neurotoxicity in the lower limbs, especially, should therefore be offered this therapy. Bioelectromagnetics. 38:85–94, 2017. © 2016 The Authors. Bioelectromagnetics published by Wiley Periodicals, Inc.
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Affiliation(s)
- Oliver Rick
- Klinik Reinhardshöhe, Medical Center of Cancer Rehabilitation, Bad Wildungen, Germany
| | | | - Eberhard Mikus
- Klinik Reinhardshöhe, Medical Center of Cancer Rehabilitation, Bad Wildungen, Germany
| | - Hermann Dertinger
- Karlsruher Institute of Technology (KIT), Eggenstein-Leopoldshafen, Germany
| | - Georg Geiger
- Klinik Reinhardshöhe, Medical Center of Cancer Rehabilitation, Bad Wildungen, Germany
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Geiger G, Mikus E, Dertinger H, Rick O. Low frequency magnetic field therapy in patients with cytostatic-induced polyneuropathy: a phase II pilot study. Bioelectromagnetics 2015; 36:251-4. [PMID: 25644670 DOI: 10.1002/bem.21897] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 12/26/2014] [Indexed: 11/11/2022]
Abstract
Cytostatic-induced polyneuropathy (CIPN) is a common and serious toxicity in tumor patients. Treatment and prophylactic measures are mainly ineffective. Therefore, there is an urgent need to establish a sufficient therapy for pPNP. Between July 2007 and August 2008, 20 patients were treated with low frequency (4-12 Hz) magnetic field therapy (MFT), and neurological examinations were conducted at the trial therapy's beginning, as well as after 3-4 weeks. Standardized testing methods were applied, i.e., the Common Toxicity Criteria questionnaire of the National Cancer Institute and the measurement of nerve conduction velocity (NCV) in the electrophysiological examination. In terms of the components sensory ataxia and neuropathy as well as neuropathic pain, an improvement was achieved using MFT. This effect was confirmed by an increase in NCV. Using low frequency MFT, CIPN was influenced positively on both hands and feet. This could represent a future therapy principle for these patients.
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Affiliation(s)
- Georg Geiger
- Klinik Reinhardshöhe, Klinik für Onkologische Rehabilitation, Bad Wildungen, Germany
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Rick O, Metz T, Eberlein M, Schirren J, Bölükbas S. The Six-Minute-Walk Test in assessing respiratory function after tumor surgery of the lung: a cohort study. J Thorac Dis 2014; 6:421-8. [PMID: 24822098 DOI: 10.3978/j.issn.2072-1439.2014.03.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 01/13/2014] [Indexed: 11/14/2022]
Abstract
INTRODUCTION The Six-Minute-Walk Test (6-MWT) is an established and well-validated diagnostic procedure in cardiovascular and pulmonary diseases. The significance of the 6-MWT in the assessment of the respiratory function in tumor patients after lung surgery is yet unclear. METHODS The retrospective study included 227 patients following oncological rehabilitation after lobectomy, pneumonectomy or wedge- and segmental resection due to a malignant tumor disease. Spirometry and 6-MWT were performed at the beginning (T1) and at the end (T2) of oncological rehabilitation and correlated with each other. A subgroup analysis on clinically relevant parameters was conducted as well. RESULTS A significant improvement of the walking distance measured in 6-MWT as well as of forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were detected within the scope of spirometry (all three P<0.01). This effect was demonstrable in all subgroups, except for patients who underwent pneumonectomy. However, a low correlation of the parameters walking distance and FEV1 was observed at both measurement points T1 (rho value =0.21) and T2 (rho value =0.25). CONCLUSIONS Measuring the walking distance in the 6-MWT could be a suitable parameter to assess respiratory function.
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Affiliation(s)
- Oliver Rick
- 1 Klinik Reinhardshöhe, Klinik für Onkologische Rehabilitation, Quellenstr. 8-12, 34537 Bad Wildungen, Germany ; 2 Division of Pulmonary, Critical Care and Occupational Medicine, Carver College of Medicine, University of Iowa, Iowa City, USA ; 3 Dr. Horst Schmidt Kliniken, Klinik für Thoraxchirurgie, Ludwig Erhard Str. 100, 65199 Wiesbaden, Germany
| | - Tsegaye Metz
- 1 Klinik Reinhardshöhe, Klinik für Onkologische Rehabilitation, Quellenstr. 8-12, 34537 Bad Wildungen, Germany ; 2 Division of Pulmonary, Critical Care and Occupational Medicine, Carver College of Medicine, University of Iowa, Iowa City, USA ; 3 Dr. Horst Schmidt Kliniken, Klinik für Thoraxchirurgie, Ludwig Erhard Str. 100, 65199 Wiesbaden, Germany
| | - Michael Eberlein
- 1 Klinik Reinhardshöhe, Klinik für Onkologische Rehabilitation, Quellenstr. 8-12, 34537 Bad Wildungen, Germany ; 2 Division of Pulmonary, Critical Care and Occupational Medicine, Carver College of Medicine, University of Iowa, Iowa City, USA ; 3 Dr. Horst Schmidt Kliniken, Klinik für Thoraxchirurgie, Ludwig Erhard Str. 100, 65199 Wiesbaden, Germany
| | - Joachim Schirren
- 1 Klinik Reinhardshöhe, Klinik für Onkologische Rehabilitation, Quellenstr. 8-12, 34537 Bad Wildungen, Germany ; 2 Division of Pulmonary, Critical Care and Occupational Medicine, Carver College of Medicine, University of Iowa, Iowa City, USA ; 3 Dr. Horst Schmidt Kliniken, Klinik für Thoraxchirurgie, Ludwig Erhard Str. 100, 65199 Wiesbaden, Germany
| | - Servet Bölükbas
- 1 Klinik Reinhardshöhe, Klinik für Onkologische Rehabilitation, Quellenstr. 8-12, 34537 Bad Wildungen, Germany ; 2 Division of Pulmonary, Critical Care and Occupational Medicine, Carver College of Medicine, University of Iowa, Iowa City, USA ; 3 Dr. Horst Schmidt Kliniken, Klinik für Thoraxchirurgie, Ludwig Erhard Str. 100, 65199 Wiesbaden, Germany
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Beyer J, Albers P, Altena R, Aparicio J, Bokemeyer C, Busch J, Cathomas R, Cavallin-Stahl E, Clarke NW, Claßen J, Cohn-Cedermark G, Dahl AA, Daugaard G, De Giorgi U, De Santis M, De Wit M, De Wit R, Dieckmann KP, Fenner M, Fizazi K, Flechon A, Fossa SD, Germá Lluch JR, Gietema JA, Gillessen S, Giwercman A, Hartmann JT, Heidenreich A, Hentrich M, Honecker F, Horwich A, Huddart RA, Kliesch S, Kollmannsberger C, Krege S, Laguna MP, Looijenga LHJ, Lorch A, Lotz JP, Mayer F, Necchi A, Nicolai N, Nuver J, Oechsle K, Oldenburg J, Oosterhuis JW, Powles T, Rajpert-De Meyts E, Rick O, Rosti G, Salvioni R, Schrader M, Schweyer S, Sedlmayer F, Sohaib A, Souchon R, Tandstad T, Winter C, Wittekind C. Maintaining success, reducing treatment burden, focusing on survivorship: highlights from the third European consensus conference on diagnosis and treatment of germ-cell cancer. Ann Oncol 2012; 24:878-88. [PMID: 23152360 PMCID: PMC3603440 DOI: 10.1093/annonc/mds579] [Citation(s) in RCA: 252] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In November 2011, the Third European Consensus Conference on Diagnosis and Treatment of Germ-Cell Cancer (GCC) was held in Berlin, Germany. This third conference followed similar meetings in 2003 (Essen, Germany) and 2006 (Amsterdam, The Netherlands) [Schmoll H-J, Souchon R, Krege S et al. European consensus on diagnosis and treatment of germ-cell cancer: a report of the European Germ-Cell Cancer Consensus Group (EGCCCG). Ann Oncol 2004; 15: 1377-1399; Krege S, Beyer J, Souchon R et al. European consensus conference on diagnosis and treatment of germ-cell cancer: a report of the second meeting of the European Germ-Cell Cancer Consensus group (EGCCCG): part I. Eur Urol 2008; 53: 478-496; Krege S, Beyer J, Souchon R et al. European consensus conference on diagnosis and treatment of germ-cell cancer: a report of the second meeting of the European Germ-Cell Cancer Consensus group (EGCCCG): part II. Eur Urol 2008; 53: 497-513]. A panel of 56 of 60 invited GCC experts from all across Europe discussed all aspects on diagnosis and treatment of GCC, with a particular focus on acute and late toxic effects as well as on survivorship issues. The panel consisted of oncologists, urologic surgeons, radiooncologists, pathologists and basic scientists, who are all actively involved in care of GCC patients. Panelists were chosen based on the publication activity in recent years. Before the meeting, panelists were asked to review the literature published since 2006 in 20 major areas concerning all aspects of diagnosis, treatment and follow-up of GCC patients, and to prepare an updated version of the previous recommendations to be discussed at the conference. In addition, ∼50 E-vote questions were drafted and presented at the conference to address the most controversial areas for a poll of expert opinions. Here, we present the main recommendations and controversies of this meeting. The votes of the panelists are added as online supplements.
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Affiliation(s)
- J Beyer
- Department of Hematology and Oncology, Vivantes Klinikum Am Urban, Berlin.
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Rick O, Kalusche EM, Dauelsberg T, König V, Korsukéwitz C, Seifart U. Reintegrating cancer patients into the workplace. Dtsch Arztebl Int 2012; 109:702-8. [PMID: 23264814 DOI: 10.3238/arztebl.2012.0702] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 07/30/2012] [Indexed: 01/06/2023]
Abstract
BACKGROUND In Germany at present, 64% of women and 59% of men who receive a diagnosis of cancer are still alive five years later. 45% of men and 57% of women with cancer are still of working age. Cancer can markedly harm their ability to work. METHODS We analyzed data from selected publications to calculate the percentage of cancer patients in Germany who are now returning to work. RESULTS The efficacy of oncological rehabilitation has not been demonstrated by a randomized controlled trial, nor is it clear whether the existing studies have accounted for potentially confounding variables. A combined assessment of reports from various countries reveals that 63% of cancer patients who are of working age go back to work after being unable to work for an average of five months. The situation varies markedly across countries: In Germany, the percentage of women with breast cancer who return to work is only 59%, compared to 80% in the USA and 82% in the United Kingdom. Younger and better educated patients are more likely to return to work, as are those who have received less invasive treatment with fewer complications. CONCLUSION Most cancer patients of working age go back to work, but the percentages vary widely from one country to another, perhaps reflecting differences in social systems.
