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Tempfer C, Horn LC, Ackermann S, Dittrich R, Einenkel J, Günthert A, Haase H, Kratzsch J, Kreißl M, Polterauer S, Ebert A, Steiner E, Thiel F, Eichbaum M, Fehm T, Koch MC, Gass P. Gestational and Non-gestational Trophoblastic Neoplasia. Guideline of the DGGG, OEGGG and SGGG (S2k-Level, AWMF Registry No. 032/049, April 2022). Geburtshilfe Frauenheilkd 2023; 83:267-288. [PMID: 37020431 PMCID: PMC10070003 DOI: 10.1055/a-1904-6461] [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] [Received: 07/12/2022] [Accepted: 07/16/2022] [Indexed: 03/11/2023] Open
Abstract
Abstract
Purpose The aim was to develop and update a guideline which would improve the quality of care offered to women with gestational and non-gestational trophoblastic disease, a group of diseases characterized by their rarity and biological heterogeneity.
Methods In accordance with the method used to compile S2k-guidelines, the guideline authors carried out a search of the literature (MEDLINE) for the period 1/2020 to 12/2021 and evaluated the recent literature. No key questions were formulated. No structured literature search with methodical evaluation and assessment of the level of evidence was carried out. The text of the precursor version of the guideline from 2019 was updated based on the most recent literature, and new statements and recommendations were drafted.
Recommendations The updated guideline contains recommendations for the diagnosis and therapy of women with hydatidiform mole (partial and complete moles), gestational trophoblastic neoplasia after pregnancy or without prior pregnancy, persistent trophoblastic disease after molar pregnancy, invasive moles, choriocarcinoma, placental site nodules, placental site trophoblastic tumor, hyperplasia at the implantation site und epithelioid trophoblastic tumor. Separate chapters cover the determination and assessment of human chorionic gonadotropin (hCG), histopathological evaluation of specimens, and the appropriate molecular pathological and immunohistochemical diagnostic procedures. Separate chapters on immunotherapy, surgical therapy, multiple pregnancies with simultaneous trophoblastic disease, and pregnancy after trophoblastic disease were formulated, and the corresponding recommendations agreed upon.
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Affiliation(s)
- Clemens Tempfer
- Universitätsfrauenklinik der Ruhr-Universität Bochum, Marienhospital Herne, Bochum/Herne, Germany
| | | | - Sven Ackermann
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Darmstadt, Darmstadt, Germany
| | - Ralf Dittrich
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Jens Einenkel
- Klinik für Frauenheilkunde und Geburtshilfe, Sana-Kliniken Leipziger Land, Leipzig, Germany
| | | | | | - Jürgen Kratzsch
- Institut für Laboratoriumsmedizin, Klinische Chemie und Molekulare Diagnostik, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Michael Kreißl
- Universitätsklinik für Radiologie und Nuklearmedizin, Klinikum Magdeburg, Magdeburg, Germany
| | | | - Andreas Ebert
- Praxis für Gynäkologie und Geburtshilfe, Berlin, Germany
| | - Eric Steiner
- Frauenklinik, GPR-Klinikum Rüsselsheim, Rüsselsheim, Germany
| | - Falk Thiel
- Frauenklinik, Klinik am Eichert, Göppingen, Germany
| | - Michael Eichbaum
- Klinik für Frauenheilkunde und Geburtshilfe, Helios Dr. Horst-Schmidt-Kliniken Wiesbaden, Wiesbaden, Germany
| | - Tanja Fehm
- Klinik für Frauenheilkunde, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Martin C. Koch
- Klinik für Gynäkologie und Geburtshilfe, Ansbach, Germany
| | - Paul Gass
- Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Comprehensive Cancer Center Erlangen/Europäische Metropolregion Nürnberg (CCC ER-EMN), Erlangen, Germany
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Weber WP, Shaw J, Pusic A, Wyld L, Morrow M, King T, Mátrai Z, Heil J, Fitzal F, Potter S, Rubio IT, Cardoso MJ, Gentilini OD, Galimberti V, Sacchini V, Rutgers EJT, Benson J, Allweis TM, Haug M, Paulinelli RR, Kovacs T, Harder Y, Gulluoglu BM, Gonzalez E, Faridi A, Elder E, Dubsky P, Blohmer JU, Bjelic-Radisic V, Barry M, Hay SD, Bowles K, French J, Reitsamer R, Koller R, Schrenk P, Kauer-Dorner D, Biazus J, Brenelli F, Letzkus J, Saccilotto R, Joukainen S, Kauhanen S, Karhunen-Enckell U, Hoffmann J, Kneser U, Kühn T, Kontos M, Tampaki EC, Carmon M, Hadar T, Catanuto G, Garcia-Etienne CA, Koppert L, Gouveia PF, Lagergren J, Svensjö T, Maggi N, Kappos EA, Schwab FD, Castrezana L, Steffens D, Krol J, Tausch C, Günthert A, Knauer M, Katapodi MC, Bucher S, Hauser N, Kurzeder C, Mucklow R, Tsoutsou PG, Sezer A, Çakmak GK, Karanlik H, Fairbrother P, Romics L, Montagna G, Urban C, Walker M, Formenti SC, Gruber G, Zimmermann F, Zwahlen DR, Kuemmel S, El-Tamer M, Vrancken Peeters MJ, Kaidar-Person O, Gnant M, Poortmans P, de Boniface J. Oncoplastic breast consortium recommendations for mastectomy and whole breast reconstruction in the setting of post-mastectomy radiation therapy. Breast 2022; 63:123-139. [PMID: 35366506 PMCID: PMC8976143 DOI: 10.1016/j.breast.2022.03.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 12/01/2021] [Revised: 03/03/2022] [Accepted: 03/14/2022] [Indexed: 12/31/2022] Open
Abstract
Aim Demand for nipple- and skin- sparing mastectomy (NSM/SSM) with immediate breast reconstruction (BR) has increased at the same time as indications for post-mastectomy radiation therapy (PMRT) have broadened. The aim of the Oncoplastic Breast Consortium initiative was to address relevant questions arising with this clinically challenging scenario. Methods A large global panel of oncologic, oncoplastic and reconstructive breast surgeons, patient advocates and radiation oncologists developed recommendations for clinical practice in an iterative process based on the principles of Delphi methodology. Results The panel agreed that surgical technique for NSM/SSM should not be formally modified when PMRT is planned with preference for autologous over implant-based BR due to lower risk of long-term complications and support for immediate and delayed-immediate reconstructive approaches. Nevertheless, it was strongly believed that PMRT is not an absolute contraindication for implant-based or other types of BR, but no specific recommendations regarding implant positioning, use of mesh or timing were made due to absence of high-quality evidence. The panel endorsed use of patient-reported outcomes in clinical practice. It was acknowledged that the shape and size of reconstructed breasts can hinder radiotherapy planning and attention to details of PMRT techniques is important in determining aesthetic outcomes after immediate BR. Conclusions The panel endorsed the need for prospective, ideally randomised phase III studies and for surgical and radiation oncology teams to work together for determination of optimal sequencing and techniques for PMRT for each patient in the context of BR Autologous breast reconstruction is increasingly preferred over implants in the setting of radiation therapy. Use of patient-reported outcomes is endorsed. Shape and size of reconstructed breasts can hinder radiotherapy planning. There is a need for randomised phase III trials.
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Affiliation(s)
- Walter Paul Weber
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland.
