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Funk L, Grossmann N, Fankhauser C, Beyer J, Lorch A, Hermanns T. Improved quality of care for patients with germ-cell cancer: The interdisciplinary testis cancer clinic. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00650-9] [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: 11/04/2022]
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Lausch C, Lorch A, Giertzuch S, Rieger A, Trefz F. Additive prognostic value of preoperative plasma glucose concentrations in calves undergoing abdominal surgery. JDS Commun 2021; 2:387-392. [PMID: 36337104 PMCID: PMC9623730 DOI: 10.3168/jdsc.2021-0133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/16/2021] [Indexed: 06/16/2023]
Abstract
Surgical abdominal emergencies in calves are associated with a guarded prognosis, especially if neonates are affected. Because hypoglycemia has been associated with sepsis and endotoxemia, this study aimed to assess the prognostic relevance of preoperative plasma glucose concentrations (GLUC) in calves requiring surgery for an acute abdominal disorder. For this purpose, data from retrospective and prospective case series were analyzed, consisting of 586 and 83 hospitalized calves, respectively. The outcomes of calves were evaluated until hospital discharge (both study populations) and for 3 mo following discharge by a phone call to the farmer (prospective study population). For the retrospective study population, the overall survival rate was 31.2%. Calves with a negative outcome (NO) had significantly lower median GLUC (4.3 mmol/L) than calves with a positive outcome (PO; 5.0 mmol/L). The survival rates of calves with GLUC <2.4 mmol/L and 2.4 to 3.1 mmol/L were 3.6 and 8.3%, respectively. The inclusion of GLUC improved a previous prognostic model based on plasma l-lactate concentration and age. The resulting analyses indicated that NO was associated with low age (<7 d), hyper-l-lactatemia (>8.84 mmol/L), and GLUC <4.4 mmol/L (age 7-20 d) and <3.3 mmol/L (age ≥21 d), respectively. The area under the receiver operating characteristic curve of this model was 0.79 (95% confidence interval: 0.76-0.83) and the resulting sensitivity and specificity for NO at the optimal probability cut-point of 0.69 were 66.7 and 85.8%, respectively. For the prospective study population, the established model had sensitivity and specificity for predicting NO after 3 mo (proportion 24%) of 61.9 and 85%, respectively. In both study populations, hypoglycemia was significantly associated with intraoperative evidence of a septic process within the abdominal cavity. The present analyses show that hypoglycemia was highly indicative of a poor prognosis and serious intraoperative findings such as peritonitis. Determination of GLUC should therefore be part of the diagnostic work-up in calves suffering from an acute abdominal emergency.
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Affiliation(s)
- C.K. Lausch
- Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität (LMU) Munich, Sonnenstrasse 16, 85764 Oberschleissheim, Germany
| | - A. Lorch
- Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität (LMU) Munich, Sonnenstrasse 16, 85764 Oberschleissheim, Germany
| | - S. Giertzuch
- Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität (LMU) Munich, Sonnenstrasse 16, 85764 Oberschleissheim, Germany
| | - A. Rieger
- Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität (LMU) Munich, Sonnenstrasse 16, 85764 Oberschleissheim, Germany
| | - F.M. Trefz
- Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität (LMU) Munich, Sonnenstrasse 16, 85764 Oberschleissheim, Germany
- Clinic for Ruminants, Vetsuisse-Faculty, University of Bern, Bremgartenstrasse 109a, 3012 Bern, Switzerland
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Papachristofilou A, Bedke J, Hayoz S, Schratzenstaller U, Pless M, Hentrich M, Krege S, Lorch A, Aebersold D, Putora PM, Berthold D, Zihler D, Azinwi N, Zengerling F, Dieing A, Mueller AC, Schaer C, Biaggi C, Gillessen S, Cathomas R. LBA30 Single-dose carboplatin followed by involved-node radiotherapy as curative treatment for seminoma stage IIA/B: Efficacy results from the international multicenter phase II trial SAKK 01/10. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.2106] [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: 11/25/2022] Open
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Darr C, Zschäbitz S, Ivanyi P, Wirth M, Staib P, Schostak M, Müller L, Metz M, Bergmann L, Steiner T, Lorch A, Schütt P, Rafiyan MR, Hellmis E, Hinke A, Mänz M, Meiler J, Kretz T, Flörcken A, Grünwald V. 679P Final results on efficacy and patient reported outcomes (PRO) of a randomized phase II trial investigating nivolumab switch-maintenance after TKI induction in metastatic clear cell renal cell carcinoma (mRCC) patients (NIVOSWITCH). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Grogg J, Fronzaroli J, Bode P, Oliveira P, Lorch A, Beyer J, Eberli D, Sangar V, Hermanns T, Clarke N, Fankhauser C. Clinicopathological characteristics and outcomes in men with mesothelioma of the tunica vaginalis testis: Analysis of published case series data. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)36274-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Giertzuch S, Lorch A, Lausch CK, Knubben-Schweizer G, Trefz FM. Prognostic utility of pre- and postoperative plasma l-lactate measurements in hospitalized cows with acute abdominal emergencies. J Dairy Sci 2020; 103:11769-11781. [PMID: 32981725 DOI: 10.3168/jds.2020-19102] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 06/17/2020] [Accepted: 07/02/2020] [Indexed: 11/19/2022]
Abstract
The aim of the present analyses was to compare the prognostic value of pre- and postoperative l-lactate measurements in hospitalized cows requiring surgical intervention for an acute abdominal emergency, such as gastrointestinal ileus or peritonitis. For this purpose, we analyzed data from retro- and prospective case series, consisting of 754 and 98 cows, respectively. Plasma l-lactate concentrations (L-LAC) were determined upon admission to the hospital (both study populations), immediately before initiation of surgical intervention (prospective study population), and 6, 12, 24, 48, and 72 h later (prospective study population). The outcome of cows was evaluated until hospital discharge (both study populations) and 3 mo after discharge by a phone call to the farmer (prospective study population). A negative outcome was defined as death or euthanasia during hospitalization, or if discharged animals had an unsatisfied owner or were culled for medical reasons that were directly related to the initial abdominal emergency. For the retrospective study population, the overall survival rate until hospital discharge was 66%. Cows with a negative outcome (median: 6.81 mmol/L) had significantly higher L-LAC than cows with a positive outcome (3.66 mmol/L) of therapy. At the individual diagnosis level, L-LAC was associated with mortality in cows with a diagnosis of abomasal volvulus, local peritonitis, hemorrhagic bowel syndrome, and jejunal volvulus. Considering the whole study population, the area under the receiver operating characteristic curve was 0.66. For the prospective study population, the proportion of cows with a positive outcome was 65% until hospital discharge and 61% after the 3-mo observation period. At all sampling times, before and during the first 12 h after surgical intervention, cows with a negative outcome had significantly higher L-LAC than cows with a positive outcome. The largest area under the receiver operating characteristic curve for L-LAC was observed at 6 h (0.89). A cut-point of 1.77 mmol/L was identified, which had a sensitivity and specificity for predicting a negative outcome until hospital discharge of 88.9 and 73.4%, respectively. The present analyses confirmed previous findings in calves and show that persistent hyper-l-lactatemia during the early postoperative period is a more reliable indicator for a negative outcome than hyper-l-lactatemia before initiation of surgical intervention.
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Affiliation(s)
- S Giertzuch
- Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität (LMU) Munich, Sonnenstrasse 16, 85764 Oberschleißheim, Germany
| | - A Lorch
- Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität (LMU) Munich, Sonnenstrasse 16, 85764 Oberschleißheim, Germany
| | - C K Lausch
- Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität (LMU) Munich, Sonnenstrasse 16, 85764 Oberschleißheim, Germany
| | - G Knubben-Schweizer
- Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität (LMU) Munich, Sonnenstrasse 16, 85764 Oberschleißheim, Germany
| | - F M Trefz
- Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität (LMU) Munich, Sonnenstrasse 16, 85764 Oberschleißheim, Germany; Clinic for Ruminants, Vetsuisse-Faculty, University of Bern, Bremgartenstrasse 109a, 3012 Bern, Switzerland.