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Hartmann JT, Metzner B, Binder C, Mergenthaler HG, Rick O, Sayer HG, Mayer F, Beyer J, Lorch A, Berdel WE, Frickhofen N, Bokemeyer C, Schleicher J, Gauler TC. Addition of darbepoetin alfa to sequential high-dose VIP chemotherapy for patients with advanced metastatic germ cell cancer. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e15026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
e15026 Background: High-dose VIP chemotherapy plus ABSCT given as first line treatment might be a strategy in patient with advanced germ cell tumors (GCT) with poor prognosis. The objective of the trial was to investigate the addition of darbepoetin alfa to HD-VIP in order to reduce anemia/red blood cell (RBC) transfusions. Methods: This was a randomized, open-label multicenter phase 2 study conducted in 20 hospitals. Darbepoetin 2.25 mcg/kg weekly or 500 mcg Q3W s.c., started with high dose VIP (dose level 6) was applied in arm B (arm A: HD-VIP alone). The primary objective was freedom from blood transfusions (FFT). Secondary objectives included objective remission rate (ORR) after chemotherapy, 24 mos PFS and OS, median course of hemoglobin (Hb) levels during 3 HD-VIP cycles as well as drug safety. Results: Between 7/2003 and 11/2008 108 pts were allocated to the study, and 106 were included in the intention-to-treat (ITT) analysis. By March 2011 the median follow-up time after randomization was 20 mos. Localisation of primary was gonadal in 66%, retroperitoneal in 19% and mediastinal in 14%s. A favourable treatment outcome (CR/NED/PR m-) in conjunction with secondary surgery (n = 76 pts) was achieved in 58% of pts with no difference between arms A and B. Overall FFT occurred in 2 pts (4.2%) in arm A and 3 pts (5.6%) in arm B, and in 23%/15%/15% and 15%/17%/19% of pts during cycles 1-3, respectively. No differences in baseline Hb, severity of anemia, no of RBC transfusions and area under the curve of Hb levels during HD-VIP was observed. Pts assigned to darbepoetin had similar treatment toxicity compared to those assigned to HD-VIP alone. 24-mos OS in arm A was 86.3% compared to 67.8% (p=.064) in Arm B. 2-year RFS was 66.8% in arm A vs 55.5% in Arm B (p=0.45). Darbopoetin was generally well tolerated with 2 pts discontinuing treatment due to thrombosis. Since compliance to study protocol was generally poor (6 out of 55 pts never received study drug during HD-VIP) a per-protocol analysis is in preparation. Conclusions: Based on ITT analysis, the addition of darbepoetin alfa to the high dose regimen compared to HD-VIP alone does not appear to impact on FFT, ORR, and 2-year survival rate in poor prognosis GCT pts (NCT00204633).
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Affiliation(s)
| | | | | | | | - Oliver Rick
- Klinik Reinhardshöhe, Bad Wildungen, Germany
| | | | - Frank Mayer
- University Hospital, Medical Center II, Tuebingen, Germany
| | | | - Anja Lorch
- University Hospital Duesseldorf, Duesseldorf, Germany
| | | | | | - Carsten Bokemeyer
- Department of Oncology/Hematology, University Hospital Hamburg, Hamburg, Germany
| | | | - Thomas C. Gauler
- West German Tumor Center, University Hospital Essen, Essen, Germany
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Lorch A, Kleinhans A, Kramar A, Kollmannsberger CK, Hartmann JT, Bokemeyer C, Rick O, Beyer J. Sequential Versus Single High-Dose Chemotherapy in Patients With Relapsed or Refractory Germ Cell Tumors: Long-Term Results of a Prospective Randomized Trial. J Clin Oncol 2012; 30:800-5. [PMID: 22291076 DOI: 10.1200/jco.2011.38.6391] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [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
Purpose To evaluate the long-term survival rates in patients with relapsed or refractory germ cell tumors (GCTs) after single or sequential high-dose chemotherapy (HDCT). Patients and Methods Between November 1999 and November 2004, 211 patients with relapsed or refractory GCT were randomly assigned to treatment with either one cycle of cisplatin 100 mg/m2, etoposide 375 mg/m2, and ifosfamide 6 g/m2 (VIP) plus three cycles of high-dose carboplatin 1,500 mg/m2 and etoposide 1,500 mg/m2 (CE, arm A) or three cycles of VIP plus one cycle of high-dose carboplatin 2,200 mg/m2, etoposide 1,800 mg/m2, and cyclophosphamide 6,400 mg/m2 (CEC, arm B) followed by autologous stem-cell reinfusion. Long-term progression-free survival (PFS) and overall survival (OS) 6 years after random assignment of the last patient were compared by using the log-rank test. Results Overall, 108 and 103 patients were randomly assigned to arms A and B, respectivelyl. The study was stopped prematurely because of excess treatment-related mortality in arm B (14%) compared with that in arm A (4%; P = .01). As of December 2010, nine (5%) of 211 patients were lost to follow-up; 94 (45%) of 211 are alive and 88 (94%) of 94 patients are progression free. Five-year PFS is 47% (95% CI, 37% to 56%) in arm A and 45% (95% CI, 35% to 55%) in arm B (hazard ratio [HR], 1.16; 95% CI, 0.79 to 1.70; P = .454). Five-year OS is 49% (95% CI, 40% to 59%) in arm A and 39% (95% CI, 30% to 49%) in arm B (HR, 1.42; 95% CI, 0.99 to 2.05; P = .057). Conclusion Patients with relapsed or refractory GCT achieve durable long-term survival after single as well as sequential HDCT. Fewer early deaths related to toxicity translated into superior long-term OS after sequential HDCT.
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Affiliation(s)
- Anja Lorch
- Anja Lorch and Antje Kleinhans, University of Giessen and Marburg, Marburg; Christian K. Kollmannsberger, Jörg T. Hartmann, and Carsten Bokemeyer, Eberhard-Karls Universität, Tübingen; Jörg T. Hartmann, Universität Schleswig-Hostein, Kiel; Carsten Bokemeyer, University Clinic Eppendorf, Hamburg; Oliver Rick, Klinikum Reinhardshöhe, Bad Wildungen; Jörg Beyer, Vivantes Klinikum Am Urban, Berlin, Germany; Andrew Kramar, Centre Oscar Lambret, Lille, France; and Christian K. Kollmannsberger, British Columbia
| | - Antje Kleinhans
- Anja Lorch and Antje Kleinhans, University of Giessen and Marburg, Marburg; Christian K. Kollmannsberger, Jörg T. Hartmann, and Carsten Bokemeyer, Eberhard-Karls Universität, Tübingen; Jörg T. Hartmann, Universität Schleswig-Hostein, Kiel; Carsten Bokemeyer, University Clinic Eppendorf, Hamburg; Oliver Rick, Klinikum Reinhardshöhe, Bad Wildungen; Jörg Beyer, Vivantes Klinikum Am Urban, Berlin, Germany; Andrew Kramar, Centre Oscar Lambret, Lille, France; and Christian K. Kollmannsberger, British Columbia
| | - Andrew Kramar
- Anja Lorch and Antje Kleinhans, University of Giessen and Marburg, Marburg; Christian K. Kollmannsberger, Jörg T. Hartmann, and Carsten Bokemeyer, Eberhard-Karls Universität, Tübingen; Jörg T. Hartmann, Universität Schleswig-Hostein, Kiel; Carsten Bokemeyer, University Clinic Eppendorf, Hamburg; Oliver Rick, Klinikum Reinhardshöhe, Bad Wildungen; Jörg Beyer, Vivantes Klinikum Am Urban, Berlin, Germany; Andrew Kramar, Centre Oscar Lambret, Lille, France; and Christian K. Kollmannsberger, British Columbia
| | - Christian K. Kollmannsberger
- Anja Lorch and Antje Kleinhans, University of Giessen and Marburg, Marburg; Christian K. Kollmannsberger, Jörg T. Hartmann, and Carsten Bokemeyer, Eberhard-Karls Universität, Tübingen; Jörg T. Hartmann, Universität Schleswig-Hostein, Kiel; Carsten Bokemeyer, University Clinic Eppendorf, Hamburg; Oliver Rick, Klinikum Reinhardshöhe, Bad Wildungen; Jörg Beyer, Vivantes Klinikum Am Urban, Berlin, Germany; Andrew Kramar, Centre Oscar Lambret, Lille, France; and Christian K. Kollmannsberger, British Columbia
| | - Jörg T. Hartmann
- Anja Lorch and Antje Kleinhans, University of Giessen and Marburg, Marburg; Christian K. Kollmannsberger, Jörg T. Hartmann, and Carsten Bokemeyer, Eberhard-Karls Universität, Tübingen; Jörg T. Hartmann, Universität Schleswig-Hostein, Kiel; Carsten Bokemeyer, University Clinic Eppendorf, Hamburg; Oliver Rick, Klinikum Reinhardshöhe, Bad Wildungen; Jörg Beyer, Vivantes Klinikum Am Urban, Berlin, Germany; Andrew Kramar, Centre Oscar Lambret, Lille, France; and Christian K. Kollmannsberger, British Columbia
| | - Carsten Bokemeyer
- Anja Lorch and Antje Kleinhans, University of Giessen and Marburg, Marburg; Christian K. Kollmannsberger, Jörg T. Hartmann, and Carsten Bokemeyer, Eberhard-Karls Universität, Tübingen; Jörg T. Hartmann, Universität Schleswig-Hostein, Kiel; Carsten Bokemeyer, University Clinic Eppendorf, Hamburg; Oliver Rick, Klinikum Reinhardshöhe, Bad Wildungen; Jörg Beyer, Vivantes Klinikum Am Urban, Berlin, Germany; Andrew Kramar, Centre Oscar Lambret, Lille, France; and Christian K. Kollmannsberger, British Columbia
| | - Oliver Rick
- Anja Lorch and Antje Kleinhans, University of Giessen and Marburg, Marburg; Christian K. Kollmannsberger, Jörg T. Hartmann, and Carsten Bokemeyer, Eberhard-Karls Universität, Tübingen; Jörg T. Hartmann, Universität Schleswig-Hostein, Kiel; Carsten Bokemeyer, University Clinic Eppendorf, Hamburg; Oliver Rick, Klinikum Reinhardshöhe, Bad Wildungen; Jörg Beyer, Vivantes Klinikum Am Urban, Berlin, Germany; Andrew Kramar, Centre Oscar Lambret, Lille, France; and Christian K. Kollmannsberger, British Columbia
| | - Jörg Beyer
- Anja Lorch and Antje Kleinhans, University of Giessen and Marburg, Marburg; Christian K. Kollmannsberger, Jörg T. Hartmann, and Carsten Bokemeyer, Eberhard-Karls Universität, Tübingen; Jörg T. Hartmann, Universität Schleswig-Hostein, Kiel; Carsten Bokemeyer, University Clinic Eppendorf, Hamburg; Oliver Rick, Klinikum Reinhardshöhe, Bad Wildungen; Jörg Beyer, Vivantes Klinikum Am Urban, Berlin, Germany; Andrew Kramar, Centre Oscar Lambret, Lille, France; and Christian K. Kollmannsberger, British Columbia
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Lorch A, Kleinhans A, Kramar A, Hartmann JT, Bokemeyer C, Rick O, Beyer J. Superior survival after sequential high-dose chemotherapy (HDCT) as compared to single HDCT in patients with relapsed or refractory germ cell tumors (GCT): Six-year long-term follow-up of a prospective, randomized phase II trial. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Burchert A, Sytik L, Lorch A, Hartmann JT, Bokemeyer C, Rick O, Beyer J, Kim TD, Neubauer A. Clinical relevance of germ cell cancer cells detected by real time PCR in apheresis products of poor risk patients undergoing high dose chemotherapy. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4579] [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: 11/20/2022] Open
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Lorch A, Neubauer A, Hackenthal M, Dieing A, Hartmann JT, Rick O, Bokemeyer C, Beyer J. High-dose chemotherapy (HDCT) as second-salvage treatment in patients with multiple relapsed or refractory germ-cell tumors. Ann Oncol 2009; 21:820-825. [PMID: 19822531 DOI: 10.1093/annonc/mdp366] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Survival after high-dose chemotherapy (HDCT) as second-salvage treatment (SST) in multiple relapsed germ-cell tumors (GCTs). PATIENTS AND METHODS Existing databases in Berlin and Marburg of HDCT trials from 1989 to 2008 were retrospectively screened. Among 534 patients, 71 of 534 (13%) patients were scheduled for HDCT having failed previous conventional-dose first-line and first-salvage chemotherapy regimens; those 49 patients who had received at least cisplatin plus etoposide first-line as well as conventional-dose cisplatin-based first-salvage regimens and were diagnosed after 1 January 1990 were further analyzed. RESULTS Median age at SST was 32 years (range 19-52 years). Median follow-up for surviving patients was 4 years (range 1.7-8.5 years). Three of 49 (6%) patients either progressed or died before scheduled HDCT; the remaining 46 of 49 (94%) received either single or sequential HDCT. The rate of favorable responses to HDCT was 27 of 49 (55%). Nine patients remain alive and free of progression. One additional patient was lost to follow without progression at 4 years. The projected overall survival rate at 5 years was 17% (95% confidence intervals 7% to 30%). CONCLUSION HDCT can induce remissions in patients with multiple relapsed GCTs with a long-term survival rate of approximately 17%.