| | - Jane Shaw
- Patient Advocacy Group, Oncoplastic Breast Consortium, Basel, Switzerland
| | - Andrea Pusic
- Brigham and Women's/Dana Farber Cancer Center, USA
| | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Monica Morrow
- Breast Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tari King
- Department of Surgery, Brigham and Women's Hospital / Dana Farber Cancer Institute, USA
| | - Zoltán Mátrai
- Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary
| | - Jörg Heil
- Department of Obstetrics and Gynecology, University of Heidelberg, Medical School, Heidelberg, Germany
| | - Florian Fitzal
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Shelley Potter
- Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Clifton, Bristol, UK
| | - Isabel T Rubio
- Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Spain
| | - Maria-Joao Cardoso
- Breast Unit, Champalimaud Clinical Centre, Champalimaud Foundation, And Nova Medical School, Lisbon, Portugal
| | | | | | - Virgilio Sacchini
- Breast Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emiel J T Rutgers
- Department of Surgery, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - John Benson
- Cambridge Breast Unit, Addenbrooke's Hospital Cambridge, Cambridge, UK; Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation TRUST, School of Medicine, Anglia Ruskin University, Cambridge, UK
| | - Tanir M Allweis
- Hadassah Medical Center & Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Martin Haug
- Breast Center and Department of Plastic, Reconstructive, Aesthetic and Handsurgery University Hospital Basel, University of Basel, Basel, Switzerland
| | - Regis R Paulinelli
- Federal University of Goiás, Araújo Jorge Hospital, Goiás Anti-Cancer Association, Goiás, Brazil
| | - Tibor Kovacs
- Jiahui Internatioonal Hospital Shanghai, China; Guy's and St. Thomas' NHS Foundation Trust London, UK
| | - Yves Harder
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland; Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
| | | | - Eduardo Gonzalez
- Departament of Mastology, Breast Unit- Instituto de Oncología Angel H Roffo, Buenos Aires Univesity. Buenos Aires, Argentina
| | - Andree Faridi
- Department of Senology/Breast Center, University Hospital Bonn, Germany
| | - Elisabeth Elder
- Westmead Breast Cancer Institute, Westmead Hospital, University of Sydney, Australia
| | - Peter Dubsky
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Breast Center, Hirslanden Clinic St. Anna, Lucerne, Switzerland
| | - Jens-Uwe Blohmer
- Department of Gynecology and Breast Center, Charité University Hospital, Berlin, Germany
| | - Vesna Bjelic-Radisic
- Breast Unit, Helios University Hospital, University Witten/Herdecke, Wuppertal, Germany
| | - Mitchel Barry
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Susanne Dieroff Hay
- Patient Advocacy Group, Oncoplastic Breast Consortium, President, the Swedish Breast Cancer Association, Stockholm, Sweden
| | - Kimberly Bowles
- Patient Advocacy Group, Oncoplastic Breast Consortium, Not Putting on A Shirt, Pittsburgh, USA
| | - James French
- Westmead Breast Cancer Institute, Westmead Hospital, University of Sydney, Australia
| | - Roland Reitsamer
- Breast Center Salzburg, University Clinic Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Rupert Koller
- Department of Plastic, Aesthetic and Reconstructive Surgery, Vienna Health Services, Clinic Landstrasse and Clinic Ottakring, Vienna, Austria
| | - Peter Schrenk
- Breast Cancer Center, Kepler University Hospital, Linz, Austria
| | | | - Jorge Biazus
- Division of Breast Surgery, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
| | - Fabricio Brenelli
- Breast Oncology Division, University of Campinas, Campinas, São Paulo, Brazil
| | - Jaime Letzkus
- San Borja Arriaran Clinical Hospital, University of Chile, Chile
| | | | | | - Susanna Kauhanen
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ulla Karhunen-Enckell
- Tampere University Hospital, Department of Surgery and Tays Cancer Center, Tampere, Finland
| | - Juergen Hoffmann
- Breast Center, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery - Burn Center, BG Trauma Center Ludwigshafen/Rhine, Hand and Plastic Surgery, University Heidelberg, Heidelberg, Germany
| | - Thorsten Kühn
- Interdisciplinary Breast Center, Klinikum Esslingen, Germany
| | | | - Ekaterini Christina Tampaki
- Department of Plastic, Reconstructive Surgeryand Burn Unit, KAT Athens Hospital and Trauma Center, Athens, Greece
| | | | - Tal Hadar
- Hadassah Medical Center & Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Giuseppe Catanuto
- Multidisciplinary Breast Unit, Azienda Ospedaliera Cannizzaro, Catania, Italy
| | | | - Linetta Koppert
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Pedro F Gouveia
- Breast Unit, Champalimaud Clinical Centre, Champalimaud Foundation, And Nova Medical School, Lisbon, Portugal
| | - Jakob Lagergren
- Department of Surgery, Capio St Goran's Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Tor Svensjö
- Department of Surgery, Central Hospital, Kristianstad, Sweden
| | - Nadia Maggi
- Breast Center, University Hospital Basel, Basel, Switzerland