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Bruins H, Veskimae E, Hernandez V, Neuzillet Y, Rouanne M, Cathomas R, Compérat E, Cowan N, Gakis G, Espinós E, Lorch A, Ribal M, Thalmann G, Yuan Y, Van Der Heijden A, Witjes J. Radical cystectomy: The significance of hospital volume and surgeon volume. A systematic review and recommendations by the EAU MIBC Guideline Panel. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33803-9] [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: 11/30/2022] Open
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Honecker F, Aparicio J, Berney D, Beyer J, Bokemeyer C, Cathomas R, Clarke N, Cohn-Cedermark G, Daugaard G, Dieckmann KP, Fizazi K, Fosså S, Germa-Lluch JR, Giannatempo P, Gietema JA, Gillessen S, Haugnes HS, Heidenreich A, Hemminki K, Huddart R, Jewett MAS, Joly F, Lauritsen J, Lorch A, Necchi A, Nicolai N, Oing C, Oldenburg J, Ondruš D, Papachristofilou A, Powles T, Sohaib A, Ståhl O, Tandstad T, Toner G, Horwich A. ESMO Consensus Conference on testicular germ cell cancer: diagnosis, treatment and follow-up. Ann Oncol 2019; 29:1658-1686. [PMID: 30113631 DOI: 10.1093/annonc/mdy217] [Citation(s) in RCA: 179] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The European Society for Medical Oncology (ESMO) consensus conference on testicular cancer was held on 3-5 November 2016 in Paris, France. The conference included a multidisciplinary panel of 36 leading experts in the diagnosis and treatment of testicular cancer (34 panel members attended the conference; an additional two panel members [CB and K-PD] participated in all preparatory work and subsequent manuscript development). The aim of the conference was to develop detailed recommendations on topics relating to testicular cancer that are not covered in detail in the current ESMO Clinical Practice Guidelines (CPGs) and where the available level of evidence is insufficient. The main topics identified for discussion related to: (1) diagnostic work-up and patient assessment; (2) stage I disease; (3) stage II-III disease; (4) post-chemotherapy surgery, salvage chemotherapy, salvage and desperation surgery and special topics; and (5) survivorship and follow-up schemes. The experts addressed questions relating to one of the five topics within five working groups. Relevant scientific literature was reviewed in advance. Recommendations were developed by the working groups and then presented to the entire panel. A consensus vote was obtained following whole-panel discussions, and the consensus recommendations were then further developed in post-meeting discussions in written form. This manuscript presents the results of the expert panel discussions, including the consensus recommendations and a summary of evidence supporting each recommendation. All participants approved the final manuscript.
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Affiliation(s)
- F Honecker
- Tumor and Breast Center ZeTuP, St. Gallen, Switzerland; Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center, Hamburg, Germany.
| | - J Aparicio
- Department of Medical Oncology, Hospital Universitari i Politècnic la Fe, Valencia, Spain
| | - D Berney
- Department of Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - J Beyer
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - C Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center, Hamburg, Germany
| | - R Cathomas
- Department of Oncology and Hematology, Kantonsspital Graubünden, Chur, Switzerland
| | - N Clarke
- Department of Surgery, The Christie NHS Foundation Trust, Manchester, UK
| | - G Cohn-Cedermark
- Department of Oncology-Pathology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - G Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - K-P Dieckmann
- Department of Urology, Asklepios Klinik Altona, Hamburg, Germany
| | - K Fizazi
- Department of Cancer Medicine, Gustave Roussy, University of Paris Sud, Villejuif, France
| | - S Fosså
- Department of Oncology, Oslo University Hospital Radiumhospitalet, Oslo, Norway
| | - J R Germa-Lluch
- Department of Medical Oncology, Catalan Institute of Oncology (ICO), Barcelona University, Barcelona, Spain
| | - P Giannatempo
- Department of Medical Oncology, Fondazione IRCCS Istituto dei Tumori, Milan, Italy
| | - J A Gietema
- Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - S Gillessen
- Department of Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen; University of Bern, Bern, Switzerland
| | - H S Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine, UIT - The Arctic University, Tromsø, Norway
| | - A Heidenreich
- Department of Urology, Uro-Oncology, Robot-assisted and Specialised Urologic Surgery, University of Cologne, Cologne, Germany
| | - K Hemminki
- Department of Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - R Huddart
- Department of Radiotherapy and Imaging, The Institute of Cancer Research, Royal Marsden Hospital, Sutton, UK
| | - M A S Jewett
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada
| | - F Joly
- Department of Urology-Gynaecology, Centre Francois Baclesse, Caen, France
| | - J Lauritsen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - A Lorch
- Department of Urology, Genitourinary Medical Oncology, Heinrich-Heine University Hospital Düsseldorf, Düsseldorf, Germany
| | - A Necchi
- Department of Medical Oncology, Fondazione IRCCS Istituto dei Tumori, Milan, Italy
| | - N Nicolai
- Department of Surgery, Urology and Testis Surgery Unit, Fondazione IRCCS Istituto dei Tumori, Milan, Italy
| | - C Oing
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center, Hamburg, Germany
| | - J Oldenburg
- Department of Oncology, Akershus University Hospital, Lørenskog, Norway
| | - D Ondruš
- 1st Department of Oncology, St. Elisabeth Cancer Institute, Comenius University Faculty of Medicine, Bratislava, Slovak Republic
| | - A Papachristofilou
- Department of Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - T Powles
- Department of Medical Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - A Sohaib
- Department of Radiology, Royal Marsden Hospital, Sutton, UK
| | - O Ståhl
- Department of Oncology, Skane University Hospital, Lund University, Lund, Sweden
| | - T Tandstad
- The Cancer Clinic, St. Olavs Hospital, Trondheim, Norway
| | - G Toner
- Department of Medical Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Australia
| | - A Horwich
- The Institute of Cancer Research, Royal Marsden Hospital, Sutton, UK
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Lausch CK, Lorch A, Giertzuch S, Rieger A, Knubben-Schweizer G, Trefz FM. Prognostic relevance of pre- and postoperative plasma l-lactate measurements in calves with acute abdominal emergencies. J Dairy Sci 2019; 103:1856-1865. [PMID: 31759607 DOI: 10.3168/jds.2019-17224] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 07/07/2019] [Accepted: 09/28/2019] [Indexed: 02/02/2023]
Abstract
In both human and veterinary medicine, l-lactate is a well-established prognostic biomarker of disease severity and mortality and has also attracted increasing attention in bovine medicine due to the availability and validation of cheap and portable l-lactate analyzers. The aim of the present study was to evaluate the prognostic accuracy of plasma L-lactate measurements in calves with acute abdominal emergencies before and during the initial therapeutic period after surgical intervention. A prospective observational study was carried out involving 83 hospitalized calves up to an age of 7 mo, which required surgical intervention for reasons of an acute abdominal emergency such as gastrointestinal ileus or peritonitis. Plasma l-lactate (L-LAC) concentrations were determined immediately before initiation of surgery and 6, 12, 24, 48, and 72 h later. The outcome of calves was evaluated 3 mo after discharge by a phone call to the farmer, and a positive outcome was defined if the calf was still alive and the owner was satisfied with the animal's postsurgical progress. A total of 29% of calves were discharged from the hospital and the proportion of calves with a positive outcome after the 3-mo period was 24%. At all sampling times during the first 48 h after initiation of surgical intervention, calves with a negative outcome had significantly higher L-LAC than calves with a positive outcome. A binary logistic regression analysis indicated that the odds for a negative outcome during the 3-mo observation period increased by a factor of 1.23 [95% confidence interval (CI): 1.04-1.44] for every mmol/L increase of L-LAC before initiation of surgical intervention, but by a factor of 5.29 (95% CI: 1.69-16.6) and 5.92 (95% CI: 1.29-27.3) at 12 and 24 h, respectively. The largest area under the receiver operating characteristic curve for L-LAC was observed at 12 h (0.91; 95% CI: 0.83-0.99), and a cut-point of 2.75 mmol/L was identified that had a sensitivity and specificity for predicting a negative outcome of 68 and 100%, respectively. In conclusion, persistent hyper-l-lactatemia during the early postoperative period is a more reliable indicator for a negative outcome in calves with acute surgical abdominal emergencies than hyper-l-lactatemia before initiation of surgical intervention. Postoperative measurements of L-LAC are therefore a clinically useful tool to identify patients with an increased risk for a negative outcome at an early stage after surgical intervention was carried out.
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Affiliation(s)
- C K Lausch
- Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität (LMU) Munich, Sonnenstrasse 16, 85764 Oberschleißheim, Germany
| | - A Lorch
- Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität (LMU) Munich, Sonnenstrasse 16, 85764 Oberschleißheim, Germany
| | - S Giertzuch
- Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität (LMU) Munich, Sonnenstrasse 16, 85764 Oberschleißheim, Germany
| | - A Rieger
- Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität (LMU) Munich, Sonnenstrasse 16, 85764 Oberschleißheim, Germany
| | - G Knubben-Schweizer
- Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität (LMU) Munich, Sonnenstrasse 16, 85764 Oberschleißheim, Germany
| | - F M Trefz
- Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität (LMU) Munich, Sonnenstrasse 16, 85764 Oberschleißheim, Germany; Clinic for Ruminants, Vetsuisse-Faculty, University of Bern, Bremgartenstrasse 109a, 3012 Bern, Switzerland.