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Affiliation(s)
- A Lorch
- Departments of Hematology and Oncology, Universitätsklinikum Giessen und Marburg GmbH, Marburg
| | - A Neubauer
- Departments of Hematology and Oncology, Universitätsklinikum Giessen und Marburg GmbH, Marburg
| | - M Hackenthal
- Departments of Hematology and Oncology, Vivantes Klinikum Am Urban, Berlin
| | - A Dieing
- Departments of Hematology and Oncology, Charite Campus Mitte, Berlin
| | - J T Hartmann
- Departments of Hematology and Oncology, South West German Comprehensive Cancer Center, Tübingen
| | - O Rick
- Departments of Hematology and Oncology, Klinik Reinhardshöhe, Bad Wildungen
| | - C Bokemeyer
- Departments of Oncology, Hematology and BMT with section Pneumology, Hubertus Wald Tumorzentrum - UCCH University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - J Beyer
- Departments of Hematology and Oncology, Vivantes Klinikum Am Urban, Berlin.
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Beyer J, Hackenthal M, Lorch A, Neubauer A, Dieing A, Rick O, Hartmann JT, Bokemeyer C. High-dose chemotherapy (HDCT) as second salvage treatment in patients with multiple relapsed or refractory germ cell tumors. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.5082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
5082 Background: To determine the activity of high-dose chemotherapy (HDCT) as intensification of second salvage treatment (SST) in patients with multiple relapsed germ-cell tumors (GCT). Methods: Databases in Berlin and Marburg (Germany) on patients treated with HDCT between 1989 and 2008 for germ-cell tumors were screened. Among 534 patients overall, 71/534 (13%) patients were identified as scheduled for HDCT having failed at least one previous conventional-dose first-line and first-salvage chemotherapy regimen. Forty-nine patients who had received at least cisplatin- and etoposide as first-line as well as conventional-dose cisplatin as first-salvage treatment and were diagnosed after January 1, 1990, were further analyzed. Results: Median age at SST was 32 years (range 19 to 52 years). Median follow-up for surviving patients was 4 years (range 1,7 to 8,5 years). Histology was pure seminoma in 5/49 (10%) patients and non-seminoma or mixed histologies in 44/49 (90%). The median number of cisplatin-based treatment cycles prior to SST was 7 (range 5 to 11 cycles). Three of forty-nine (6%) patients either progressed or died prior to scheduled HDCT, the remaining 46/49 (94%) received either single or sequential HDCT. The rate of favorable responses to HDCT as intensification of SST was 27/49 (55%). Ten patients are alive without progression. One additional patient is lost-to-follow at four years without progression. The projected overall survival rate at five years after initiation of SST was 17%. Conclusions: HDCT can induce long term remissions even in patients with multiple relapsed GCT. No significant financial relationships to disclose.
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Affiliation(s)
- J. Beyer
- Vivantes Klinikum Am Urban, Berlin, Germany; University Hospital Giessen Marburg, Marburg, Germany; Charite, Campus Mitte, Berlin, Germany; Klinikum Reinhardshöhe, Bad Wildungen, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - M. Hackenthal
- Vivantes Klinikum Am Urban, Berlin, Germany; University Hospital Giessen Marburg, Marburg, Germany; Charite, Campus Mitte, Berlin, Germany; Klinikum Reinhardshöhe, Bad Wildungen, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - A. Lorch
- Vivantes Klinikum Am Urban, Berlin, Germany; University Hospital Giessen Marburg, Marburg, Germany; Charite, Campus Mitte, Berlin, Germany; Klinikum Reinhardshöhe, Bad Wildungen, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - A. Neubauer
- Vivantes Klinikum Am Urban, Berlin, Germany; University Hospital Giessen Marburg, Marburg, Germany; Charite, Campus Mitte, Berlin, Germany; Klinikum Reinhardshöhe, Bad Wildungen, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - A. Dieing
- Vivantes Klinikum Am Urban, Berlin, Germany; University Hospital Giessen Marburg, Marburg, Germany; Charite, Campus Mitte, Berlin, Germany; Klinikum Reinhardshöhe, Bad Wildungen, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - O. Rick
- Vivantes Klinikum Am Urban, Berlin, Germany; University Hospital Giessen Marburg, Marburg, Germany; Charite, Campus Mitte, Berlin, Germany; Klinikum Reinhardshöhe, Bad Wildungen, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - J. T. Hartmann
- Vivantes Klinikum Am Urban, Berlin, Germany; University Hospital Giessen Marburg, Marburg, Germany; Charite, Campus Mitte, Berlin, Germany; Klinikum Reinhardshöhe, Bad Wildungen, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - C. Bokemeyer
- Vivantes Klinikum Am Urban, Berlin, Germany; University Hospital Giessen Marburg, Marburg, Germany; Charite, Campus Mitte, Berlin, Germany; Klinikum Reinhardshöhe, Bad Wildungen, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Rick O, Welter D, Landa S, Kirschneck M, Garza A, Cieza A. The WHO-ICF Core Set for breast cancer: Evaluation of the first results. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1088799] [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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Krege S, Beyer J, Souchon R, Albers P, Albrecht W, Algaba F, Bamberg M, Bodrogi I, Bokemeyer C, Cavallin-Ståhl E, Classen J, Clemm C, Cohn-Cedermark G, Culine S, Daugaard G, De Mulder PH, De Santis M, de Wit M, de Wit R, Derigs HG, Dieckmann KP, Dieing A, Droz JP, Fenner M, Fizazi K, Flechon A, Fosså SD, Garcia del Muro X, Gauler T, Geczi L, Gerl A, Germa-Lluch JR, Gillessen S, Hartmann JT, Hartmann M, Heidenreich A, Hoeltl W, Horwich A, Huddart R, Jewett M, Joffe J, Jones WG, Kisbenedek L, Klepp O, Kliesch S, Koehrmann KU, Kollmannsberger C, Kuczyk M, Laguna P, Galvis OL, Loy V, Mason MD, Mead GM, Mueller R, Nichols C, Nicolai N, Oliver T, Ondrus D, Oosterhof GO, Ares LP, Pizzocaro G, Pont J, Pottek T, Powles T, Rick O, Rosti G, Salvioni R, Scheiderbauer J, Schmelz HU, Schmidberger H, Schmoll HJ, Schrader M, Sedlmayer F, Skakkebaek NE, Sohaib A, Tjulandin S, Warde P, Weinknecht S, Weissbach L, Wittekind C, Winter E, Wood L, von der Maase H. Corrigendum to: “European Consensus Conference on Diagnosis and Treatment of Germ Cell Cancer: A Report of the Second Meeting of the European Germ Cell Cancer Consensus group (EGCCCG): Part I” [Eur Urol 2008;53:478–96] and to: “European Consensus Conference on Diagnosis and Treatment of Germ Cell Cancer: A Report of the Second Meeting of the European Germ Cell Cancer Consensus group (EGCCCG): Part II” [Eur Urol 2008;53:497–513]. Eur Urol 2008. [DOI: 10.1016/j.eururo.2008.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Seifart U, Albert US, Heim ME, Hübner J, Jungkunz W, Prokein R, Rick O, Hoffmann M, Engenhart-Cabillic R, Kopp I, Wagner U, Kalder M. [Lymphedema in patients with breast cancer--a consensus regarding diagnostics and therapy in patients with postoperative lymphedema after primary breast cancer]. REHABILITATION 2008; 46:340-8. [PMID: 18188805 DOI: 10.1055/s-2007-985170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
UNLABELLED Secondary lymphedema is one of the most frequent long-term side effects affecting up to 30% of all breast cancer patients after local surgical and radiation treatment. Destruction of the lymphatic system causes a progressive and chronic condition with functional impairments and disabilities limiting patients in their daily activities and involving nearly all aspects of their quality of life. Also, problems in the occupational area may be caused by lymphedema. The need for improving oncological management for early diagnosis and referral for effective treatment of lymphedema is a major goal of breast cancer heath care while survival improves. METHOD A systematic consensus process was performed involving all relevant partners and providers of lymphedema health care to develop a practical documentation concept and make recommendations according to the evidence of clinical studies and currently available guidelines. RESULTS A practical concept of documentation with defined assessment points was developed for evaluation and monitoring of lymphedema, which included the assessment of quality of life parameters with recognised instruments by the patient themselves. Consensus recommendations for the postoperative management, prevention, treatment and follow-up of breast cancer patients along a clinical algorithm for in- and outpatient care were finalized. CONCLUSION With improved survival, long-term side effects with major impact on quality of life become a most important end point criteria of oncological treatment. The clearly defined documentation concept and the comprehensive recommendations for lymphedema management may assist clinicians and patients to make timely decisions about in- and outpatient health care practice to optimize the interface between acute medicine and rehabilitation. Patients' compliance with treatment and prevention routines will be as important as ensuring the continuity of care. A longitudinal prospective study evaluating the effectiveness and efficacy of the consensus recommendation is currently being implemented.
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Affiliation(s)
- U Seifart
- Hamm-Kliniken, Bad Soden-Salmünster.