| | - Elisabeth A Kappos
- Breast Center and Department of Plastic, Reconstructive, Aesthetic and Handsurgery University Hospital Basel, University of Basel, Basel, Switzerland
| | | | | | - Daniel Steffens
- Breast Center, University Hospital Basel, Basel, Switzerland
| | - Janna Krol
- Breast Center, University Hospital Basel, Basel, Switzerland
| | | | | | - Michael Knauer
- Breast Center Eastern Switzerland, St. Gallen, Switzerland
| | - Maria C Katapodi
- University of Basel, Basel, Switzerland; Patient Advocacy Group, Oncoplastic Breast Consortium, Basel, Switzerland
| | - Susanne Bucher
- Breast Center, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Nik Hauser
- Breast Center, Hirslanden Clinic Aarau, Aarau, Frauenarztzentrum Aargau AG, Baden, Switzerland
| | - Christian Kurzeder
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Rosine Mucklow
- Patient Advocacy Group, Oncoplastic Breast Consortium, Basel, Switzerland
| | - Pelagia G Tsoutsou
- University Hospital Geneva, University of Geneva, Faculty of Medicine, Geneva, Switzerland
| | - Atakan Sezer
- Department of Surgery, Trakya University Medical School Hospital, Turkey
| | - Güldeniz Karadeniz Çakmak
- Department of Surgery, The School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | | | - Patricia Fairbrother
- Patient Advocacy Group, Oncoplastic Breast Consortium, Breakthrough Breast Cancer, Association Breast Surgery UKBCC, Kedleston, UK
| | - Laszlo Romics
- Department of Surgery, New Victoria Hospital, Glasgow, UK
| | - Giacomo Montagna
- Breast Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cicero Urban
- Breast Unit, Hospital Nossa Senhora Das Graças, Curitiba, Brazil
| | - Melanie Walker
- Breast Endocrine and General Surgery Unit, The Alfred, Melbourne, Australia; Breast Surgeons of Australia and New Zealand (BreastSurgANZ), Australia
| | - Silvia C Formenti
- Department of Radiation Oncology and Meyer Cancer Center, Weill Cornell Medicine, USA
| | - Guenther Gruber
- Institute for Radiotherapy, Klinik Hirslanden, 8032, Zurich, Switzerland; University of Berne, 3000, Bern, Switzerland
| | - Frank Zimmermann
- Clinic of Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - Daniel Rudolf Zwahlen
- Department of Radiation Oncology, Cantonal Hospital of Winterthur, Winterthur, Switzerland
| | - Sherko Kuemmel
- Department of Gynecology and Breast Center, Charité University Hospital, Berlin, Germany; Breast Unit, Kliniken Essen-Mitte, Germany
| | - Mahmoud El-Tamer
- Breast Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marie Jeanne Vrancken Peeters
- Department of Surgical Oncology Netherlands Cancer Institute, Antoni van Leeuwenhoek & Amsterdam University Medical Center, Netherlands
| | - Orit Kaidar-Person
- Breast Radiation Therapy Unit, Sheba Tel Hashomer, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Michael Gnant
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Philip Poortmans
- Iridium Netwerk and University of Antwerp, Wilrijk-Antwerpen, Belgium
| | - Jana de Boniface
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Capio St Göran's Hospital, Stockholm, Sweden
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Dubsky P, Pinker K, Cardoso F, Montagna G, Ritter M, Denkert C, Rubio IT, de Azambuja E, Curigliano G, Gentilini O, Gnant M, Günthert A, Hauser N, Heil J, Knauer M, Knotek-Roggenbauerc M, Knox S, Kovacs T, Kuerer HM, Loibl S, Mannhart M, Meattini I, Penault-Llorca F, Radosevic-Robin N, Sager P, Španić T, Steyerova P, Tausch C, Peeters MJTFDV, Weber WP, Cardoso MJ, Poortmans P. Breast conservation and axillary management after primary systemic therapy in patients with early-stage breast cancer: the Lucerne toolbox. Lancet Oncol 2021; 22:e18-e28. [PMID: 33387500 DOI: 10.1016/s1470-2045(20)30580-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/26/2020] [Accepted: 09/07/2020] [Indexed: 12/13/2022]
Abstract
Primary systemic therapy is increasingly used in the treatment of patients with early-stage breast cancer, but few guidelines specifically address optimal locoregional therapies. Therefore, we established an international consortium to discuss clinical evidence and to provide expert advice on technical management of patients with early-stage breast cancer. The steering committee prepared six working packages to address all major clinical questions from diagnosis to surgery. During a consensus meeting that included members from European scientific oncology societies, clinical trial groups, and patient advocates, statements were discussed and voted on. A consensus was reached in 42% of statements, a majority in 38%, and no decision in 21%. Based on these findings, the panel developed clinical guidance recommendations and a toolbox to overcome many clinical and technical requirements associated with the diagnosis, response assessment, surgical planning, and surgery of patients with early-stage breast cancer. This guidance could convince clinicians and patients of the major clinical advancements purported by primary systemic therapy, the use of less extensive and more targeted surgery to improve the lives of patients with breast cancer.