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Horwich A, Babjuk M, Bellmunt J, Bruins HM, De Reijke TM, De Santis M, Gillessen S, James N, Maclennan S, Palou J, Powles T, Ribal MJ, Shariat SF, Van Der Kwast T, Xylinas E, Agarwal N, Arends T, Bamias A, Birtle A, Black PC, Bochner BH, Bolla M, Boormans JL, Bossi A, Briganti A, Brummelhuis I, Burger M, Castellano D, Cathomas R, Chiti A, Choudhury A, Compérat E, Crabb S, Culine S, De Bari B, DeBlok W, De Visschere PJL, Decaestecker K, Dimitropoulos K, Dominguez-Escrig JL, Fanti S, Fonteyne V, Frydenberg M, Futterer JJ, Gakis G, Geavlete B, Gontero P, Grubmüller B, Hafeez S, Hansel DE, Hartmann A, Hayne D, Henry AM, Hernandez V, Herr H, Herrmann K, Hoskin P, Huguet J, Jereczek-Fossa BA, Jones R, Kamat AM, Khoo V, Kiltie AE, Krege S, Ladoire S, Lara PC, Leliveld A, Linares-Espinós E, Løgager V, Lorch A, Loriot Y, Meijer R, Carmen Mir M, Moschini M, Mostafid H, Müller AC, Müller CR, N'Dow J, Necchi A, Neuzillet Y, Oddens JR, Oldenburg J, Osanto S, Oyen WJG, Pacheco-Figueiredo L, Pappot H, Patel MI, Pieters BR, Plass K, Remzi M, Retz M, Richenberg J, Rink M, Roghmann F, Rosenberg JE, Rouprêt M, Rouvière O, Salembier C, Salminen A, Sargos P, Sengupta S, Sherif A, Smeenk RJ, Smits A, Stenzl A, Thalmann GN, Tombal B, Turkbey B, Vahr Lauridsen S, Valdagni R, Van Der Heijden AG, Van Poppel H, Vartolomei MD, Veskimäe E, Vilaseca A, Vives Rivera FA, Wiegel T, Wiklund P, Williams A, Zigeuner R, Witjes JA. EAU-ESMO consensus statements on the management of advanced and variant bladder cancer-an international collaborative multi-stakeholder effort: under the auspices of the EAU and ESMO Guidelines Committees†. Ann Oncol 2019; 30:1697-1727. [PMID: 31740927 PMCID: PMC7360152 DOI: 10.1093/annonc/mdz296] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [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] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Although guidelines exist for advanced and variant bladder cancer management, evidence is limited/conflicting in some areas and the optimal approach remains controversial. OBJECTIVE To bring together a large multidisciplinary group of experts to develop consensus statements on controversial topics in bladder cancer management. DESIGN A steering committee compiled proposed statements regarding advanced and variant bladder cancer management which were assessed by 113 experts in a Delphi survey. Statements not reaching consensus were reviewed; those prioritised were revised by a panel of 45 experts before voting during a consensus conference. SETTING Online Delphi survey and consensus conference. PARTICIPANTS The European Association of Urology (EAU), the European Society for Medical Oncology (ESMO), experts in bladder cancer management. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Statements were ranked by experts according to their level of agreement: 1-3 (disagree), 4-6 (equivocal), 7-9 (agree). A priori (level 1) consensus was defined as ≥70% agreement and ≤15% disagreement, or vice versa. In the Delphi survey, a second analysis was restricted to stakeholder group(s) considered to have adequate expertise relating to each statement (to achieve level 2 consensus). RESULTS AND LIMITATIONS Overall, 116 statements were included in the Delphi survey. Of these, 33 (28%) statements achieved level 1 consensus and 49 (42%) statements achieved level 1 or 2 consensus. At the consensus conference, 22 of 27 (81%) statements achieved consensus. These consensus statements provide further guidance across a broad range of topics, including the management of variant histologies, the role/limitations of prognostic biomarkers in clinical decision making, bladder preservation strategies, modern radiotherapy techniques, the management of oligometastatic disease and the evolving role of checkpoint inhibitor therapy in metastatic disease. CONCLUSIONS These consensus statements provide further guidance on controversial topics in advanced and variant bladder cancer management until a time where further evidence is available to guide our approach.
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Affiliation(s)
- A Horwich
- Emeritus Professor, The Institute of Cancer Research, London, UK; Emeritus Professor, The Institute of Cancer Research, London, UK.
| | - M Babjuk
- Depatment of Urology, 2nd Faculty of Medicine, Hospital Motol, Charles University, Prague, Czech Republic; Department of Urology, Medical University of Vienna, Vienna, Austria
| | - J Bellmunt
- IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Harvard Medical School, Boston, USA
| | - H M Bruins
- Department of Urology, Radboud University Medical Center, Nijmegen
| | - T M De Reijke
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - M De Santis
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Charité University Hospital, Berlin, Germany
| | - S Gillessen
- Division of Cancer Sciences, University of Manchester, Manchester; The Christie NHS Foundation Trust, Manchester, UK; Division of Oncology and Haematology, Kantonsspital St Gallen, St Gallen; University of Bern, Bern, Switzerland
| | - N James
- University Hospitals Birmingham NHS Foundation Trust, Birmingham; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham
| | - S Maclennan
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - J Palou
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - T Powles
- The Royal Free NHS Trust, London; Barts Cancer Institute, Queen Mary University of London, London, UK
| | - M J Ribal
- Uro-Oncology Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - S F Shariat
- Depatment of Urology, 2nd Faculty of Medicine, Hospital Motol, Charles University, Prague, Czech Republic; Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York; Department of Urology, University of Texas Southwestern Medical Center, Dallas, USA; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - T Van Der Kwast
- Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - E Xylinas
- Department of Urology, Bichat-Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris, Paris; Paris Descartes University, Paris, France
| | - N Agarwal
- Huntsman Cancer Institute, University of Utah (NCI-CCC), Salt Lake City, USA
| | - T Arends
- Urology Department, Canisius-Wilhelmina Ziekenhuis Nijmegen, Nijmegen, The Netherlands
| | - A Bamias
- 2nd Propaedeutic Dept of Internal Medicine, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - A Birtle
- Division of Cancer Sciences, University of Manchester, Manchester; Rosemere Cancer Centre, Lancashire Teaching Hospitals, Preston, UK
| | - P C Black
- Department of Urologic Sciences, Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada
| | - B H Bochner
- Department of Urology, Weill Cornell Medical College, New York; Urology Service, Department of Urology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - M Bolla
- Emeritus Professor of Radiation Oncology, Grenoble - Alpes University, Grenoble, France
| | - J L Boormans
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A Bossi
- Department of Radiation Oncology, Gustave Roussy Institute, Villejuif, France
| | - A Briganti
- Department of Urology, Urological Research Institute, Milan; Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - I Brummelhuis
- Department of Urology, Radboud University Medical Center, Nijmegen
| | - M Burger
- Department of Urology, Caritas-St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - D Castellano
- Medical Oncology Department, 12 de Octubre University Hospital (CIBERONC), Madrid, Spain
| | - R Cathomas
- Department Innere Medizin, Abteilung Onkologie und Hämatologie, Kantonsspital Graubünden, Chur, Switzerland
| | - A Chiti
- Department of Biomedical Sciences, Humanitas University, Milan; Humanitas Research Hospital, Milan, Italy
| | - A Choudhury
- Division of Cancer Sciences, University of Manchester, Manchester; The Christie NHS Foundation Trust, Manchester, UK
| | - E Compérat
- Department of Pathology, Tenon Hospital, HUEP, Paris; Sorbonne University, Paris, France
| | - S Crabb
- Cancer Sciences Unit, University of Southampton, Southampton, UK
| | - S Culine
- Department of Cancer Medicine, Hôpital Saint Louis, Paris
| | - B De Bari
- Radiation Oncology Department, Centre Hospitalier Régional Universitaire "Jean Minjoz" of Besançon, INSERM UMR 1098, Besançon, France; Radiation Oncology Department, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Lausanne, Switzerland
| | - W DeBlok
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P J L De Visschere
- Department of Radiology and Nuclear Medicine, Division of Genitourinary Radiology and Mammography, Ghent University Hospital, Ghent
| | - K Decaestecker
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - K Dimitropoulos
- Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - J L Dominguez-Escrig
- Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - S Fanti
- Department of Nuclear Medicine, Policlinico S Orsola, University of Bologna, Bologna, Italy
| | - V Fonteyne
- Department of Radiotherapy Oncology, Ghent University Hospital, Ghent, Belgium
| | - M Frydenberg
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
| | - J J Futterer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - G Gakis
- Department of Urology and Paediatric Urology, University Hospital of Würzburg, Julius-Maximillians University, Würzburg, Germany
| | - B Geavlete
- Department of Urology, Saint John Emergency Clinical Hospital, Bucharest, Romania
| | - P Gontero
- Division of Urology, Molinette Hospital, University of Studies of Torino, Torino, Italy
| | - B Grubmüller
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - S Hafeez
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London; Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - D E Hansel