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Krege S, Beyer J, Souchon R, Albers P, Albrecht W, Algaba F, Bamberg M, Bodrogi I, Bokemeyer C, Cavallin-Ståhl E, Classen J, Clemm C, Cohn-Cedermark G, Culine S, Daugaard G, De Mulder PH, De Santis M, de Wit M, de Wit R, Derigs HG, Dieckmann KP, Dieing A, Droz JP, Fenner M, Fizazi K, Flechon A, Fosså SD, Garcia del Muro X, Gauler T, Geczi L, Gerl A, Germa-Lluch JR, Gillessen S, Hartmann JT, Hartmann M, Heidenreich A, Hoeltl W, Horwich A, Huddart R, Jewett M, Joffe J, Jones WG, Kisbenedek L, Klepp O, Kliesch S, Koehrmann KU, Kollmannsberger C, Kuczyk M, Laguna P, Leiva Galvis O, Loy V, Mason MD, Mead GM, Mueller R, Nichols C, Nicolai N, Oliver T, Ondrus D, Oosterhof GO, Paz-Ares L, Pizzocaro G, Pont J, Pottek T, Powles T, Rick O, Rosti G, Salvioni R, Scheiderbauer J, Schmelz HU, Schmidberger H, Schmoll HJ, Schrader M, Sedlmayer F, Skakkebaek NE, Sohaib A, Tjulandin S, Warde P, Weinknecht S, Weissbach L, Wittekind C, Winter E, Wood L, von der Maase H. European Consensus Conference on Diagnosis and Treatment of Germ Cell Cancer: A Report of the Second Meeting of the European Germ Cell Cancer Consensus Group (EGCCCG): Part II. Eur Urol 2008; 53:497-513. [PMID: 18191015 DOI: 10.1016/j.eururo.2007.12.025] [Citation(s) in RCA: 190] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Accepted: 12/06/2007] [Indexed: 10/22/2022]
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Krege S, Beyer J, Souchon R, Albers P, Albrecht W, Algaba F, Bamberg M, Bodrogi I, Bokemeyer C, Cavallin-Ståhl E, Classen J, Clemm C, Cohn-Cedermark G, Culine S, Daugaard G, De Mulder PH, De Santis M, de Wit M, de Wit R, Derigs HG, Dieckmann KP, Dieing A, Droz JP, Fenner M, Fizazi K, Flechon A, Fosså SD, Garcia del Muro X, Gauler T, Geczi L, Gerl A, Germa-Lluch JR, Gillessen S, Hartmann JT, Hartmann M, Heidenreich A, Hoeltl W, Horwich A, Huddart R, Jewett M, Joffe J, Jones WG, Kisbenedek L, Klepp O, Kliesch S, Koehrmann KU, Kollmannsberger C, Kuczyk M, Laguna P, Leiva Galvis O, Loy V, Mason MD, Mead GM, Mueller R, Nichols C, Nicolai N, Oliver T, Ondrus D, Oosterhof GO, Paz Ares L, Pizzocaro G, Pont J, Pottek T, Powles T, Rick O, Rosti G, Salvioni R, Scheiderbauer J, Schmelz HU, Schmidberger H, Schmoll HJ, Schrader M, Sedlmayer F, Skakkebaek NE, Sohaib A, Tjulandin S, Warde P, Weinknecht S, Weissbach L, Wittekind C, Winter E, Wood L, von der Maase H. European Consensus Conference on Diagnosis and Treatment of Germ Cell Cancer: A Report of the Second Meeting of the European Germ Cell Cancer Consensus group (EGCCCG): Part I. Eur Urol 2008; 53:478-96. [PMID: 18191324 DOI: 10.1016/j.eururo.2007.12.024] [Citation(s) in RCA: 330] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Accepted: 12/06/2007] [Indexed: 10/22/2022]
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Sammler C, Beyer J, Bokemeyer C, Hartmann J, Rick O. Risk factors in germ cell tumour patients with relapse or progressive disease after first-line chemotherapy: Evaluation of a prognostic score for survival after high-dose chemotherapy. Eur J Cancer 2008; 44:237-43. [DOI: 10.1016/j.ejca.2007.10.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2007] [Revised: 10/25/2007] [Accepted: 10/30/2007] [Indexed: 10/22/2022]
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Hartmann JT, Gauler T, Metzner B, Gerl A, Casper J, Rick O, Horger M, Schleicher J, Derigs G, Mayer-Steinacker R, Beyer J, Kuczyk MA, Bokemeyer C. Phase I/II study of sequential dose-intensified ifosfamide, cisplatin, and etoposide plus paclitaxel as induction chemotherapy for poor prognosis germ cell tumors by the German Testicular Cancer Study Group. J Clin Oncol 2007; 25:5742-7. [PMID: 18089869 DOI: 10.1200/jco.2007.11.9099] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To evaluate the feasibility and the toxicity of sequential, dose-intensified chemotherapy combined with paclitaxel plus peripheral blood-derived hematopoietic stem-cell support (PBSC) for patients with untreated metastatic germ cell tumors (GCTs) who have poor International Germ Cell Consensus Cancer Group prognostic features. PATIENTS AND METHODS Paclitaxel was added to high-dose (HD) etoposide, ifosfamide, and cisplatin (VIP; etoposide 1,500 mg/m2, ifosfamide 10,000 mg/m2, and cisplatin 100 mg/m2; cumulative dose; days -6 through -2 per cycle) at three dose levels (135, 175, and 225 mg/m2) applied on day -6. Cycles were supported by PBSC and granulocyte colony-stimulating factor. One cycle of standard VIP was administered before start of HD-VIP plus paclitaxel cycles to collect autologous PBSC. RESULTS Fifty-two of 53 patients receiving 152 cycles were assessable. As expected, myelosuppression was the major adverse effect. Median durations of leukocytes less than 1,000/microL and thrombocytes less than 25,000/microL were 6 and 4 days, respectively, independently of the dose of paclitaxel applied. WHO grade 2 neurotoxicity and grade 3 encephalopathy were observed in 5% of patients each. Other main adverse effects observed were stomatitis, diarrhea, and obstipation. Seventy-nine percent of patients achieved a favorable response to chemotherapy plus secondary surgery. After a median follow-up time of 41 months in surviving patients, the calculated 2- and 5-year survival rates were 77.6% (95% CI, 65.4% to 89.9%) and 75.2% (95% CI, 62.5% to 87.8%), respectively. CONCLUSION Dose-intensive, sequential HD-VIP plus paclitaxel up to a dose of 225 mg/m2 in patients with poor prognosis GCT is a feasible approach. The regimen warrants investigation for its therapeutic potential in an expanded cohort of poor prognosis GCT patients.
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Affiliation(s)
- Jörg T Hartmann
- Department of Oncology, South West German Comprehensive Cancer Center, Eberhard-Karls-University of Tuebingen, Otfried-Mueller-Str 10, 72076 Tuebingen, Germany.
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Lorch A, Kollmannsberger C, Hartmann JT, Metzner B, Schmidt-Wolf IGH, Berdel WE, Weissinger F, Schleicher J, Egerer G, Haas A, Schirren R, Beyer J, Bokemeyer C, Rick O. Single Versus Sequential High-Dose Chemotherapy in Patients With Relapsed or Refractory Germ Cell Tumors: A Prospective Randomized Multicenter Trial of the German Testicular Cancer Study Group. J Clin Oncol 2007; 25:2778-84. [PMID: 17602082 DOI: 10.1200/jco.2006.09.2148] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.9] [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: 11/20/2022] Open
Abstract
Purpose To compare single versus sequential high-dose chemotherapy (HDCT) as first or subsequent salvage treatment in patients with relapsed or refractory germ cell tumors (GCTs). Patients and Methods Between November 1999 and November 2004, 230 patients were planned to be recruited in a prospective, randomized, multicenter trial comparing one cycle of cisplatin 100 mg/m2, etoposide 375 mg/m2, and ifosfamide 6 g/m2 (VIP) plus three cycles of high-dose carboplatin 1,500 mg/m2 and etoposide 1,500 mg/m2 (CE; arm A) versus three cycles of VIP plus one cycle of high-dose carboplatin 2,200 mg/m2, etoposide 1,800 mg/m2, and cyclophosphamide 6,400 mg/m2 (CEC; arm B). Results The study was stopped prematurely after recruitment of 216 patients as a result of excess treatment-related mortality in arm B. One hundred eleven (51%) of 216 patients were randomly assigned to sequential HDCT, and 105 (47%) of 216 patients were randomly assigned to single HDCT. Five (2%) of 216 patients had to be excluded because of non-GCT histologies at review. With a median follow-up time of 36 months, 109 (52%) of 211 patients were alive, and 91 (43%) of 211 patients were progression free. At 1 year, event-free, progression-free, and overall survival rates were 40%, 53%, and 80%, respectively, in arm A compared with 37%, 49%, and 61%, respectively, in arm B (P > .05 for all comparisons). Treatment-related deaths, mainly as a result of sepsis and cardiac toxicity, were less frequent in arm A (four of 108 patients, 4%) compared with arm B (16 of 103 patients, 16%; P < .01). Conclusion We found no difference in survival probabilities between single HDCT using CE and sequential HDCT using CEC. Sequential HDCT was better tolerated and resulted in fewer treatment-related deaths.
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Affiliation(s)
- Anja Lorch
- Department of Hematology, Universitätsklinikum Giessen und Marburg GmbH, Marburg, Germany
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Lorch A, Rick O, Hartmann JT, Metzner B, Glasmacher A, Berdel W, Schirren R, Bokemeyer C, Beyer J. Outcome in 41 patients with late relapse germ cell tumors (GCT) treated with high-dose chemotherapy (HDCT). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.5086] [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
5086 Background: The management of patients (pts) with late-relapse GCT and unresectable tumors or very high tumor markers is controversial. Methods: A total of 41 late-relapse pts were identified among a group of 216 pts with refractory or relapsed GCT who were treated in an open, prospective, randomized, multicenter phase III trial. Late relapse was defined as any relapse occurring more than 2 years after completion of initial chemotherapy for GCT. Treatment consisted of either one cycle cisplatin 100 mg/m2, etoposide 375 mg/m2 and ifosfamide 6 g/m2 (VIP) plus three cycles of high-dose carboplatin 1,500 mg/m2 and etoposide 1,500 mg/m2 (CE, arm A) or of three cycles of VIP plus one cycle high-dose carboplatin 2,200 mg/m2, etoposide 1,800 mg/m2 and cyclophosphamide 6,400 mg/m2 (CEC, arm B). Each HDCT was followed by reinfusion of autologous peripheral blood progenitor cells. Results: Overall 20 pts with late-relapse GCT received sequential HDCT and 21 pts single HDCT when the study was stopped due to excess treatment-related mortality in arm B; median time to late relapse in 41 pts was 5.4 years (range 2–18 years); 8/41 (20%) pts had seminomatous GCT, 32/41 (78%) pts had nonseminomatous GCT with or without teratoma; one pt (2%) had unknown GCT histology. No non-GCT histologies were included. The retroperitonum was most commonly involved in 30/41 (73%) pts. 29 of 41 (71%) pts had unresectable, multifocal disease and 20/41 (49%) pts also had very high markers. A complete remission to chemotherapy alone was achieved in 4/41 (10%) pts, 16/41 (39%) pts achieved a partial remission with negative tumor markers. The remaining 21/41 (51%) either had a transient or no response despite HDCT. Residual tumor resections were performed in 17/41 (41%) pts. Residual tumor histology was viable cancer in 8/17 (47%) pts, teratoma in 4/17 (24%) pts and necrosis in 5/17 (25%) pts. With a minimum follow-up of 1 year and a median follow-up of 3 years the estimated Kaplan-Meier rates are 17%, 20% and 32% for event-free, progression-free and overall survival. Conclusion: Treatment outcome after HDCT was inferior in late-relapse pts compared to the group of pts who relapsed within less than 2 years. Despite an overall poor prognosis, HDCT can still result in long-term remissions in selected late-relapse GCT pts. No significant financial relationships to disclose.