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Affiliation(s)
- Peter Dubsky
- Breast Centre, Hirslanden Klinik St Anna, Luzern, Switzerland; Department of Surgery, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
| | - Katja Pinker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria; Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center and Foundation, Lisbon, Portugal
| | - Giacomo Montagna
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Breast Center, University Hospital Basel, Basel, Switzerland
| | - Mathilde Ritter
- Breast Center, University Hospital Basel, Basel, Switzerland
| | - Carsten Denkert
- Institute of Pathology, Philipps-University Marburg and University Hospital Marburg, Marburg, Germany
| | - Isabel T Rubio
- Breast Surgical Oncology Unit, Clinica Universidad de Navarra, Universidad de Navarra, Madrid, Spain
| | - Evandro de Azambuja
- Institut Jules Bordet, Brussels, Belgium; l'Université Libre de Bruxelles, Brussels, Belgium
| | | | - Oreste Gentilini
- Breast Surgery, San Raffaele University and Research Hospital, Milan, Italy
| | - Michael Gnant
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Andreas Günthert
- Breast Centre, Hirslanden Klinik St Anna, Luzern, Switzerland; Department of Breast Surgery, Gyn-zentrum Luzern, Luzern, Switzerland
| | - Nik Hauser
- Breast Centre Aarau Cham Zug, Hirslanden Klinik, Aarau, Switzerland; Frauenarztzentrum Aargau Ag, Baden, Switzerland
| | - Joerg Heil
- Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Knauer
- Breast Center Eastern Switzerland, St Gallen, Switzerland
| | | | - Susan Knox
- Europa Donna-The European Breast Cancer Coalition, Milan, Italy
| | - Tibor Kovacs
- Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK; Breast Institute, Jiahui International Hospital, Shanghai, China
| | - Henry M Kuerer
- Division of Surgery, Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sibylle Loibl
- German Breast Group, Neu-Isenburg, Germany; Centre for Haematology and Oncology Bethanien, Frankfurt, Germany
| | - Meinrad Mannhart
- Breast Centre Aarau Cham Zug, Hirslanden Klinik, Aarau, Switzerland
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M Serio", University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Frederique Penault-Llorca
- Department of Pathology and Biopathology, Jean Perrin Comprehensive Cancer Centre, University Clermont Auvergne, INSERM U1240 IMoST, Clermont-Ferrand, France
| | - Nina Radosevic-Robin
- Department of Pathology and Biopathology, Jean Perrin Comprehensive Cancer Centre, University Clermont Auvergne, INSERM U1240 IMoST, Clermont-Ferrand, France
| | | | - Tanja Španić
- Europa Donna-The European Breast Cancer Coalition, Milan, Italy
| | - Petra Steyerova
- Breast Cancer Screening and Diagnostic Center, Clinic of Radiology, General University Hospital in Prague, Prague, Czech Republic
| | | | | | - Walter P Weber
- Breast Center, University Hospital Basel, Basel, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Maria J Cardoso
- Breast Unit, Champalimaud Clinical Center and Foundation, Lisbon, Portugal; Nova Medical School, Lisbon, Portugal
| | - Philip Poortmans
- Iridium Kankernetwerk, Wilrijk-Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk-Antwerp, Belgium