- Department of Urology, University of California, San Diego Pathology, La Jolla, USA
| | - A Hartmann
- Institute of Pathology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - D Hayne
- Department of Urology, UWA Medical School, University of Western Australia, Perth, Australia
| | - A M Henry
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - V Hernandez
- Department of Urology, Hospital Universitario Fundación de Alcorcón, Madrid, Spain
| | - H Herr
- Urology Service, Department of Urology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - K Herrmann
- Department of Nuclear Medicine, Universitätsklinikum Essen, Essen, Germany
| | - P Hoskin
- Division of Cancer Sciences, University of Manchester, Manchester; The Christie NHS Foundation Trust, Manchester, UK; Mount Vernon Centre for Cancer Treatment, London, UK
| | - J Huguet
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - B A Jereczek-Fossa
- Department of Oncology and Hemato-oncology, University of Milan, Milan; Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - R Jones
- Institute of Cancer Sciences, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - A M Kamat
- Department of Urology - Division of Surgery, The University of Texas, MD Anderson Cancer Center, Houston, USA
| | - V Khoo
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London; Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, London, UK; Department of Medicine, University of Melbourne, Melbourne; Monash University, Melbourne, Australia
| | - A E Kiltie
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - S Krege
- Department of Urology, Pediatric Urology and Urologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - S Ladoire
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - P C Lara
- Department of Oncology, Hospital Universitario San Roque, Canarias; Universidad Fernando Pessoa, Canarias, Spain
| | - A Leliveld
- Department of Urology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - V Løgager
- Department of Radiology, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark
| | - A Lorch
- Department of Medical Oncology and Hematology, University Hospital Zürich, Zürich, Switzerland
| | - Y Loriot
- Département de Médecine Oncologique, Gustave Roussy, INSERM U981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - R Meijer
- UMC Utrecht Cancer Center, MS Oncologic Urology, Utrecht, The Netherlands
| | - M Carmen Mir
- Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - M Moschini
- Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland
| | - H Mostafid
- Department of Urology, Royal Surrey County Hospital, Guildford, UK
| | - A-C Müller
- Department of Radiation Oncology, Eberhard Karls University, Tübingen, Germany
| | - C R Müller
- Cancer Treatment Centre, Sorlandet Hospital, Kristiansand, Norway
| | - J N'Dow
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - A Necchi
- Department of Medical Oncology, Istituto Nazionale Tumori of Milan, Milan, Italy
| | - Y Neuzillet
- Department of Urology, Hospital Foch, University of Versailles-Saint-Quentin-en-Yvelines, Suresnes, France
| | - J R Oddens
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - J Oldenburg
- Department of Oncology, Akershus University Hospital, Lørenskog; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - S Osanto
- Department of Clinical Oncology, Leiden University Medical Center, Leiden
| | - W J G Oyen
- Department of Biomedical Sciences, Humanitas University, Milan; Humanitas Research Hospital, Milan, Italy; Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - L Pacheco-Figueiredo
- Department of Urology, Centro Hospitalar São João, Porto; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - H Pappot
- Department of Oncology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - M I Patel
- Department of Urology, Westmead Hospital, University of Sydney, Sydney, Australia
| | - B R Pieters
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam
| | - K Plass
- EAU Guidelines Office, Arnhem, The Netherlands
| | - M Remzi
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - M Retz
- Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany
| | - J Richenberg
- Department of Imaging and Nuclear Medicine, Royal Sussex County Hospital, Brighton; Brighton and Sussex Medical School, Brighton, UK
| | - M Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg
| | - F Roghmann
- Department of Urology, Ruhr-University Bochum, Marien Hospital, Herne, Germany
| | - J E Rosenberg
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York; Weill Cornell Medical College, New York, USA
| | - M Rouprêt
- Department of Urology, Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, Paris
| | - O Rouvière
- Hospices Civils de Lyon, Service d'Imagerie Urinaire et Vasculaire, Hôpital Edouard Herriot, Lyon; Université de Lyon, Université Lyon 1, Faculté de Médecine Lyon Est, Lyon, France
| | - C Salembier
- Department of Radiation Oncology, Europe Hospitals Brussels, Brussels, Belgium
| | - A Salminen
- Department of Urology, University Hospital of Turku, Turku, Finland
| | - P Sargos
- Department of Radiotherapy, Institut Bergonié, Bordeaux, France
| | - S Sengupta
- Department of Surgery, Austin Health, University of Melbourne, Melbourne; Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - A Sherif
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - R J Smeenk
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A Smits
- Department of Urology, Radboud University Medical Center, Nijmegen
| | - A Stenzl
- Department of Urology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - G N Thalmann
- Department of Urology, Inselspital, Bern University Hospital, Berne, Switzerland
| | - B Tombal
- Division of Urology, IREC, Cliniques Universitaires Saint Luc, UCL, Brussels, Belgium
| | - B Turkbey
- Molecular Imaging Program, National Cancer Institute, Bethesda, USA
| | - S Vahr Lauridsen
- Department of Urology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - R Valdagni
- Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - H Van Poppel
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - M D Vartolomei
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Cell and Molecular Biology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
| | - E Veskimäe
- Department of Urology, Tampere University Hospital, Tampere, Finland
| | - A Vilaseca
- Uro-Oncology Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - F A Vives Rivera
- Clinica HematoOncologica Bonadona Prevenir, Universidad Metropolitana, Clinica Club de Leones, Barranquilla, Colombia
| | - T Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - P Wiklund
- Icahn School of Medicine, Mount Sinai Health System, New York City, USA; Department of Urology, Karolinska Institutet, Stockholm, Sweden
| | - A Williams
- Department of Urology, Auckland City Hospital, Auckland, New Zealand
| | - R Zigeuner
- Department of Urology, Medizinische Universität Graz, Graz, Austria
| | - J A Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen
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Lausch CK, Lorch A, Knubben-Schweizer G, Rieger A, Trefz FM. Prognostic value of preoperative plasma l-lactate concentrations in calves with acute abdominal emergencies. J Dairy Sci 2019; 102:10202-10212. [PMID: 31477288 DOI: 10.3168/jds.2019-16871] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 04/27/2019] [Accepted: 07/04/2019] [Indexed: 12/14/2022]
Abstract
Acute abdominal emergencies in calves due to abomasal disorders, gastrointestinal ileus, or peritonitis are characterized by a rapid disease progression and usually require immediate surgical intervention. Those conditions are associated with a guarded prognosis, and the aim of the present study was to assess the prognostic relevance of preoperatively measured plasma l-lactate concentrations (l-LAC) in a large study population of calves with a broad spectrum of acute abdominal emergencies. For the purpose of this study, the medical records of 587 calves admitted to a veterinary teaching hospital over a 10-yr period were analyzed retrospectively. Plasma l-LAC was measured as part of a routinely performed biochemistry panel before initiation of surgical intervention. Hyper-l-lactatemia (plasma l-LAC >2.2 mmol/L) was evident in 75% of calves, and the overall survival rate until hospital discharge was 31%. Calves with a negative outcome were younger (median: 3.4 vs. 6 wk) and had higher plasma l-LAC (median: 4.96 vs. 3.09 mmol/L) than calves with a positive outcome. At the individual diagnosis level, l-LAC was associated with mortality in calves with a diagnosis of mesenteric torsion, right-sided dilated abomasum, small intestinal volvulus, or paralytic ileus, but not in calves suffering from peritonitis, malformations, abomasal volvulus, bloat, or small intestinal intussusceptions. Considering the whole study population, the area under the receiver operating characteristic (ROC) curve for plasma l-LAC was 0.66 [95% confidence interval (CI): 0.61-0.70]. A classification tree analysis indicated that l-LAC >8.84 mmol/L and age categories of <3 wk and <1 wk were independent predictors of mortality. The area under the ROC curve of this model was 0.75 (95% CI: 0.71-0.79) and the resulting sensitivity and specificity for the prediction of nonsurvival at the optimal probability cut-point of 0.62 were 67.7 and 76.6%, respectively. In conclusion, hyper-l-lactatemia is common in calves suffering from acute abdominal emergencies. Markedly increased plasma l-LAC is associated with an increased mortality risk, but it is not possible to reliably predict the outcome of affected calves based on a single, preoperative measurement. However, a clinically important finding of this study was that the ability to predict a negative outcome is improved when the age of the calf is considered in addition to plasma l-LAC.