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Affiliation(s)
- A. Lorch
- Universitaetsklinikum Giessen und Marburg, Marburg, Germany; Klinik Reinhardshöhe, Bad Wildungen, Germany; Universitaetsklinikum Tuebingen, Tuebingen, Germany; Klinikum Oldenburg, Oldenburg, Germany; Universitaetsklinikum Bonn, Bonn, Germany; Universitaetsklinikum Muenster, Muenster, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Urban Krankenhaus Berlin, Berlin, Germany
| | - O. Rick
- Universitaetsklinikum Giessen und Marburg, Marburg, Germany; Klinik Reinhardshöhe, Bad Wildungen, Germany; Universitaetsklinikum Tuebingen, Tuebingen, Germany; Klinikum Oldenburg, Oldenburg, Germany; Universitaetsklinikum Bonn, Bonn, Germany; Universitaetsklinikum Muenster, Muenster, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Urban Krankenhaus Berlin, Berlin, Germany
| | - J. T. Hartmann
- Universitaetsklinikum Giessen und Marburg, Marburg, Germany; Klinik Reinhardshöhe, Bad Wildungen, Germany; Universitaetsklinikum Tuebingen, Tuebingen, Germany; Klinikum Oldenburg, Oldenburg, Germany; Universitaetsklinikum Bonn, Bonn, Germany; Universitaetsklinikum Muenster, Muenster, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Urban Krankenhaus Berlin, Berlin, Germany
| | - B. Metzner
- Universitaetsklinikum Giessen und Marburg, Marburg, Germany; Klinik Reinhardshöhe, Bad Wildungen, Germany; Universitaetsklinikum Tuebingen, Tuebingen, Germany; Klinikum Oldenburg, Oldenburg, Germany; Universitaetsklinikum Bonn, Bonn, Germany; Universitaetsklinikum Muenster, Muenster, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Urban Krankenhaus Berlin, Berlin, Germany
| | - A. Glasmacher
- Universitaetsklinikum Giessen und Marburg, Marburg, Germany; Klinik Reinhardshöhe, Bad Wildungen, Germany; Universitaetsklinikum Tuebingen, Tuebingen, Germany; Klinikum Oldenburg, Oldenburg, Germany; Universitaetsklinikum Bonn, Bonn, Germany; Universitaetsklinikum Muenster, Muenster, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Urban Krankenhaus Berlin, Berlin, Germany
| | - W. Berdel
- Universitaetsklinikum Giessen und Marburg, Marburg, Germany; Klinik Reinhardshöhe, Bad Wildungen, Germany; Universitaetsklinikum Tuebingen, Tuebingen, Germany; Klinikum Oldenburg, Oldenburg, Germany; Universitaetsklinikum Bonn, Bonn, Germany; Universitaetsklinikum Muenster, Muenster, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Urban Krankenhaus Berlin, Berlin, Germany
| | - R. Schirren
- Universitaetsklinikum Giessen und Marburg, Marburg, Germany; Klinik Reinhardshöhe, Bad Wildungen, Germany; Universitaetsklinikum Tuebingen, Tuebingen, Germany; Klinikum Oldenburg, Oldenburg, Germany; Universitaetsklinikum Bonn, Bonn, Germany; Universitaetsklinikum Muenster, Muenster, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Urban Krankenhaus Berlin, Berlin, Germany
| | - C. Bokemeyer
- Universitaetsklinikum Giessen und Marburg, Marburg, Germany; Klinik Reinhardshöhe, Bad Wildungen, Germany; Universitaetsklinikum Tuebingen, Tuebingen, Germany; Klinikum Oldenburg, Oldenburg, Germany; Universitaetsklinikum Bonn, Bonn, Germany; Universitaetsklinikum Muenster, Muenster, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Urban Krankenhaus Berlin, Berlin, Germany
| | - J. Beyer
- Universitaetsklinikum Giessen und Marburg, Marburg, Germany; Klinik Reinhardshöhe, Bad Wildungen, Germany; Universitaetsklinikum Tuebingen, Tuebingen, Germany; Klinikum Oldenburg, Oldenburg, Germany; Universitaetsklinikum Bonn, Bonn, Germany; Universitaetsklinikum Muenster, Muenster, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Urban Krankenhaus Berlin, Berlin, Germany
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Oechsle K, Honecker F, Kollmannsberger C, Rick O, Grünwald V, Mayer F, Hartmann JT, Bokemeyer C. An open-label, multicenter phase II trial of capecitabine in patients with cisplatin-refractory or relapsed germ cell tumors. Anticancer Drugs 2007; 18:273-6. [PMID: 17264758 DOI: 10.1097/cad.0b013e328011fd99] [Citation(s) in RCA: 8] [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: 11/27/2022]
Abstract
The objective of this multicenter phase II trial was to evaluate the efficacy and tolerability of capecitabine in patients with cisplatin-refractory or relapsed germ cell tumors. Between March 2003-June 2004, 14 patients refractory to at least two regimens of cisplatin-based chemotherapy or with relapse after high-dose chemotherapy and autologous peripheral blood stem cell transplantation received 1250 mg/qm capecitabine orally twice daily for 14 days in 3-week cycles. Treatment was continued until tumor progression. All patients were heavily pretreated with a median number of four previous lines of chemotherapy (range, 2-11) and 86% had relapsed after high-dose chemotherapy with peripheral blood stem cell transplantation. No patient responded to study treatment. Nine patients (64%) had progressive disease after two cycles. Two patients already stopped treatment after one cycle, because of a clinically overt tumor progression. One patient died of his tumor progression at the end of the second cycle. Two patients received four cycles of capecitabine, as progression was less than 30%. The median survival time was 4 months (range, 0-10). The toxicity profile was favorable. Eighty-six percent of the cycles could be applied without dose modifications or delay. Grade III/IV toxicities (diarrhea and anorexia in one patient each) occurred in 7% of the cases. No hematotoxicity grade III/IV was observed. Neutropenia grade I/II was documented in 21%, anemia in 35% and thrombocytopenia in 14% of the patients. Capecitabine was well tolerated, but is not effective in heavily pretreated patients with cisplatin-refractory or relapsed germ cell tumors.
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Affiliation(s)
- Karin Oechsle
- Department of Oncology/Hematology/Bone Marrow Transplantation/Pneumology, University Medical Center, Eppendort, Hamburg, Germany
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Rick O, Braun T, Siegert W, Beyer J. Activity of thalidomide in patients with platinum-refractory germ-cell tumours. Eur J Cancer 2006; 42:1775-9. [PMID: 16765039 DOI: 10.1016/j.ejca.2006.03.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2005] [Revised: 03/20/2006] [Accepted: 03/24/2006] [Indexed: 11/28/2022]
Abstract
The aim of this study was assess the activity of thalidomide in patients with progressive relapsed or platinum-refractory germ-cell tumours (GCT). Between April 2002 and January 2003, 15 patients with inoperable progressive GCT were treated with escalated daily doses of 200-600 mg thalidomide. All patients had failed first-line and salvage chemotherapy with a median of 6 (range 4-12) cisplatin-based treatment cycles, 13/15 (87%) patients had received high-dose chemotherapy (HDCT) and 8/15 (53%) patients were considered platinum-refractory or absolute refractory; 8/15 (53%) patients had previously received other palliative chemotherapy regimens. No patient achieved a complete remission (CR) or partial remission (PR). However, 5/15 (33%) patients achieved serological PR and 1 additional patient had stable disease for 3 months. The median duration of remissions was 3 months (range 2-12 months) including 2 patients with a progression-free survival of 9 and 12 months. Responses occurred mainly in patients with a low tumour burden, slow disease progression and alpha-foetoprotein (AFP) elevations. Responses to thalidomide were independent from platinum-sensitivity. Toxicity was mild, with lethargy and constipation in the majority of patients. Skin rash grade II developed in 2 patients and peripheral neurotoxicity grade II/III developed in 4 patients. One responding patient died suddenly from an unknown cause. It is concluded that thalidomide shows single-agent activity in patients with heavily pre-treated GCT, AFP elevations and slowly progressive disease.
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Affiliation(s)
- O Rick
- Klinikum Reinhardshöhe, Fachklinik für Onkologische Rehabilitation, Quellenstrasse 8-12, 34527 Bad Wildungen, Germany
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Lorch A, Rick O, Hartmann JT, Kollmannsberger C, Metzner B, Schmidt-Wolf I, Berdel WE, Schirren R, Beyer J, Bokemeyer C. Single versus sequential high-dose chemotherapy (HDCT) in patients with relapsed or refractory germ-cell tumors (GCT). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.4511] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4511 Background: Patients (pts) with relapsed or refractory GCT may be cured by HDCT. It is unknown whether single or sequential HDCT is superior. Methods: Between 11/99 and 11/04, 216 pts with relapsed or refractory GTC were treated in a prospective, randomized, multicenter phase III trial with either one cycle of cisplatin 100 mg/m2, etoposide 375 mg/m2 and ifosfamide 6 g/m2 (VIP) plus three cycles of high-dose carboplatin 1500 mg/m2 and etoposide 1500 mg/m2 (CE, arm A) or three cycles of VIP plus one cycle of high-dose carboplatin 2200 mg/m2, etoposide 1800 mg/m2 and cyclophosphamide 6400 mg/m2 (CEC, arm B) followed by reinfusion of autologous peripheral blood progenitor cells. Primary study endpoint was the event-free survival (EFS) one year after randomization. Secondary endpoints were progression-free survival (PFS), overall survival (OS) and toxicities. An event was defined as any deviation from the planned treatment, relapse, progression or death from any cause. The planned study size was 230 pts to detect a difference of 15% with an alpha error of 5% and a power of 80%. Results: The study was stopped after recruitment of 216 pts due to excess treatment-related mortality in arm B: 111 pts were randomized in arm A and 105 pts in arm B. Due to non-GCT histologies at review 5/216 pts had to be excluded from further analysis. With a median follow-up of 36 months, 109/211 (52%) evaluable pts are still alive and 91/211 (43%) are progression-free. At one year EFS; PFS and OS are 40%, 55% and 80% in arm A as compared to 37%, 49% and 61% in arm B. Treatment-related deaths mainly due to sepsis and cardiac toxicity were less frequent in arm A (4/111 pts, 4%) as compared to arm B (15/105 pts, 14%) (p = 0.01). Severe non-hematologic organ toxicities were also less frequent in arm A. Conclusions: Treatment with sequential high-dose carboplatin and etoposide is at least as effective but less toxic than single HDCT with carboplatin, etoposide and cyclophosphamide. No significant financial relationships to disclose.