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Weber WP, Morrow M, Boniface JD, Pusic A, Montagna G, Kappos EA, Ritter M, Haug M, Kurzeder C, Saccilotto R, Schulz A, Benson J, Fitzal F, Matrai Z, Shaw J, Peeters MJV, Potter S, Heil J, González E, Elzayat M, Koller R, Gnant M, Brenelli F, Paulinelli RR, Zobel V, Joukainen S, Karhunen-Enckell U, Kauhanen S, Piat JM, Bjelic-Radisic V, Faridi A, Heitmann C, Hoffmann J, Kneser U, Kümmel S, Kühn T, Kontos M, Tampaki EC, Barry M, Allweis TM, Carmon M, Hadar T, Catanuto G, Garcia-Etienne CA, Gentilini OD, Knox S, Klein B, Koppert L, Gouveia PF, Svensjö T, Bucher HC, Ess S, Ganz-Blättler U, Günthert A, Hauser N, Hynes N, Knauer M, Pfeiffer M, Rochlitz C, Tausch C, Harder Y, Zimmermann F, Schwab FD, D'Amico V, Soysal SD, Castrezana Lopez L, Fulco I, Hemkens LG, Lohsiriwat V, Gulluoglu BM, Karadeniz G, Karanlik H, Sezer A, Gulcelik MA, Emiroglu M, Kovacs T, Rattay T, Romics L, Vidya R, Wyld L, El-Tamer M, Sacchini V. Knowledge gaps in oncoplastic breast surgery. Lancet Oncol 2020; 21:e375-e385. [DOI: 10.1016/s1470-2045(20)30084-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 12/26/2022]
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Schnürch HG, Ackermann S, Alt-Radtke CD, Angleitner L, Barinoff J, Beckmann MW, Böing C, Dannecker C, Fehm T, Gaase R, Gass P, Gebhardt M, Gieseking F, Günthert A, Hack CC, Hantschmann P, Horn LC, Koch MC, Letsch A, Mallmann P, Mangold B, Marnitz S, Mehlhorn G, Paradies K, Reinhardt MJ, Tholen R, Torsten U, Weikel W, Wölber L, Hampl M. Diagnosis, Therapy and Follow-up of Vaginal Cancer and Its Precursors. Guideline of the DGGG and the DKG (S2k-Level, AWMF Registry No. 032/042, October 2018). Geburtshilfe Frauenheilkd 2019; 79:1060-1078. [PMID: 31680701 DOI: 10.1055/a-0919-4959] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 05/13/2019] [Accepted: 05/13/2019] [Indexed: 01/20/2023] Open
Abstract
Purpose This is an official guideline, published and coordinated by the Gynecological Oncology Working Group (AGO) of the German Cancer Society (DKG) and the German Society for Gynecology and Obstetrics (DGGG). Vaginal cancers are rare tumors, which is why there is very little evidence on these tumors. Knowledge about the optimal clinical management is limited. This first German S2k guideline on vaginal cancer has aimed to compile the most current expert knowledge and offer new recommendations on the appropriate treatment as well as providing pointers about individually adapted therapies with lower morbidity rates than were previously generally available. The purpose of this guideline is also to set up a register to record data on treatment data and the course of disease as a means of obtaining evidence in future. Methods The present S2k guideline was developed by members of the Vulvar und Vaginal Tumors Commission of the AGO in an independently moderated, structured, formal consensus process and the contents were agreed with the mandate holders of the participating scientific societies and organizations. Recommendations To optimize the daily care of patients with vaginal cancer: 1. Monitor the spread pattern; 2. Follow the step-by-step diagnostic workup based on initial stage at detection; 3. As part of individualized clinical therapeutic management of vaginal cancer, follow the sentinel lymph node protocol described here, where possible; 4. Participate in the register study on vaginal cancer.
