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Kloker LD, Sidiras M, Flaadt T, Brecht IB, Deinzer CKW, Groß T, Benzler K, Zender L, Lauer UM. Clinical management of NUT carcinoma (NC) in Germany: Analysis of survival, therapy response, tumor markers and tumor genome sequencing in 35 adult patients. Lung Cancer 2024; 189:107496. [PMID: 38301600 DOI: 10.1016/j.lungcan.2024.107496] [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: 11/24/2023] [Revised: 01/22/2024] [Accepted: 01/27/2024] [Indexed: 02/03/2024]
Abstract
NUT carcinomas (NC) are very rare and highly aggressive tumors, molecularly defined by an aberrant gene fusion involving the NUTM1 gene. NCs preferentially arise intrathoracically or in the head and neck region, having a highly adverse prognosis with almost no long-term survivors. Here, we report on a cohort of 35 adult NC patients who were evaluated at University Hospital Tuebingen in an eight year time span, i.e. between 2016 and 2023. Primary objectives were overall survival (OS) and influence of primary tumor locations, fusion gene types and staging on OS. Secondary objectives were patient baseline characteristics, risk factors, tumor markers, treatment decisions and responses to therapy comparing thoracic vs non-thoracic origins. Further, data from tumor genome sequencing were analyzed. In this monocentric German cohort, 54 % of patients had thoracic tumors and 65 % harbored a BRD4-NUTM1 fusion gene. Median OS was 7.5 months, being significantly dependent on primary tumor location and nodal status. Initial misdiagnosis was a problem in 31 % of the cases. Surgery was the first treatment in most patients (46 %) and 80 % were treated with polychemotherapies, showing longer progression free survival (PFS) with ifosfamide-based than with platinum-based regimens. Patients treated with an immune checkpoint inhibitor (ICI) in addition to first-line chemotherapy tended to have longer OS. Initial LDH levels could be identified as a prognostic measure for survival prognosis. Sequencing data highlight aberrant NUTM1 fusion genes as unique tumor driver genes. This is the largest adult European cohort of this orphan tumor disease, showing epidemiologic and molecular features as well as relevant clinical data. Awareness to prevent misdiagnosis, fast contact to a specialized nation-wide center and referral to clinical studies are essential as long-term survival is rarely achieved with any of the current therapeutic regimes.
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Affiliation(s)
- Linus D Kloker
- Department of Medical Oncology and Pneumology, Medical University Hospital, Tuebingen, Germany.
| | - Mirjana Sidiras
- Department of Medical Oncology and Pneumology, Medical University Hospital, Tuebingen, Germany
| | - Tim Flaadt
- Pediatric Hematology/Oncology, Department of Pediatrics, University Hospital, Tuebingen, Germany
| | - Ines B Brecht
- Pediatric Hematology/Oncology, Department of Pediatrics, University Hospital, Tuebingen, Germany
| | - Christoph K W Deinzer
- Department of Medical Oncology and Pneumology, Medical University Hospital, Tuebingen, Germany
| | - Thorben Groß
- Department of Medical Oncology and Pneumology, Medical University Hospital, Tuebingen, Germany
| | - Katrin Benzler
- Department of Medical Oncology and Pneumology, Medical University Hospital, Tuebingen, Germany
| | - Lars Zender
- Department of Medical Oncology and Pneumology, Medical University Hospital, Tuebingen, Germany; DFG Cluster of Excellence 2180 'Image-guided and Functional Instructed Tumor Therapy', University of Tuebingen, Tuebingen, Germany; National Center for Tumor Diseases (NCT), NCT Tuebingen, a partnership between DKFZ and the University Hospital Tuebingen, Germany
| | - Ulrich M Lauer
- Department of Medical Oncology and Pneumology, Medical University Hospital, Tuebingen, Germany; German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Tuebingen, Germany; National Center for Tumor Diseases (NCT), NCT Tuebingen, a partnership between DKFZ and the University Hospital Tuebingen, Germany
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Groß T, Woziwodski A, Simka S. [Metastatic Pulmonary Calcification: A Rare Entity in the Differential Diagnosis Examination of Interstitial Lung Diseases]. Pneumologie 2021; 75:864-868. [PMID: 33975369 DOI: 10.1055/a-1482-2403] [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] [Indexed: 06/12/2023]
Abstract
A 70-year-old patient who received a kidney transplant about 20 years ago due to anti-neutrophil cytoplasmic antibody (ANCA)-positive, rapidly progressive glomerulonephritis was assigned to us for an evaluation of fibrosing interstitial lung disease with computer tomography (CT)-radiological changes assigned to acute alveolitis. She complained about long-term exertional dyspnea. In terms of lung function, there was some slight restriction (FVC 78 % of the target), and pronounced severe diffusion disorder (DLCO 41 % of the target). There was no evidence of exogenous allergic alveolitis in either the history or serology. In the bronchoscopically obtained samples, changes in the sense of a non-specific interstitial lung disease of the fibrotic type, e. g., matching a reaction in the context of immunosuppressive therapy, were observed. Herpes simplex virus was detected microbiologically in the bronchoalveolar lavage (BAL) fluid using the polymerase chain reaction (PCR). Antiviral therapy was carried out under the working diagnosis of herpes pneumonitis. Immunosuppressive therapy was continued. The herpes virus could no longer be detected in a control. The patient initially reported subjective improvement of dyspnea. Repeated control CT imaging was carried out and after about one year, the initial radiological changes were still present and dyspnea was persistent. A new transbronchial lung biopsy revealed metastatic pulmonary calcification. Fortunately, the disease was not active. CONCLUSION: In the differential diagnostic evaluation of interstitial lung diseases, especially in patients with a vulnerable calcium-phosphate balance and acid-base balance, as occurs, for example, in the context of chronic kidney diseases, the possibility of metastatic pulmonary calcification (MPC) must also be considered especially if the radiological picture shows persistent, upper lobe-accentuated ground glass opacities. The diagnosis requires multidisciplinary cooperation between pulmonologists, radiologists and pathologists.