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Affiliation(s)
- A. Lorch
- University Hospital, Marburg, Germany; Klinik Reinhardshoehe, Bad Wildungen, Germany; University Hospital, Tuebingen, Germany; BC Cancer Agency, Vancouver, DC, Canada; Staedtische Kliniken, Oldenburg, Germany; University Hospital, Bonn, Germany; University Hospital, Muenster, Germany; Oberschwabenklinik, Ravensburg, Germany; University Hospital, Hamburg, Germany
| | - O. Rick
- University Hospital, Marburg, Germany; Klinik Reinhardshoehe, Bad Wildungen, Germany; University Hospital, Tuebingen, Germany; BC Cancer Agency, Vancouver, DC, Canada; Staedtische Kliniken, Oldenburg, Germany; University Hospital, Bonn, Germany; University Hospital, Muenster, Germany; Oberschwabenklinik, Ravensburg, Germany; University Hospital, Hamburg, Germany
| | - J. T. Hartmann
- University Hospital, Marburg, Germany; Klinik Reinhardshoehe, Bad Wildungen, Germany; University Hospital, Tuebingen, Germany; BC Cancer Agency, Vancouver, DC, Canada; Staedtische Kliniken, Oldenburg, Germany; University Hospital, Bonn, Germany; University Hospital, Muenster, Germany; Oberschwabenklinik, Ravensburg, Germany; University Hospital, Hamburg, Germany
| | - C. Kollmannsberger
- University Hospital, Marburg, Germany; Klinik Reinhardshoehe, Bad Wildungen, Germany; University Hospital, Tuebingen, Germany; BC Cancer Agency, Vancouver, DC, Canada; Staedtische Kliniken, Oldenburg, Germany; University Hospital, Bonn, Germany; University Hospital, Muenster, Germany; Oberschwabenklinik, Ravensburg, Germany; University Hospital, Hamburg, Germany
| | - B. Metzner
- University Hospital, Marburg, Germany; Klinik Reinhardshoehe, Bad Wildungen, Germany; University Hospital, Tuebingen, Germany; BC Cancer Agency, Vancouver, DC, Canada; Staedtische Kliniken, Oldenburg, Germany; University Hospital, Bonn, Germany; University Hospital, Muenster, Germany; Oberschwabenklinik, Ravensburg, Germany; University Hospital, Hamburg, Germany
| | - I. Schmidt-Wolf
- University Hospital, Marburg, Germany; Klinik Reinhardshoehe, Bad Wildungen, Germany; University Hospital, Tuebingen, Germany; BC Cancer Agency, Vancouver, DC, Canada; Staedtische Kliniken, Oldenburg, Germany; University Hospital, Bonn, Germany; University Hospital, Muenster, Germany; Oberschwabenklinik, Ravensburg, Germany; University Hospital, Hamburg, Germany
| | - W. E. Berdel
- University Hospital, Marburg, Germany; Klinik Reinhardshoehe, Bad Wildungen, Germany; University Hospital, Tuebingen, Germany; BC Cancer Agency, Vancouver, DC, Canada; Staedtische Kliniken, Oldenburg, Germany; University Hospital, Bonn, Germany; University Hospital, Muenster, Germany; Oberschwabenklinik, Ravensburg, Germany; University Hospital, Hamburg, Germany
| | - R. Schirren
- University Hospital, Marburg, Germany; Klinik Reinhardshoehe, Bad Wildungen, Germany; University Hospital, Tuebingen, Germany; BC Cancer Agency, Vancouver, DC, Canada; Staedtische Kliniken, Oldenburg, Germany; University Hospital, Bonn, Germany; University Hospital, Muenster, Germany; Oberschwabenklinik, Ravensburg, Germany; University Hospital, Hamburg, Germany
| | - J. Beyer
- University Hospital, Marburg, Germany; Klinik Reinhardshoehe, Bad Wildungen, Germany; University Hospital, Tuebingen, Germany; BC Cancer Agency, Vancouver, DC, Canada; Staedtische Kliniken, Oldenburg, Germany; University Hospital, Bonn, Germany; University Hospital, Muenster, Germany; Oberschwabenklinik, Ravensburg, Germany; University Hospital, Hamburg, Germany
| | - C. Bokemeyer
- University Hospital, Marburg, Germany; Klinik Reinhardshoehe, Bad Wildungen, Germany; University Hospital, Tuebingen, Germany; BC Cancer Agency, Vancouver, DC, Canada; Staedtische Kliniken, Oldenburg, Germany; University Hospital, Bonn, Germany; University Hospital, Muenster, Germany; Oberschwabenklinik, Ravensburg, Germany; University Hospital, Hamburg, Germany
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Sammler C, Beyer J, Bokemeyer C, Hartmann J, Siegert W, Rick O. Evaluation of prognosis in relapsed germ cell tumors: Identification of patients who profit from high dose chemotherapy (HDCT). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.4585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
4585 Background: To identify prognostic variables in patients (pts) with metastatic germ cell tumors (GCT) and relapse or progression after first-line chemotherapy (FLC). Methods: In our database of 257 GCT pts treated with HDCT, 176/257 (67.4%) pts with first relapse or progression were identified. All patients had received platinum-based FLC. As salvage treatment all pts had received 1–3 cycles of conventional-dose salvage chemotherapy (CDCT) followed by one cycle HDCT. First, pts were retrospectively classified according to a prognostic score developed for CDCT by Fossa et al. [Br J Cancer 1999,80:1392], based on variables present at the time of relapse. Thereafter, a multivariate analysis was performed to evaluate further risk factors. Results: After a median follow up of 9 years the event-free survival (EFS) and overall survival (OS) for all 176 patients was 34% and 38%, respectively. Patients with good (n= 100/176, 57%) and poor (n = 76/176, 43%) prognosis in accordance to Fossa et al. showed an EFS of 41% and 26% (p < 0.01) and an OS of 47% and 26% (p < 0.01). Thus, in contrast to the data of Fossa et al, long-term survival could be demonstrated even in the poor prognosis subset. In the multivariate analysis, the level of elevated tumor markers alfa-fetoprotein and human chorionic gonadotrophin (p < 0.01), the presence of extrapulmonal visceral metastases (p < 0.01) and refractoriness to cisplatin (p < 0.01) adversely influenced OS after HDCT significantly. Based on these latter factors three different groups with increasingly poor OS could be identified: none factor (n = 39/176, 22%) 4 year OS of 59%, one factor (n = 78/176, 44%) 6 year OS of 42% and more than one factor (n = 59/176, 34%) 4 year OS of 17%. Conclusion: In pts with first relapse or progression after platinum-based FLC high serum tumor markers, presence of extrapulmonal visceral metastases and cisplatin refractoriness proved to be independent prognostic significance for OS after salvage HDCT. However, even in the poor prognosis subset long-term survival could be demonstrated. No significant financial relationships to disclose.
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Affiliation(s)
- C. Sammler
- Klinikum Braunschweig, Braunschweig, Germany; Oberschwabenklinik, Ravensburg, Germany; Universitätsklinikum, Hamburg, Germany; Universitätsklinikum, Tübingen, Germany; Charité Berlin, Berlin, Germany; Klinik Reinhardshoehe, Bad Wildungen, Germany
| | - J. Beyer
- Klinikum Braunschweig, Braunschweig, Germany; Oberschwabenklinik, Ravensburg, Germany; Universitätsklinikum, Hamburg, Germany; Universitätsklinikum, Tübingen, Germany; Charité Berlin, Berlin, Germany; Klinik Reinhardshoehe, Bad Wildungen, Germany
| | - C. Bokemeyer
- Klinikum Braunschweig, Braunschweig, Germany; Oberschwabenklinik, Ravensburg, Germany; Universitätsklinikum, Hamburg, Germany; Universitätsklinikum, Tübingen, Germany; Charité Berlin, Berlin, Germany; Klinik Reinhardshoehe, Bad Wildungen, Germany
| | - J. Hartmann
- Klinikum Braunschweig, Braunschweig, Germany; Oberschwabenklinik, Ravensburg, Germany; Universitätsklinikum, Hamburg, Germany; Universitätsklinikum, Tübingen, Germany; Charité Berlin, Berlin, Germany; Klinik Reinhardshoehe, Bad Wildungen, Germany
| | - W. Siegert
- Klinikum Braunschweig, Braunschweig, Germany; Oberschwabenklinik, Ravensburg, Germany; Universitätsklinikum, Hamburg, Germany; Universitätsklinikum, Tübingen, Germany; Charité Berlin, Berlin, Germany; Klinik Reinhardshoehe, Bad Wildungen, Germany
| | - O. Rick
- Klinikum Braunschweig, Braunschweig, Germany; Oberschwabenklinik, Ravensburg, Germany; Universitätsklinikum, Hamburg, Germany; Universitätsklinikum, Tübingen, Germany; Charité Berlin, Berlin, Germany; Klinik Reinhardshoehe, Bad Wildungen, Germany
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Albert US, Seifart U, Heim ME, Hübner J, Jungkunz W, Prokein R, Rick O, Hoffmann M, Engenhart-Cabillic R, Kopp I, Wagner U, Kalder M. Lymphödem bei Mammakarzinom: Regionale Konsensus-Empfehlungen zum postoperativen Management, Prävention, Therapie und Nachsorge. Geburtshilfe Frauenheilkd 2005. [DOI: 10.1055/s-2005-872873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Hartmann JT, Rick O, Oechsle K, Kuczyk M, Gauler T, Schöffski P, Schleicher J, Mayer F, Teichmann R, Kanz L, Bokemeyer C. Role of postchemotherapy surgery in the management of patients with liver metastases from germ cell tumors. Ann Surg 2005; 242:260-6. [PMID: 16041217 PMCID: PMC1357732 DOI: 10.1097/01.sla.0000171303.32006.a2] [Citation(s) in RCA: 20] [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: 11/27/2022]
Abstract
OBJECTIVE To evaluate the role of postchemotherapy adjunctive surgery in patients with liver metastases from germ cell cancer (GCT). PATIENTS AND METHODS Forty-three male patients with nonseminoma were treated in different multicenter treatment protocols between 1990 and 1999, and they underwent hepatic surgery. The results of postchemotherapy surgical resection, histologic findings found during postchemotherapy surgery, and prognostic factors for survival were assessed. RESULTS Thirty-five of 43 patients (81%) were initially diagnosed with liver metastases and advanced GCT, and 8 patients (19%) presented with metachronous liver metastases after a median interval of 16 months (range, 6-103 months). Twelve patients (28%) had isolated liver metastases after completion of chemotherapy, while 31 patients (72%) had additional residual extrahepatic tumor masses. Liver surgery included tumor excision or segmentectomy in 32 patients (74%) and hepatectomy (right/left) or resection of multiple segments in 11 patients (26%). Histologic analysis of postchemotherapy resected residua yielded necrosis in 67%, teratoma in 12%, and viable cancer in 21%. Additional resections at other sites have been performed in 31 patients revealing necrosis in 61% (n = 19), teratoma in 29% (n = 9), and vital carcinoma in 10% (n = 3). In 39% of patients, histologic findings differed among liver and other resection sites. Refractoriness to chemotherapy was associated with a shorter survival after surgery, and a trend was seen in patients with elevation of AFP. CONCLUSION The high rate of viable cancer and teratoma found in liver specimens, differing histologic results at residual tumor locations, and the high survival rate achieved support a multidisciplinary approach including resection of liver masses since no accurate selection of patients can narrow the use of surgery.