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Affiliation(s)
| | | | - Celine D Alt-Radtke
- Institut für Diagnostische und Interventionelle Radiologie, Universität Düsseldorf, Düsseldorf, Germany
| | | | - Jana Barinoff
- St.-Gertrauden-Krankenhaus GmbH Berlin, Berlin, Germany
| | - Matthias W Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; Comprehensive Cancer Center (CCC) Erlangen-EMN, Erlangen, Germany
| | - Carsten Böing
- Katholisches Klinikum Oberhausen, Frauenklinik St. Clemens-Hospital, Oberhausen, Germany
| | - Christian Dannecker
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universität München, Campus Großhadern, München, Germany
| | - Tanja Fehm
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Düsseldorf, Düsseldorf, Germany
| | - Rüdiger Gaase
- Gemeinschaftspraxis für Frauenheilkunde Gaase+Hugger, Worms, Germany
| | - Paul Gass
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; Comprehensive Cancer Center (CCC) Erlangen-EMN, Erlangen, Germany
| | | | - Friederike Gieseking
- Dysplasiesprechstunde/Gynäkologisches Laserzentrum in der Frauenarztpraxis Heussweg, Hamburg, Germany
| | | | - Carolin C Hack
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; Comprehensive Cancer Center (CCC) Erlangen-EMN, Erlangen, Germany
| | - Peer Hantschmann
- Abteilung Gynäkologie und Geburtshilfe, Kreiskliniken Altötting - Burghausen, Altötting, Germany
| | | | - Martin C Koch
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; Comprehensive Cancer Center (CCC) Erlangen-EMN, Erlangen, Germany
| | - Anne Letsch
- Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Charité Berlin, Berlin, Germany
| | - Peter Mallmann
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universität Köln, Köln, Germany
| | | | - Simone Marnitz
- Klinik für Radioonkologie, CyberKnife- und Strahlentherapie, Uniklinik Köln, Köln, Germany
| | | | - Kerstin Paradies
- Konferenz Onkologischer Kranken- und Kinderkrankenpflege, Berlin, Germany
| | | | - Reina Tholen
- Deutscher Verband für Physiotherapie, Köln, Germany
| | - Uwe Torsten
- Klinik für Gynäkologie und Zentrum für Beckenbodenerkrankungen, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Wolfgang Weikel
- Klinik für Gynäkologie und gynäkologische Onkologie, Universitätsfrauenklinik Mainz, Mainz, Germany
| | - Linn Wölber
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Monika Hampl
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Düsseldorf, Düsseldorf, Germany
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6
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Bustamante Eduardo M, Popovici V, Imboden S, Aebi S, Ballabio N, Altermatt HJ, Günthert A, Jaggi R. Characterization of molecular scores and gene expression signatures in primary breast cancer, local recurrences and brain metastases. BMC Cancer 2019; 19:549. [PMID: 31174485 PMCID: PMC6556009 DOI: 10.1186/s12885-019-5752-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 05/27/2019] [Indexed: 12/11/2022] Open
Abstract
Background Breast cancer is a leading cause of cancer-related death in women worldwide. Despite extensive studies in all areas of basic, clinical and applied research, accurate prognosis remains elusive, thus leading to overtreatment of many patients. Diagnosis could be improved by introducing multigene molecular scores in standard clinical practice. Several tests that work with formalin-fixed tissue have become routine. Molecular scores usually include several genes representing processes, response to oestrogens, progestogens and human epidermal growth factor receptor 2 (Her2), respectively, which are combined additively in single values. These multi-gene scores have the advantage of being more robust and reproducible than single-gene scores. Their utility may be further enhanced by combining them with classical diagnostic parameters. Here, we present an exploratory study comparing the RISK and research versions of Oncotype DX recurrence score (RS), Prosigna Risk of Recurrence (ROR) and EndoPredict (EP) with respect to their prognostic potential for ipsilateral recurrence and/or distant relapse in brain, and we compared the scores to the intrinsic subtypes based on PAM50. Methods RNA was extracted from formalin-fixed, paraffin-embedded (FFPE) tissue cores of primary tumours, local recurrences and brain metastases. Gene expression was measured on a NanoString nCounter Analysis System. Intrinsic subtypes and molecular scores were computed according to published literature and RISK, RS, ROR and EP were compared against each other and to the intrinsic subtypes Luminal A (lumA), Luminal B (lumB), Her2-enriched (Her2↑), Basal-like (basal), and Normal-like (normal) of PAM50. Local recurrences and brain metastases were compared to their corresponding primary tumours. Results All four molecular scores were highly correlated. Highest correlations were observed among genes related to proliferation while lower correlations were found among oestrogen-related genes. The scores were significantly higher in primary tumours progressing to brain metastases as compared to recurrence-free primary tumours and primary tumours that relapsed as local recurrences. Conclusions RISK and ROR-P are prognostic for primary tumours metastasizing to the brain. All four scores, RISK, RS, EP and ROR-P failed to discriminate between primary tumours that remained recurrence-free and primary tumours relapsing as local recurrences. Electronic supplementary material The online version of this article (10.1186/s12885-019-5752-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Vlad Popovici
- RECETOX, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Sara Imboden
- Department of Gynecology and Obstetrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefan Aebi
- Department of Medical Oncology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | | | | | | | - Rolf Jaggi
- Department for Biomedical Research, University of Bern, Murtenstrasse, 40, 3008, Bern, Switzerland.