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Affiliation(s)
- C K Lausch
- Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität (LMU) Munich, Sonnenstrasse 16, 85764 Oberschleissheim, Germany
| | - A Lorch
- Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität (LMU) Munich, Sonnenstrasse 16, 85764 Oberschleissheim, Germany
| | - G Knubben-Schweizer
- Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität (LMU) Munich, Sonnenstrasse 16, 85764 Oberschleissheim, Germany
| | - A Rieger
- Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität (LMU) Munich, Sonnenstrasse 16, 85764 Oberschleissheim, Germany
| | - F M Trefz
- Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität (LMU) Munich, Sonnenstrasse 16, 85764 Oberschleissheim, Germany; Clinic for Ruminants, Vetsuisse-Faculty, University of Bern, Bremgartenstrasse 109a, 3012 Bern, Switzerland.
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12
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Nettersheim D, Oing C, Schönberger S, Skowron M, Vermeulen M, Müller M, Watolla M, Bremmer F, Pfister D, Calaminus G, Looijenga L, Lorch A, Albers P. [Current research on pediatric and adult germ cell tumors : A report from the first "Düsseldorfer Testis Cancer Day"]. Urologe A 2019; 58:804-808. [PMID: 31119354 DOI: 10.1007/s00120-019-0954-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- D Nettersheim
- Klinik für Urologie, Urologisches Forschungslabor, Translationale Uroonkologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland.
| | - C Oing
- Klinik für Onkologie, Hämatologie und Knochenmarkstransplantation mit Abteilung für Pneumologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - S Schönberger
- Zentrum für Kinderheilkunde, Abteilung für Pädiatrische Hämatologie und Onkologie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - M Skowron
- Klinik für Urologie, Urologisches Forschungslabor, Translationale Uroonkologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - M Vermeulen
- Klinik für Urologie, Urologisches Forschungslabor, Translationale Uroonkologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - M Müller
- Klinik für Urologie, Urologisches Forschungslabor, Translationale Uroonkologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - M Watolla
- Klinik für Urologie, Urologisches Forschungslabor, Translationale Uroonkologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - F Bremmer
- Institut für Pathologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - D Pfister
- Urologie, Uro-Onkologie, spezielle urologische und Roboter-assistierte Chirurgie, Universitätsklinikum Köln, Köln, Deutschland
| | - G Calaminus
- Zentrum für Kinderheilkunde, Abteilung für Pädiatrische Hämatologie und Onkologie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - L Looijenga
- Department of Pathology, Laboratory for Experimental Patho-Oncology, Erasmus MC, Cancer Institute, University Medical Center, Rotterdam, Niederlande
- Pediatric Oncology, Princess Maxima Center, Utrecht, Niederlande
| | - A Lorch
- Klinik für Medizinische Onkologie und Hämatologie, Universitätsspital Zürich, Zürich, Schweiz
| | - P Albers
- Klinik für Urologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
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Castellano D, Duran I, Rodríguez-Vida A, Crabb S, van der Heijden M, Font Pous A, Gravis G, Anido Herranz U, Protheroe A, Ravaud A, Maillet D, Mendez-Vidal M, Suarez C, Lorch A, Sternberg C, Linch M, Sarker SJ, Notta J, Mousa K, Powles T. A phase II study investigating the safety and efficacy of neoadjuvent atezolizumab in muscle invasive bladder cancer (ABACUS). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy283.108] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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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Trefz FM, Lorch A, Zitzl J, Kutschke A, Knubben-Schweizer G, Lorenz I. Risk factors for the development of hypokalemia in neonatal diarrheic calves. J Vet Intern Med 2015; 29:688-95. [PMID: 25818223 PMCID: PMC4895488 DOI: 10.1111/jvim.12541] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 11/21/2014] [Accepted: 12/16/2014] [Indexed: 12/22/2022] Open
Abstract
Background Neonatal diarrheic calves have a clear negative potassium balance because of intestinal losses and decreased milk intake but in the presence of acidemia, they usually show normokalemic or hyperkalemic plasma concentrations. Objectives To assess whether marked hypokalemia occurs in response to the correction of acidemia and dehydration and to identify factors that are associated with this condition. Animals Eighty‐three calves with a clinical diagnosis of neonatal diarrhea. Methods Prospective cohort study. Calves were treated according to a clinical protocol using an oral electrolyte solution and commercially available packages of 8.4% sodium bicarbonate, 0.9% saline and 40% dextrose infusion solutions. Results The proportion of hypokalemic calves after 24 hours of treatment (19.3%) was twice as great as it was on admission to the hospital. Plasma K+ after 24 hours of treatment was not significantly correlated to venous blood pH values at the same time but positively correlated to venous blood pH values on admission (r = 0.51, P < .001). Base excess on admission (Odds ratio [OR] = 0.81, 95% confidence interval [CI] = 0.70–0.94), duration of diarrhea (OR = 1.37, 95% CI = 1.05–1.80), milk intake during hospitalization (OR = 0.54, 95% CI = 0.37–0.79) and plasma sodium concentrations after 24 hours (OR = 1.12, 95% CI = 1.01–1.25) were identified to be independently associated (P < .05) with a hypokalemic state after 24 hours of treatment. Conclusions and Clinical Importance Findings of this study suggest that marked depletion of body potassium stores is evident in diarrheic calves that suffered from marked metabolic acidosis, have a low milk intake and a long history of diarrhea.
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Affiliation(s)
- F M Trefz
- Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, LMU Munich, Oberschleißheim, Germany
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15
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Fischer S, Tandstad T, Weather M, Fléchon A, Aparicio J, Klingbiel D, Skrbinc B, Shamash J, Lorch A, Basso U, Dieckmann K, Huddart R, Cohn-Cedermark G, Ståhl O, Chau C, Arriola E, Laguerre B, Maroto P, Beyer J, Gillessen S. 2601 Outcome of relapses after adjuvant carboplatin in clinical stage I seminoma. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31419-8] [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: 10/22/2022]
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Trefz FM, Lorch A, Zitzl J, Kutschke A, Knubben-Schweizer G, Lorenz I. Effects of alkalinization and rehydration on plasma potassium concentrations in neonatal calves with diarrhea. J Vet Intern Med 2015; 29:696-704. [PMID: 25641097 PMCID: PMC4895490 DOI: 10.1111/jvim.12537] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 11/13/2014] [Accepted: 12/04/2014] [Indexed: 11/28/2022] Open
Abstract
Background Increased plasma potassium concentrations (K+) in neonatal calves with diarrhea are associated with acidemia and severe clinical dehydration and are therefore usually corrected by intravenous administration of fluids containing sodium bicarbonate. Objectives To identify clinical and laboratory variables that are associated with changes of plasma K+ during the course of treatment and to document the plasma potassium‐lowering effect of hypertonic (8.4%) sodium bicarbonate solutions. Animals Seventy‐one neonatal diarrheic calves. Methods Prospective cohort study. Calves were treated according to a clinical protocol using an oral electrolyte solution and commercially available packages of 8.4% sodium bicarbonate (250–750 mmol), 0.9% saline (5–10 L), and 40% dextrose (0.5 L) infusion solutions. Results Infusions with 8.4% sodium bicarbonate solutions in an amount of 250–750 mmol had an immediate and sustained plasma potassium‐lowering effect. One hour after the end of such infusions or the start of a sodium bicarbonate containing constant drip infusion, changes of plasma K+ were most closely correlated to changes of venous blood pH, plasma sodium concentrations and plasma volume (r = −0.73, −0.57, −0.53; P < .001). Changes of plasma K+ during the subsequent 23 hours were associated with changes of venous blood pH, clinical hydration status (enophthalmos) and serum creatinine concentrations (r = −0.71, 0.63, 0.62; P < .001). Conclusions and Clinical Importance This study emphasizes the importance of alkalinization and the correction of dehydration in the treatment of hyperkalemia in neonatal calves with diarrhea.