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Affiliation(s)
- Jörg Thomas Hartmann
- Department of Hematology/Oncology/Immunology, UKT Medical Center II, Eberhard-Karls-University, Tübingen, Germany.
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Dieckmann KP, Albers P, Classen J, De Wit M, Pichlmeier U, Rick O, Müllerleile U, Kuczyk M. LATE RELAPSE OF TESTICULAR GERM CELL NEOPLASMS: A DESCRIPTIVE ANALYSIS OF 122 CASES. J Urol 2005; 173:824-9. [PMID: 15711278 DOI: 10.1097/01.ju.0000154013.96349.36] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.4] [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: 01/03/2023]
Abstract
PURPOSE The problem of late relapse of testicular germ cell tumor (GCT) is poorly understood. No more than approximately 300 cases have been reported to date. It appears that late relapse (L/R) of GCT involves a more aggressive biology than virginal GCT. In the present study we increased the understanding of L/R by analyzing these events in a large patient sample. MATERIALS AND METHODS Late relapse was defined as recurrence of disease more than 2 years after completion of primary treatment. A total of 122 patients (50 with pure seminoma and 72 with nonseminoma) were retrospectively studied. Several parameters were analyzed including age, clinical stage, treatment at primary presentation, occurrence of prior early relapse, interval to L/R, tumor markers, site of relapse, and mode and outcome of L/R treatment. Possible effects of various clinical parameters on treatment results were studied by multivariate statistical analysis. RESULTS Median age at first presentation was 34 years and 26.5 years in patients with seminoma and nonseminoma, respectively. The intervals to L/R were 42 months (range 25 to 276) in seminoma and 64.5 months (range 28 to 216) in nonseminoma. A total of 75% of nonseminomas but only 20% of seminomas had disseminated disease at first presentation, while 51 patients with nonseminoma had initially received chemotherapy. alpha-Fetoprotein was increased in 45 patients (of 59 eligible) with nonseminoma at L/R, human chorionic gonadotropin in 12 cases. alpha-Fetoprotein levels greater than 100 U/l indicated poor prognosis. Topographically relapses were mainly confined to lymph nodes of the abdomen, chest and neck. Of 72 patients with nonseminoma cure failed in 37 in contrast to only 6 patients with seminoma (of 48 eligible). Inclusion of surgery increased the chance of cure (RR 4.0, 95% confidence interval 0.9-18.5). CONCLUSIONS Late relapses of GCT are biologically and clinically distinct from virginal GCT. These events occur in nonseminoma and seminoma, but clinical features are quite different in the 2 groups. Increase of alpha-fetoprotein is typical in late relapsing nonseminoma and levels of more than 100 U/l appear to indicate poor prognosis. Anatomically L/R presents as lymphadenopathy of abdomen, chest or neck. Treatment should include surgery in nonseminoma. Seminomas and otherwise chemotherapy naive cases might respond to chemotherapy only. Particular risk groups for late relapse are nonseminoma with prior early relapse, patients receiving chemotherapy for disseminated disease at first presentation and those with pure teratoma. These latter subgroups should be followed with annual health examinations for at least 10 years.
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Rick O, Bokemeyer C, Weinknecht S, Schirren J, Pottek T, Hartmann JT, Braun T, Rachud B, Weissbach L, Hartmann M, Siegert W, Beyer J. Residual tumor resection after high-dose chemotherapy in patients with relapsed or refractory germ cell cancer. J Clin Oncol 2004; 22:3713-9. [PMID: 15365067 DOI: 10.1200/jco.2004.07.124] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.0] [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: 11/20/2022] Open
Abstract
PURPOSE To assess the role of residual tumor resection performed after high-dose chemotherapy (HDCT) in patients with relapsed or refractory germ cell tumors (GCT). PATIENTS AND METHODS Between July 1987 and October 1999, postchemotherapy resections of residual tumors were performed in 57 patients who had been treated with HDCT for relapsed or refractory GCT and who had achieved a partial remission to this treatment. RESULTS Complete resections of residual masses were achieved in 52 (91%) of 57 patients who were rendered disease free; in five (9%) of 57 patients, the resections were incomplete. Resection of a single site was performed in 39 (68%) of 57 patients, and the remaining 18 (32%) of 57 patients required interventions at two or more residual tumor sites. Necrosis was found in 22 (38%) of 57 patients, mature teratoma with or without necrosis was found in nine (16%) of 57 patients, and viable cancer with or without additional necrosis or mature teratoma was found in 26 (46%) of 57 patients. Viable cancer consisted either of residual germ cell or undifferentiated cancer in 22 (85%) of 26 patients, with additional non-GCT histologies in the remaining four patients. Patients with viable cancer had a significantly inferior outcome after surgery compared with patients with necrosis and/or mature teratoma even if all cancer was completely resected. Pulmonary lesions with a diameter of more than 2 cm were the only predictive variable for viable cancer in univariate analysis. CONCLUSION Resections of all residual tumors should be attempted in patients with relapsed or refractory GCT and partial remissions after HDCT.
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Affiliation(s)
- O Rick
- Department of Hematology and Oncology, Charité, Germany
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Schmoll HJ, Souchon R, Krege S, Albers P, Beyer J, Kollmannsberger C, Fossa SD, Skakkebaek NE, de Wit R, Fizazi K, Droz JP, Pizzocaro G, Daugaard G, de Mulder PHM, Horwich A, Oliver T, Huddart R, Rosti G, Paz Ares L, Pont O, Hartmann JT, Aass N, Algaba F, Bamberg M, Bodrogi I, Bokemeyer C, Classen J, Clemm S, Culine S, de Wit M, Derigs HG, Dieckmann KP, Flasshove M, Garcia del Muro X, Gerl A, Germa-Lluch JR, Hartmann M, Heidenreich A, Hoeltl W, Joffe J, Jones W, Kaiser G, Klepp O, Kliesch S, Kisbenedek L, Koehrmann KU, Kuczyk M, Laguna MP, Leiva O, Loy V, Mason MD, Mead GM, Mueller RP, Nicolai N, Oosterhof GON, Pottek T, Rick O, Schmidberger H, Sedlmayer F, Siegert W, Studer U, Tjulandin S, von der Maase H, Walz P, Weinknecht S, Weissbach L, Winter E, Wittekind C. European consensus on diagnosis and treatment of germ cell cancer: a report of the European Germ Cell Cancer Consensus Group (EGCCCG). Ann Oncol 2004; 15:1377-99. [PMID: 15319245 DOI: 10.1093/annonc/mdh301] [Citation(s) in RCA: 380] [Impact Index Per Article: 19.0] [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: 11/12/2022] Open
Abstract
Germ cell tumour is the most frequent malignant tumour type in young men with a 100% rise in the incidence every 20 years. Despite this, the high sensitivity of germ cell tumours to platinum-based chemotherapy, together with radiation and surgical measures, leads to the high cure rate of > or = 99% in early stages and 90%, 75-80% and 50% in advanced disease with 'good', 'intermediate' and 'poor' prognostic criteria (IGCCCG classification), respectively. The high cure rate in patients with limited metastatic disease allows the reduction of overall treatment load, and therefore less acute and long-term toxicity, e.g. organ sparing surgery for specific cases, reduced dose and treatment volume of irradiation or substitution of node dissection by surveillance or adjuvant chemotherapy according to the presence or absence of vascular invasion. Thus, different treatment options according to prognostic factors including histology, stage and patient factors and possibilities of the treating centre as well may be used to define the treatment strategy which is definitively chosen for an individual patient. However, this strategy of reduction of treatment load as well as the treatment itself require very high expertise of the treating physician with careful management and follow-up and thorough cooperation by the patient as well to maintain the high rate for cure. Treatment decisions must be based on the available evidence which has been the basis for this consensus guideline delivering a clear proposal for diagnostic and treatment measures in each stage of gonadal and extragonadal germ cell tumour and individual clinical situations. Since this guideline is based on the highest evidence level available today, a deviation from these proposals should be a rare and justified exception.
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Affiliation(s)
- H J Schmoll
- European Germ Cell Cancer Consensus Group, Martin-Luther-University, Department of Hematology/Oncology, Halle, Germany.