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Affiliation(s)
- T Groß
- Klinik für Innere Medizin, Sektion Pneumologie, Bundeswehrkrankenhaus Westerstede
| | | | - S Simka
- Institut für diagnostische und interventionelle Radiologie, Ammerlandklinik Westerstede
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Häntschel M, Niebling J, Häring A, Häring MF, Groß T, Horger M, Riessen R, Haap M, Lewis RA, Böckeler M, Hetzel J. Life-threatening pneumonitis after first-line treatment with osimertinib for primary T790M mutated non-small cell lung cancer. Thorac Cancer 2020; 11:2044-2047. [PMID: 32374485 PMCID: PMC7327687 DOI: 10.1111/1759-7714.13476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/20/2020] [Indexed: 12/26/2022] Open
Abstract
Epithelial growth factor receptor (EGFR) directed tyrosine kinase inhibitor (TKI) treatment is the standard approach in patients with advanced, EGFR‐mutated non‐small cell lung cancer (NSCLC). Although benefit/risk ratio is favorable for these TKI and side effects are manageable in the vast majority of patients, severe and even life‐threatening side effects have been reported. TKI‐induced interstitial lung disease (ILD) has been reported for single cases in modest severity, predominantly in EGFR‐TKI pretreated patients. Here, we report a case of successful stabilization of a life‐threatening ILD in a de novo T790M mutated NSCLC during first‐line treatment with osimertinib. As osimertinib will be used more often in many EGFR‐positive NSCLC patients in the future, this potentially life‐threatening side effect should receive special attention, especially in first‐line treatment.
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Affiliation(s)
- Maik Häntschel
- Department of Internal Medicine VIII, Medical Oncology and Pneumology, Eberhard Karls University, Tübingen, Germany
| | - Johannes Niebling
- Department of Internal Medicine II, Oncology, Hematology, Clinical Immunology and Rheumatology, Eberhard Karls University, Tübingen, Germany
| | - Almut Häring
- Department of Internal Medicine II, Oncology, Hematology, Clinical Immunology and Rheumatology, Eberhard Karls University, Tübingen, Germany
| | - Max-Felix Häring
- Department of Internal Medicine II, Oncology, Hematology, Clinical Immunology and Rheumatology, Eberhard Karls University, Tübingen, Germany
| | - Thorben Groß
- Department of Internal Medicine VIII, Medical Oncology and Pneumology, Eberhard Karls University, Tübingen, Germany
| | - Marius Horger
- Department of Radiology, University Hospital and Comprehensive Cancer Center Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Reimer Riessen
- Department of Internal Medicine, Medical Intensive Care Unit, Eberhard Karls University, Tübingen, Germany
| | - Michael Haap
- Department of Internal Medicine, Medical Intensive Care Unit, Eberhard Karls University, Tübingen, Germany
| | | | - Michael Böckeler
- Department of Internal Medicine VIII, Medical Oncology and Pneumology, Eberhard Karls University, Tübingen, Germany
| | - Jürgen Hetzel
- Department of Internal Medicine VIII, Medical Oncology and Pneumology, Eberhard Karls University, Tübingen, Germany
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Groß T, Niedeggen A, Janssens U. [Cardiac congestion due to compression of the left atrium by an endoleak following endovascular aortic repair (EVAR)]. Med Klin Intensivmed Notfmed 2018; 115:152-155. [PMID: 30357421 DOI: 10.1007/s00063-018-0499-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 08/23/2018] [Accepted: 08/27/2018] [Indexed: 11/29/2022]
Abstract
In rare cases, global cardiac decompensation is the only sign of a relevant endoleak after endovascular aortic repair (EVAR) therapy from a thoracic aortic aneurysm due to a mechanical compression of the left atrium. In this case report, we describe such an unusual course of disease and we point out the importance of early bed-side echocardiography in the emergency department for immediate diagnostic and therapeutic planning.