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Affiliation(s)
- F M Trefz
- Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, LMU Munich, Oberschleißheim, Germany
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Oldenburg J, Aparicio J, Beyer J, Cohn-Cedermark G, Cullen M, Gilligan T, De Giorgi U, De Santis M, de Wit R, Fosså SD, Germà-Lluch JR, Gillessen S, Haugnes HS, Honecker F, Horwich A, Lorch A, Ondruš D, Rosti G, Stephenson AJ, Tandstad T. Personalizing, not patronizing: the case for patient autonomy by unbiased presentation of management options in stage I testicular cancer. Ann Oncol 2014; 26:833-838. [PMID: 25378299 DOI: 10.1093/annonc/mdu514] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [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: 09/16/2014] [Accepted: 10/28/2014] [Indexed: 11/12/2022] Open
Abstract
Testicular cancer (TC) is the most common neoplasm in males aged 15-40 years. The majority of patients have no evidence of metastases at diagnosis and thus have clinical stage I (CSI) disease [Oldenburg J, Fossa SD, Nuver J et al. Testicular seminoma and non-seminoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013; 24(Suppl 6): vi125-vi132; de Wit R, Fizazi K. Controversies in the management of clinical stage I testis cancer. J Clin Oncol 2006; 24: 5482-5492.]. Management of CSI TC is controversial and options include surveillance and active treatment. Different forms of adjuvant therapy exist, including either one or two cycles of carboplatin chemotherapy or radiotherapy for seminoma and either one or two cycles of cisplatin-based chemotherapy or retroperitoneal lymph node dissection for non-seminoma. Long-term disease-specific survival is ∼99% with any of these approaches, including surveillance. While surveillance allows most patients to avoid additional treatment, adjuvant therapy markedly lowers the relapse rate. Weighing the net benefits of surveillance against those of adjuvant treatment depends on prioritizing competing aims such as avoiding unnecessary treatment, avoiding more burdensome treatment with salvage chemotherapy and minimizing the anxiety, stress and life disruption associated with relapse. Unbiased information about the advantages and disadvantages of surveillance and adjuvant treatment is a prerequisite for informed consent by the patient. In a clinical scenario like CSI TC, where different disease-management options produce indistinguishable long-term survival rates, patient values, priorities and preferences should be taken into account. In this review, we provide an overview about risk factors for relapse, potential benefits and harms of adjuvant chemotherapy and active surveillance and a rationale for involving patients in individualized decision making about their treatment rather than adopting a uniform recommendation for all.
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Affiliation(s)
- J Oldenburg
- Department of Oncology, Akershus University Hospital, Lørenskog; Department of Oncology, University of Oslo, Oslo, Norway.
| | - J Aparicio
- Department of Oncology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - J Beyer
- Department of Oncology, Universitätsspital Zürich, Zürich, Switzerland
| | - G Cohn-Cedermark
- Department of Oncology-Pathology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - M Cullen
- Department of Medical Oncology, Queen Elizabeth Hospital, University Hospital Birmingham Foundation Trust, Birmingham, UK
| | - T Gilligan
- Department of Solid Tumor Oncology, Cleveland Clinic, Cleveland, USA
| | - U De Giorgi
- Department of Medical Oncology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Italy
| | - M De Santis
- Kaiser Franz Josef Hospital and ACR-ITR and LBI-ACR Vienna-CTO, Vienna, Austria
| | - R de Wit
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - S D Fosså
- Department of Oncology, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - J R Germà-Lluch
- Department of Oncology, Institut Català d'Oncologia, Gran Via de l'Hospitalet Hospitalet de Llobregat, Barcelona, Spain
| | - S Gillessen
- Department of Medical Oncology, Kantonsspital, St Gallen, Switzerland
| | - H S Haugnes
- Oncology Department, University Hospital of North Norway, Tromsø, Norway
| | - F Honecker
- Tumor and Breast Center ZeTuP, St. Gallen, Switzerland
| | - A Horwich
- Department of Clinical Oncology, Royal Marsden Hospital and Institute of Cancer Research, Sutton, UK
| | - A Lorch
- Klinik für Urologie, konservative Uroonkologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - D Ondruš
- Department of Oncology, Comenius University Faculty of Medicine, St Elisabeth Cancer Institute, Bratislava, Slovak Republic
| | - G Rosti
- Medical Oncology, Ospedale Generale, Treviso, Italy
| | | | - T Tandstad
- The Cancer Clinic, St Olavs University Hospital, Trondheim, Norway
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Beyer J, Lorch A, Powles T, Kramar A, van Alstine L, Giannatempo P, Sava T, Albany C, Einhorn L, Flechon A, Aparicio J, Chung P, Huddart R, Bokemeyer C, Tryakin A, Winquist E, Sweeney C, Hentrich M, Margolin K, Feldman D. Brain Metastases in Male Germ Cell Tumors (Gct): a Large Retrospective Analysis on Behalf of the Swenoteca and the G3 Consortium. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu337.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Trefz FM, Constable PD, Sauter-Louis C, Lorch A, Knubben-Schweizer G, Lorenz I. Hyperkalemia in neonatal diarrheic calves depends on the degree of dehydration and the cause of the metabolic acidosis but does not require the presence of acidemia. J Dairy Sci 2013; 96:7234-7244. [PMID: 24011947 DOI: 10.3168/jds.2013-6945] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Accepted: 07/12/2013] [Indexed: 11/19/2022]
Abstract
Hyperkalemia is a clinically important electrolyte imbalance in neonatal diarrheic calves that has previously been associated with skeletal muscle weakness and life-threatening cardiac arrhythmias. The aim of the present retrospective analysis was to identify risk factors for hyperkalemia in a convenience sample of 832 calves (≤ 21 d of age) with a clinical diagnosis of diarrhea admitted to a veterinary teaching hospital. Plasma potassium concentrations were most closely associated with parameters of dehydration and renal function such as serum creatinine [Spearman correlation (rs) = 0.61], urea (rs = 0.51), and inorganic phosphorus concentrations (rs = 0.64). Plasma potassium concentrations were weakly associated with venous blood pH (rs = -0.21). Although venous blood pH was not predictive in a multivariate linear regression analysis, the odds of having hyperkalemia (>5.8 mmol/L) in acidemic calves was found to be 8.6 times as high as in nonacidemic calves [95% confidence interval (CI): 4.8-15.4]. However, the presence of hyperkalemia depended on the nature of an existing acidosis, and the odds for the presence of hyperkalemia in acidemic calves with hyper-D-lactatemia (>3.96 mmol/L) were only 0.15 times as high as in acidemic calves with normal D-lactate concentrations (95% CI, 0.11-0.22). Acidemia in hyperkalemic diarrheic calves was associated with hyponatremia and increased concentrations of inorganic phosphorus, L-lactate, and unidentified strong anions that presumably included uremic anions such as sulfate. We conclude that hyper-D-lactatemia in neonatal diarrheic calves is not usually associated with elevated plasma potassium concentrations. Application of the simplified strong ion acid-base model indicated that dehydration is an important contributor to the pathogenesis of hyperkalemia and acidemia in neonatal calves with diarrhea.
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Affiliation(s)
- F M Trefz
- Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, LMU Munich, Sonnenstraße 16, 85764 Oberschleißheim, Germany.
| | - P D Constable
- College of Veterinary Medicine, Purdue University, West Lafayette, IN 47907
| | - C Sauter-Louis
- Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, LMU Munich, Sonnenstraße 16, 85764 Oberschleißheim, Germany
| | - A Lorch
- Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, LMU Munich, Sonnenstraße 16, 85764 Oberschleißheim, Germany
| | - G Knubben-Schweizer
- Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, LMU Munich, Sonnenstraße 16, 85764 Oberschleißheim, Germany
| | - I Lorenz
- UCD School of Veterinary Medicine, University College Dublin, Belfield, Dublin 4, Ireland
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Lorch A. [Metastatic prostate cancer: new insights and developments]. Dtsch Med Wochenschr 2013; 138:703-6. [PMID: 23533034 DOI: 10.1055/s-0032-1332995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- A Lorch
- Bereich Konservative Urologische Onkologie, Klinik für Urologie, Universitätsklinikum Düsseldorf, Düsseldorf
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Massard C, Kramar A, Beyer J, Hartmann JT, Lorch A, Pico JL, Rosti G, Droz JP, Fizazi K. Tumor marker kinetics predict outcome in patients with relapsed disseminated non-seminomatous germ-cell tumors. Ann Oncol 2013; 24:322-328. [PMID: 23104726 DOI: 10.1093/annonc/mds504] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND An early serum tumor marker (TM) decline during chemotherapy was shown to independently predict survival in patients with poor-prognosis disseminated non-seminomatous germ-cell tumors (NSGCTs). The aim of this study was to assess whether a TM decline (TMD) also correlates with the outcome in the salvage setting. PATIENTS AND METHODS Data regarding 400 patients with progressive or relapsed disseminated NSGCTs after first-line chemotherapy prospectively accrued onto two phase III clinical trials were obtained. Serum alpha-fetoprotein (AFP) and/or human chorionic gonadotropin (hCG) were assessed at baseline and after 6 weeks of chemotherapy. A total of 297 patients, 185 and 112 in the training and validation sets, with initially abnormal TMs for whom a change from baseline could be established were used for this analysis. RESULTS An unfavorable decline in either AFP or hCG was predictive of progression-free survival (PFS) [hazard ratio, HR = 2.15, (95% CI 1.48-3.11); P < 0.001; 2-year PFS rate: 50% versus 26%] as was the Lorch prognostic score (LPS). In the multivariate analysis, an unfavorable TMD, stratified based on the LPS, was an independent adverse prognostic factor for PFS and OS. CONCLUSION An unfavorable TMD during the first 6 weeks after chemotherapy is associated with a poorer outcome in patients with relapsed disseminated NSGCTs.