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Kollmannsberger C, Schleucher N, Rick O, Metzner B, Schaefer-Eckart K, Naumann R, Mayer-Steinacker R, Hartmann JT, Kanz L, Bokemeyer C. Gonadal late effects, fertility and sexual functioning in long-term survivors after high-dose chemotherapy with autologous stem cell transplantation (HD-CT) for testicular cancer. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.4537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- C. Kollmannsberger
- University of Tuebingen Medical Center, Tuebingen, Germany; West German Cancer Center, Essen, Germany; Charite Berlin, Berlin, Germany; Klinikum Oldenburg, Oldenburg, Germany; Klinikum Nuernberg, Nuernberg, Germany; University of Dresden, Dresden, Germany; University of Ulm, Ulm, Germany
| | - N. Schleucher
- University of Tuebingen Medical Center, Tuebingen, Germany; West German Cancer Center, Essen, Germany; Charite Berlin, Berlin, Germany; Klinikum Oldenburg, Oldenburg, Germany; Klinikum Nuernberg, Nuernberg, Germany; University of Dresden, Dresden, Germany; University of Ulm, Ulm, Germany
| | - O. Rick
- University of Tuebingen Medical Center, Tuebingen, Germany; West German Cancer Center, Essen, Germany; Charite Berlin, Berlin, Germany; Klinikum Oldenburg, Oldenburg, Germany; Klinikum Nuernberg, Nuernberg, Germany; University of Dresden, Dresden, Germany; University of Ulm, Ulm, Germany
| | - B. Metzner
- University of Tuebingen Medical Center, Tuebingen, Germany; West German Cancer Center, Essen, Germany; Charite Berlin, Berlin, Germany; Klinikum Oldenburg, Oldenburg, Germany; Klinikum Nuernberg, Nuernberg, Germany; University of Dresden, Dresden, Germany; University of Ulm, Ulm, Germany
| | - K. Schaefer-Eckart
- University of Tuebingen Medical Center, Tuebingen, Germany; West German Cancer Center, Essen, Germany; Charite Berlin, Berlin, Germany; Klinikum Oldenburg, Oldenburg, Germany; Klinikum Nuernberg, Nuernberg, Germany; University of Dresden, Dresden, Germany; University of Ulm, Ulm, Germany
| | - R. Naumann
- University of Tuebingen Medical Center, Tuebingen, Germany; West German Cancer Center, Essen, Germany; Charite Berlin, Berlin, Germany; Klinikum Oldenburg, Oldenburg, Germany; Klinikum Nuernberg, Nuernberg, Germany; University of Dresden, Dresden, Germany; University of Ulm, Ulm, Germany
| | - R. Mayer-Steinacker
- University of Tuebingen Medical Center, Tuebingen, Germany; West German Cancer Center, Essen, Germany; Charite Berlin, Berlin, Germany; Klinikum Oldenburg, Oldenburg, Germany; Klinikum Nuernberg, Nuernberg, Germany; University of Dresden, Dresden, Germany; University of Ulm, Ulm, Germany
| | - J. T. Hartmann
- University of Tuebingen Medical Center, Tuebingen, Germany; West German Cancer Center, Essen, Germany; Charite Berlin, Berlin, Germany; Klinikum Oldenburg, Oldenburg, Germany; Klinikum Nuernberg, Nuernberg, Germany; University of Dresden, Dresden, Germany; University of Ulm, Ulm, Germany
| | - L. Kanz
- University of Tuebingen Medical Center, Tuebingen, Germany; West German Cancer Center, Essen, Germany; Charite Berlin, Berlin, Germany; Klinikum Oldenburg, Oldenburg, Germany; Klinikum Nuernberg, Nuernberg, Germany; University of Dresden, Dresden, Germany; University of Ulm, Ulm, Germany
| | - C. Bokemeyer
- University of Tuebingen Medical Center, Tuebingen, Germany; West German Cancer Center, Essen, Germany; Charite Berlin, Berlin, Germany; Klinikum Oldenburg, Oldenburg, Germany; Klinikum Nuernberg, Nuernberg, Germany; University of Dresden, Dresden, Germany; University of Ulm, Ulm, Germany
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Rick O, Beyer J, Braun T, Marquart U, Siegert W. Thalidomide shows activity in patients with heavily pretreated germ-cell tumors. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.4722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- O. Rick
- Universitaetsklinikum Charite, Berlin, Germany; Universitaetsklinikum Marburg, Marburg, Germany
| | - J. Beyer
- Universitaetsklinikum Charite, Berlin, Germany; Universitaetsklinikum Marburg, Marburg, Germany
| | - T. Braun
- Universitaetsklinikum Charite, Berlin, Germany; Universitaetsklinikum Marburg, Marburg, Germany
| | - U. Marquart
- Universitaetsklinikum Charite, Berlin, Germany; Universitaetsklinikum Marburg, Marburg, Germany
| | - W. Siegert
- Universitaetsklinikum Charite, Berlin, Germany; Universitaetsklinikum Marburg, Marburg, Germany
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Hartmann JT, Rick O, Thomas M, Schleicher J, Metzner B, Flasshove M, Kollmannsberger C, Schmoll HJ, Kanz L, Bokemeyer C. The role of paclitaxel in the first-line treatment of patients with ‘poor prognosis’ germ cell tumor (GCT) undergoing sequential high dose chemotherapy. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.4633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- J. T. Hartmann
- Tuebingen University, Tuebingen, Germany; Virchow Klinikum, Berlin, Germany; Muenster University, Muenster, Germany; Katharinenhospital, Stuttgart, Germany; Klinikum, Oldenburg, Germany; Essen University, Essen, Germany; Halle University, Halle, Germany
| | - O. Rick
- Tuebingen University, Tuebingen, Germany; Virchow Klinikum, Berlin, Germany; Muenster University, Muenster, Germany; Katharinenhospital, Stuttgart, Germany; Klinikum, Oldenburg, Germany; Essen University, Essen, Germany; Halle University, Halle, Germany
| | - M. Thomas
- Tuebingen University, Tuebingen, Germany; Virchow Klinikum, Berlin, Germany; Muenster University, Muenster, Germany; Katharinenhospital, Stuttgart, Germany; Klinikum, Oldenburg, Germany; Essen University, Essen, Germany; Halle University, Halle, Germany
| | - J. Schleicher
- Tuebingen University, Tuebingen, Germany; Virchow Klinikum, Berlin, Germany; Muenster University, Muenster, Germany; Katharinenhospital, Stuttgart, Germany; Klinikum, Oldenburg, Germany; Essen University, Essen, Germany; Halle University, Halle, Germany
| | - B. Metzner
- Tuebingen University, Tuebingen, Germany; Virchow Klinikum, Berlin, Germany; Muenster University, Muenster, Germany; Katharinenhospital, Stuttgart, Germany; Klinikum, Oldenburg, Germany; Essen University, Essen, Germany; Halle University, Halle, Germany
| | - M. Flasshove
- Tuebingen University, Tuebingen, Germany; Virchow Klinikum, Berlin, Germany; Muenster University, Muenster, Germany; Katharinenhospital, Stuttgart, Germany; Klinikum, Oldenburg, Germany; Essen University, Essen, Germany; Halle University, Halle, Germany
| | - C. Kollmannsberger
- Tuebingen University, Tuebingen, Germany; Virchow Klinikum, Berlin, Germany; Muenster University, Muenster, Germany; Katharinenhospital, Stuttgart, Germany; Klinikum, Oldenburg, Germany; Essen University, Essen, Germany; Halle University, Halle, Germany
| | - H.-J. Schmoll
- Tuebingen University, Tuebingen, Germany; Virchow Klinikum, Berlin, Germany; Muenster University, Muenster, Germany; Katharinenhospital, Stuttgart, Germany; Klinikum, Oldenburg, Germany; Essen University, Essen, Germany; Halle University, Halle, Germany
| | - L. Kanz
- Tuebingen University, Tuebingen, Germany; Virchow Klinikum, Berlin, Germany; Muenster University, Muenster, Germany; Katharinenhospital, Stuttgart, Germany; Klinikum, Oldenburg, Germany; Essen University, Essen, Germany; Halle University, Halle, Germany
| | - C. Bokemeyer
- Tuebingen University, Tuebingen, Germany; Virchow Klinikum, Berlin, Germany; Muenster University, Muenster, Germany; Katharinenhospital, Stuttgart, Germany; Klinikum, Oldenburg, Germany; Essen University, Essen, Germany; Halle University, Halle, Germany
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Rick O, Kollmannsberger C, Hartmann JT, Braun T, Siegert W, Bokemeyer C, Beyer J. The role of high-dose chemotherapy in relapsed germ cell tumors. World J Urol 2004; 22:25-32. [PMID: 15034739 DOI: 10.1007/s00345-004-0396-x] [Citation(s) in RCA: 4] [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] [Received: 01/22/2004] [Accepted: 01/22/2004] [Indexed: 10/26/2022] Open
Abstract
Overall, patients with relapsed or progressive germ cell tumors after cisplatin-based chemotherapy have a low chance of cure. Using conventional-dose chemotherapy (CDCT) as salvage treatment, only 15-30% of the patients will become long-term survivors. It is well known that the majority of these patients will ultimately die of their disease. Therefore, improvement of the standard treatment is clearly desirable. In the last years, high-dose chemotherapy (HDCT) has been established as an effective salvage modality. A matched-pair analysis showed an advantage for HDCT compared with CDCT with an improvement in event-free and overall survival. Furthermore, due to increasing clinical experience in the management of side-effects, the use of peripheral blood progenitor cells and the availability of hematopoietic growth factors, HDCT has become relatively safe. Therefore, HDCT should be administered in patients with first relapse and unfavorable prognostic factors, and as second or subsequent salvage treatment followed by complete resections of tumor residuals. Patients with relapse or progressive disease after HDCT who do not qualify for desperation surgery could be salvaged with palliative chemotherapy combinations using gemcitabine, oxaliplatin and paclitaxel. This report reviews the current treatment strategies and recent developments with respect to HDCT given as salvage treatment and discusses the role of prognostic factors in the management of such situations.
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Affiliation(s)
- O Rick
- Medizinische Klinik II m.S. Onkologie/Hämatologie, Universitätsklinikum Charité, Campus Mitte, Humboldt Universität, Schumannstrasse 20/21, 10117 Berlin, Germany.
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Kollmannsberger C, Beyer J, Liersch R, Schoeffski P, Metzner B, Hartmann JT, Rick O, Stengele K, Hohloch K, Spott C, Kanz L, Bokemeyer C. Combination Chemotherapy With Gemcitabine Plus Oxaliplatin in Patients With Intensively Pretreated or Refractory Germ Cell Cancer: A Study of the German Testicular Cancer Study Group. J Clin Oncol 2004; 22:108-14. [PMID: 14701772 DOI: 10.1200/jco.2004.06.068] [Citation(s) in RCA: 126] [Impact Index Per Article: 6.3] [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: 11/20/2022] Open
Abstract
Purpose Long-term survival is rarely achieved in patients with cisplatin-refractory germ cell cancer (GCT). Both single-agent gemcitabine and oxaliplatin have shown activity in patients who experience relapse or are refractory to cisplatin treatment. This study investigates the activity of a gemcitabine plus oxaliplatin regimen in these patients. Patients and Methods Gemcitabine was administered at a dose of 1,000 mg/m2 on days 1 and 8; oxaliplatin was administered at a dose of 130 mg/m2 on day 1. Response was evaluated every 4 weeks. Results Thirty-five patients with a median age of 37 years (range, 21 to 54 years) were enrolled onto the study. Primary tumor localization was gonadal, retroperitoneal, or mediastinal in 30, one, and four patients, respectively. Patients had been pretreated with a median of six platinum-containing cycles (range, four to 13 cycles) and 89% of patients previously had experienced treatment failure after high-dose chemotherapy with peripheral-blood stem-cell transplantation. Sixty-three percent of patients were considered absolutely cisplatin-refractory or cisplatin-refractory. A median of two cycles (range, 1 to 6 cycles) per patient were applied. Toxicity consisted mainly of myelosuppression, with Common Toxicity Criteria grade 3 occurring in 54% of patients. Only 9% of patients developed neutropenic fever. Three patients attained a complete remission (CR), two patients attained a marker-negative partial remission, and 11 patients attained a marker-positive partial remission, resulting in an overall response rate of 46% (95% CI, 30% to 64%). All three patients with CR and one patient with a marker-negative partial remission remained disease free at 16+, 12+, 4+, and 2+ months of follow-up. Seven (44%) of these 16 responses, including one CR, occurred in cisplatin-refractory patients. Conclusion Gemcitabine plus oxaliplatin demonstrates antitumor activity with acceptable toxicity in heavily pretreated patients with relapsed or cisplatin-refractory GCT, and may offer a chance of long-term survival for selected patients.
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Affiliation(s)
- C Kollmannsberger
- Department of Hematology/Oncology, University of Tuebingen Medical Center, Otfried-Mueller-Strasse 10, 72076 Tuebingen, Germany
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