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Affiliation(s)
- T Groß
- Klinik für Innere Medizin und Internistische Intensivmedizin, St.-Antonius-Hospital, Dechant-Deckers-Str. 8, 52249, Eschweiler, Deutschland.
| | - A Niedeggen
- Klinik für Innere Medizin und Internistische Intensivmedizin, St.-Antonius-Hospital, Dechant-Deckers-Str. 8, 52249, Eschweiler, Deutschland
| | - U Janssens
- Klinik für Innere Medizin und Internistische Intensivmedizin, St.-Antonius-Hospital, Dechant-Deckers-Str. 8, 52249, Eschweiler, Deutschland
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Groß T, Hashim N, Khairunniza-Bejo S, Aziz SA, Zude-Sasse M. of maturity stages of oil palm fresh fruit bunches using multispectral imaging method. Acta Hortic 2017:71-76. [DOI: 10.17660/actahortic.2017.1152.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Dachsel RM, Dachsel R, Domke S, Groß T, Schubert O, Kotrini L, Ladegast K, Vogel J, Jordan T, Zawade S. [Optic neuropathy after retrobulbar neuritis in multiple sclerosis: are optical coherence tomography and magnetic resonance imaging useful and necessary follow-up parameters?]. Nervenarzt 2015; 86:187-196. [PMID: 25645891 DOI: 10.1007/s00115-014-4241-1] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND This study evaluated whether progressive optic neuropathy (ON) is commonly found after retrobulbar neuritis and whether optical coherence tomography (OCT) is a useful tool for follow-up of patients with multiple sclerosis (MS). METHODS An observational study of 86 MS patients (currently treated with immunomodulation) with a past medical history of ON was carried out. Patients were assessed in 2010 and 2012 using the expanded disability status scale (EDSS), visual acuity, visual evoked potentials (VEP) and OCT but magnetic resonance imaging (MRI) was performed only in 2012. RESULTS In this study 16 men and 70 women with a mean age of 41.6 and 43.8 years, respectively, were evaluated (28 patients post bilateral and 58 patients post unilateral ON including 114 eyes post-ON and 58 eyes without previous ON). Visual acuity and VEPs improved or remained the same over the study period. Visual acuity, VEPs, retinal nerve fiber layer (RNFL) thickness and macular volume were significantly worse in eyes post-ON compared to eyes without previous ON. The RNFL significantly decreased over the study period in eyes post-ON from an average of 79.9 ± 13.3 μm to 77.0 ± 12.9 μm (p < 0.0001) and eyes without previous ON from 89.5 ± 12.9 μm to 86.0 ± 12.5 μm (p < 0.0001). The number of VEPs and RNFL thickness were significantly correlated with visual acuity in all eyes. In patients after unilateral ON the brain atrophy parameters corpus callosum index (CCI) and cella media index (CMI) were negatively correlated with the EDSS. CONCLUSION Initially MS often begins with an episode of ON which can be stabilized by immunomodulation. A mild progressive ON was generally detectable in this study but severe progressive ON was rarely observed. The OCT measurements showed no better correlation than the VEPs with visual acuity; however, OCT can be applied for confirmation of atypical ON. The corpus callosum index seems to be best associated with the degree of disability while, as already described in the literature, the number of T2 lesions is not well correlated with disability, probably due to the small-world network function of the brain and the position of the lesions in areas with no clinical relevance.
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Affiliation(s)
- R M Dachsel
- East Surrey Hospital, Canada Avenue, Redhill, RH1 5RH, Redhill, UK,
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Groß T, Merten C. Design and Strength Analysis of Exhaust Heat Exchanger Components. CHEM-ING-TECH 2001. [DOI: 10.1002/1522-2640(200106)73:6<648::aid-cite6483333>3.0.co;2-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Self-diffusion coefficients
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Buchhauser J, Groß T, Karger N, Lüdemann HD. Self-diffusion in CD4 and ND3: With notes on the dynamic isotope effect in liquids. J Chem Phys 1999. [DOI: 10.1063/1.477898] [Citation(s) in RCA: 21] [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] [Indexed: 11/14/2022] Open
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