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Affiliation(s)
- C Massard
- Department of Medical Oncology, Institut Gustave Roussy, University of Paris Sud, Villejuif.
| | - A Kramar
- Unit of Biostatistics, Centre Oscar Lambret, Lille, France
| | - J Beyer
- Department of Cancer Medicine, Vivantes Klinikum am Urban, Berlin
| | - J T Hartmann
- Cancer Center North, Christian-Albrechts-Universität zu Kiel, Keil
| | - A Lorch
- Genitourinary Medical Oncology, Department of Urology, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - J L Pico
- Department of Medical Oncology, Institut Gustave Roussy, University of Paris Sud, Villejuif
| | - G Rosti
- Department of Cancer Medicine, Ospedale Ca'Foncello, Treviso, Italy
| | - J P Droz
- Department of Cancer Medicine, Centre Léon-Bérard, Lyon, France
| | - K Fizazi
- Department of Medical Oncology, Institut Gustave Roussy, University of Paris Sud, Villejuif
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Abstract
Despite adequate surgical treatment by radical cystectomy and pelvic lymphadenectomy, about half of patients suffering from muscle-invasive urothelial bladder cancer will die. Both overall and cancer-specific survival has been improved by neoadjuvant chemotherapy. However, it is still not possible to predict who is likely to benefit from neoadjuvant treatment and who will not. In contrast to neoadjuvant chemotherapy, the efficacy of adjuvant chemotherapy has not definitely been proven. In metastatic urothelial cancer chemotherapy is usually a palliative treatment option. However, in a significant proportion of patients, disease stabilisation and even long-term response can be achieved. Important advances to tailor first- and second-line chemotherapy have recently been reported for clinical prognostic parameters. This review discusses the current standards and developments in the chemotherapeutic treatment of urothelial bladder cancer. Furthermore, it should provide a framework for reasonable treatment choices in daily clinical practice.
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Affiliation(s)
- G. Niegisch
- Medizinische Fakultät, Urologische Klinik, Heinrich-Heine-Universität, Düsseldorf
| | - A. Lorch
- Medizinische Fakultät, Urologische Klinik, Heinrich-Heine-Universität, Düsseldorf
| | - P. Albers
- Medizinische Fakultät, Urologische Klinik, Heinrich-Heine-Universität, Düsseldorf
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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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Trefz FM, Lorch A, Feist M, Sauter-Louis C, Lorenz I. Metabolic acidosis in neonatal calf diarrhea-clinical findings and theoretical assessment of a simple treatment protocol. J Vet Intern Med 2011; 26:162-70. [PMID: 22168181 DOI: 10.1111/j.1939-1676.2011.00848.x] [Citation(s) in RCA: 28] [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] [Received: 06/30/2011] [Revised: 09/19/2011] [Accepted: 11/03/2011] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Clinical assessment of metabolic acidosis in calves with neonatal diarrhea can be difficult because increased blood concentrations of d-lactate and not acidemia per se are responsible for most of the clinical signs exhibited by these animals. OBJECTIVES To describe the correlation between clinical and laboratory findings and d-lactate concentrations. Furthermore, the theoretical outcome of a simplified treatment protocol based on posture/ability to stand and degree of dehydration was evaluated. ANIMALS A total of 121 calves with diagnosis of neonatal diarrhea admitted to a veterinary teaching hospital during an 8-month study period. METHODS Prospective blinded cohort study. Physical examinations were carried out following a standardized protocol. Theoretical outcome of treatment was calculated. RESULTS Type and degree of metabolic acidosis were age dependent. The clinical parameters posture, behavior, and palpebral reflex were closely correlated to base excess (r = 0.74, 0.78, 0.68; P < .001) and d-lactate concentrations (r = 0.59, 0.59, 0.71; P < .001), respectively. Thus, determining the degree of loss of the palpebral reflex was identified as the best clinical tool for diagnosing increase in serum d-lactate concentrations. Theoretical outcome of treatment revealed that the tested dosages of sodium bicarbonate are more likely to overdose than to underdose calves with diarrhea and metabolic acidosis. CONCLUSIONS AND CLINICAL IMPORTANCE The degree of metabolic acidosis in diarrheic calves can be predicted based on clinical findings. The assessed protocol provides a useful tool to determine bicarbonate requirements, but a revision is necessary for calves with ability to stand and marked metabolic acidosis.
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Affiliation(s)
- F M Trefz
- Centre for Clinical Veterinary Medicine, LMU Munich, Oberschleißheim, Germany.
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Lorch A, Albers P, Winter C, Beyer J. [High-dose chemotherapy and residual tumor resection in male germ cell tumors]. Urologe A 2011; 50:1047-54. [PMID: 21845425 DOI: 10.1007/s00120-011-2683-7] [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: 11/25/2022]
Abstract
As a consequence of the unsatisfactory results of conventional dose salvage regimens, in particular for patients with poor prognostic features at the time of relapse or in patients with refractory disease, high-dose chemotherapy (HDCT) was introduced into clinical practice in the late 1980s. The combination of carboplatin and etoposide (CE) still remains the backbone of most high-dose regimens. Multiple modifications with more dose escalations or addition of further drugs have been explored, most often with increased toxicity. With improved expertise in supportive care and the use of peripheral blood stem cells, hematopoetic recovery has been significantly shortened and the initial high treatment-related mortality reduced from more than 10% to about 3%. Since the incorporation of HDCT, even patients with unfavorable prognostic features or patients with second or subsequent relapses can achieve long-term remission. Following HDCT residual tumor resection plays a major role in achieving these long-term results. The proportion of vital residual tumor after HDCT is much higher than in patients after conventional chemotherapy. The role of HDCT remains controversial particularly as a first-line treatment and less so in the first salvage setting. As these patients are rare HDCT and residual tumor resection should only be be provided by high-volume centers with sufficient expertise in performing these complex procedures.
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Affiliation(s)
- A Lorch
- Klinik für Hämatologie, Onkologie und Immunologie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Baldingerstraße, 35033, Marburg, Deutschland.
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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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Powles T, Mollevi C, Kramar A, Lorch A, Beyer J. The prognostic significance of LDH levels in patients with relapsed/refractory seminoma and their predictive value of the new international prognostic score. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4584] [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, Mollevi C, Kramar A, Einhorn LH, Necchi A, Massard C, DeGiorgi U, Flechon A, Margolin KA, Beyer J. Conventional-dose versus high-dose chemotherapy in relapsed or refractory male germ-cell tumors: A retrospective study in 1,594 patients. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4513] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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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Lorch A, Beyer J, Mollevi C, Guerra M, Kramar A. Prognostic factors in relapsed or refractory male germ cell tumors: Results from an international study of 1,593 patients. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.5030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5030 Background: The results of salvage treatment in male patients (pts) with relapsed or refractory germ-cell tumors (rr-GCT) depend considerably on prognostic factors. However, individual factors are not broadly accepted. Methods: Between 09/2007 and 12/2008 data on 1984 pts with rr-GCT were collected from 38 centers/groups worldwide. Inclusion criteria were (1) First line treatment for metastatic GCT after January 1, 1990; (2) Cisplatin and etoposide as part of first-line regimens; (3) No first-line high-dose chemotherapy (HDCT); (4) Relapse or progression after first-line treatment; (5) Cisplatin- based conventional-dose regimens or HDCT as salvage treatment. Data were centrally reviewed and checked for consistency. The primary endpoint was progression-free survival (PFS). Prognostic factors were identified using Cox multivariate regression analysis. Results: Overall 1593 (80%) pts fulfilled the strict inclusion criteria. Salvage treatment given as consolidation of first-line treatment in patients without progression was the most frequent cause of exclusion. Median follow-up was 58 months (range 1 to 206 months). Three-year PFS for the entire group was 38% (95% CI: 35%-40%), the overall survival was 51% (95% CI: 48%-54%). Multivariate analysis on a randomly selected 2/3 training dataset identified the following variables as the most significant ones for PFS: see Table . Cisplatin-refractory or absolute refractory disease was a confounding factor for response to first-line treatment. Conclusions: This preliminary analysis of a large dataset allowed the identification of important prognostic factors in rr- GCT. A prognostic score for first-salvage treatment based on the results of a final analysis will be presented. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- A. Lorch
- Philipps-University, Marburg, Germany; Vivantes Klinikum am Urban, Berlin, Germany; CRLC Val d’Aurelle-Paul Lamarque, Montpellier, France
| | - J. Beyer
- Philipps-University, Marburg, Germany; Vivantes Klinikum am Urban, Berlin, Germany; CRLC Val d’Aurelle-Paul Lamarque, Montpellier, France
| | - C. Mollevi
- Philipps-University, Marburg, Germany; Vivantes Klinikum am Urban, Berlin, Germany; CRLC Val d’Aurelle-Paul Lamarque, Montpellier, France
| | - M. Guerra
- Philipps-University, Marburg, Germany; Vivantes Klinikum am Urban, Berlin, Germany; CRLC Val d’Aurelle-Paul Lamarque, Montpellier, France
| | - A. Kramar
- Philipps-University, Marburg, Germany; Vivantes Klinikum am Urban, Berlin, Germany; CRLC Val d’Aurelle-Paul Lamarque, Montpellier, France
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Massard C, Huguet H, Kramar A, Beyer J, Hartmann JT, Lorch A, Pico J, Rosti G, Droz J, Fizazi K. Cross-validation of a new prognostic index integrating tumor marker decline in patients with relapsed disseminated germ cell tumors. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.5086] [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
5086 Background: Early serum tumor marker decline during chemotherapy was previously shown to be prognostic for progression-free survival (PFS) and overall survival (OS) in patients with relapsed GCT in an analysis of the IT94 phase III trial, which compared conventional chemotherapy versus high dose chemotherapy (Massard C, ASCO 2008. Abstract No. 5085). The aim of this study was to validate this concept in an independent set of patients. Methods: Data on tumor site, response to first line chemotherapy, serum tumor markers at baseline and after two cycles of chemotherapy were obtained from 235 patients accrued in the IT94 trial (training set) and from 181 patients included in phase III prospective trials of high-dose chemotherapy conducted by the German GCT group (Lorch et al, J Clin Oncol. 2007) (validation set). The change from baseline of serum alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG) was assessed and classified into ‘favorable marker decline‘ and ‘unfavorable marker decline‘ group, as previously described (ASCO 2008. Abstract No. 5085). Results: In both series, favourable serum AFP decline was significantly associated with a better 2-year PFS (46% vs 24%; p < 0.0001) and OS (62% vs 34%; p = 0.0013) while serum hCG decline did not affect outcome. In multivariate analysis of the IT94 trial, an unfavorable AFP decline and a mediastinal primary site were adverse prognostic factors for both PFS and OS, and this was confirmed in the validation set. Among patients from the good prognostic group (favorable AFP decline and non-mediastinal primary site), those who were treated with high-dose chemotherapy had a better PFS (2-year PFS rate: 54% vs 37%; HR = 0.62; p = 0.017), and a trend for a better OS (2-year OS rate: 68% vs. 58%; HR = 0.77; p = 0.29) as compared to patients who were treated with conventional chemotherapy. In contrast, there was no difference in outcome in patients from the poor prognostic group (unfavourable AFP decline and/or mediastinal primary site), whether they received conventional chemotherapy or high-dose chemotherapy. Conclusions: AFP decline during the first 6 weeks of salvage chemotherapy and a mediastinal primary tumor site predict for PFS and OS in patients with relapsed disseminated GCT. No significant financial relationships to disclose.
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Affiliation(s)
- C. Massard
- Institut Gustave Roussy, Villejuif, France; Centre du Val d'Aurelle, Montpellier, France; Direktor Klinik für Hämatologie und Onkologie, Berlin, Germany; CCC Tübingen, Tübingen, Germany; Hämatologie, Onkologie und Immunologie, Marburg, Germany; Department of Oncology, Trevisio, Italy; Centre Léon Bérard, Lyon, France
| | - H. Huguet
- Institut Gustave Roussy, Villejuif, France; Centre du Val d'Aurelle, Montpellier, France; Direktor Klinik für Hämatologie und Onkologie, Berlin, Germany; CCC Tübingen, Tübingen, Germany; Hämatologie, Onkologie und Immunologie, Marburg, Germany; Department of Oncology, Trevisio, Italy; Centre Léon Bérard, Lyon, France
| | - A. Kramar
- Institut Gustave Roussy, Villejuif, France; Centre du Val d'Aurelle, Montpellier, France; Direktor Klinik für Hämatologie und Onkologie, Berlin, Germany; CCC Tübingen, Tübingen, Germany; Hämatologie, Onkologie und Immunologie, Marburg, Germany; Department of Oncology, Trevisio, Italy; Centre Léon Bérard, Lyon, France
| | - J. Beyer
- Institut Gustave Roussy, Villejuif, France; Centre du Val d'Aurelle, Montpellier, France; Direktor Klinik für Hämatologie und Onkologie, Berlin, Germany; CCC Tübingen, Tübingen, Germany; Hämatologie, Onkologie und Immunologie, Marburg, Germany; Department of Oncology, Trevisio, Italy; Centre Léon Bérard, Lyon, France
| | - J. T. Hartmann
- Institut Gustave Roussy, Villejuif, France; Centre du Val d'Aurelle, Montpellier, France; Direktor Klinik für Hämatologie und Onkologie, Berlin, Germany; CCC Tübingen, Tübingen, Germany; Hämatologie, Onkologie und Immunologie, Marburg, Germany; Department of Oncology, Trevisio, Italy; Centre Léon Bérard, Lyon, France
| | - A. Lorch
- Institut Gustave Roussy, Villejuif, France; Centre du Val d'Aurelle, Montpellier, France; Direktor Klinik für Hämatologie und Onkologie, Berlin, Germany; CCC Tübingen, Tübingen, Germany; Hämatologie, Onkologie und Immunologie, Marburg, Germany; Department of Oncology, Trevisio, Italy; Centre Léon Bérard, Lyon, France
| | - J. Pico
- Institut Gustave Roussy, Villejuif, France; Centre du Val d'Aurelle, Montpellier, France; Direktor Klinik für Hämatologie und Onkologie, Berlin, Germany; CCC Tübingen, Tübingen, Germany; Hämatologie, Onkologie und Immunologie, Marburg, Germany; Department of Oncology, Trevisio, Italy; Centre Léon Bérard, Lyon, France
| | - G. Rosti
- Institut Gustave Roussy, Villejuif, France; Centre du Val d'Aurelle, Montpellier, France; Direktor Klinik für Hämatologie und Onkologie, Berlin, Germany; CCC Tübingen, Tübingen, Germany; Hämatologie, Onkologie und Immunologie, Marburg, Germany; Department of Oncology, Trevisio, Italy; Centre Léon Bérard, Lyon, France
| | - J. Droz
- Institut Gustave Roussy, Villejuif, France; Centre du Val d'Aurelle, Montpellier, France; Direktor Klinik für Hämatologie und Onkologie, Berlin, Germany; CCC Tübingen, Tübingen, Germany; Hämatologie, Onkologie und Immunologie, Marburg, Germany; Department of Oncology, Trevisio, Italy; Centre Léon Bérard, Lyon, France
| | - K. Fizazi
- Institut Gustave Roussy, Villejuif, France; Centre du Val d'Aurelle, Montpellier, France; Direktor Klinik für Hämatologie und Onkologie, Berlin, Germany; CCC Tübingen, Tübingen, Germany; Hämatologie, Onkologie und Immunologie, Marburg, Germany; Department of Oncology, Trevisio, Italy; Centre Léon Bérard, Lyon, France
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Affiliation(s)
- I. Lorenz
- School of Agriculture, Food Science and Veterinary Medicine; University College Dublin; Belfield Dublin 4 Ireland
| | - A. Lorch
- Clinic for Ruminants; Ludwig-Maximilians Universität Munich; Sonnenstrasse 16 85764 Oberschleissheim Germany
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Lorch A, Neubauer A, Schirren R, Hingott S, Hoexter M, Oechsle K, Beyer J. Analysis of paclitaxel-based high-dose chemotherapy (Tax HD-VIP) in 18 patients (pts) with relapsed germ-cell tumors (GCT). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.16055] [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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Oechsle K, Lorch A, Honecker FU, Kollmannsberger C, Hartmann JT, Boehlke I, Beyer J, Bokemeyer C. Patterns of relapse after primary or salvage high-dose chemotherapy in patients with advanced nonseminomatous germ cell tumors. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.16012] [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, 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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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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