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7
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Brechbühl R, Uerlings V, Kohl J, Günthert A, Christmann C, Kipp B. [First Diagnosis of a Squamos Cell Carcinoma of the Cervix Uteri FIGO 1B1 in Pregnancy]. Praxis (Bern 1994) 2019; 108:1079-1083. [PMID: 31822234 DOI: 10.1024/1661-8157/a003302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
First Diagnosis of a Squamos Cell Carcinoma of the Cervix Uteri FIGO 1B1 in Pregnancy Abstract. The squamous cell cancer of the cervix uteri is one of the most frequent detected cancers in pregnancy. As the tumor is in direct contact to the pregnancy, the treatment is challenging and has to be tackled individually. So far, standard concepts or studies are missing. Treatment should be focused on the oncological security of the mother like in non-pregnant women and should be according to current guidelines. Thanks to the existing therapy options during pregnancy, it is a reasonable option to maintain the pregnancy in compliance with oncological standards. An interdisciplinary approach is therefore necessary.
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Affiliation(s)
| | | | - Joachim Kohl
- Gynäkologie und Geburtshilfe, Luzerner Kantonsspital
| | | | | | - Barbara Kipp
- Gynäkologie und Geburtshilfe, Luzerner Kantonsspital
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8
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Kreklau A, Vâz I, Oehme F, Strub F, Brechbühl R, Christmann C, Günthert A. Measurements of a ‘normal vulva’ in women aged 15-84: a cross-sectional prospective single-centre study. BJOG 2018; 125:1656-1661. [DOI: 10.1111/1471-0528.15387] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2018] [Indexed: 11/28/2022]
Affiliation(s)
- A Kreklau
- Department of Obstetrics and Gynaecology; Cantonal Hospital Lucerne; Lucerne Switzerland
| | - I Vâz
- Department of Obstetrics and Gynaecology; Cantonal Hospital Lucerne; Lucerne Switzerland
| | - F Oehme
- Department of General Surgery; Cantonal Hospital Lucerne; Lucerne Switzerland
| | - F Strub
- Department of Obstetrics and Gynaecology; Cantonal Hospital Lucerne; Lucerne Switzerland
| | - R Brechbühl
- Department of Obstetrics and Gynaecology; Cantonal Hospital Lucerne; Lucerne Switzerland
| | - C Christmann
- Department of Obstetrics and Gynaecology; Cantonal Hospital Lucerne; Lucerne Switzerland
| | - A Günthert
- Department of Obstetrics and Gynaecology; Cantonal Hospital Lucerne; Lucerne Switzerland
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9
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Kreklau A, Lopez Benitez R, Fornaro J, Meili G, Günthert A. Computer Tomography-Guided Percutaneous Indocyanine Green Injection for Intraoperative Mapping of Metastatic Suspected Lesions. Front Med (Lausanne) 2018; 5:191. [PMID: 30042944 PMCID: PMC6048957 DOI: 10.3389/fmed.2018.00191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 02/12/2018] [Accepted: 06/08/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: Surgical treatment in oncology is one of the main part concerning the surveillance rate of the patient in case of tumor recurrence. Metastatic suspected lesions are mostly located in the abdomen or pelvis and are diagnosed by PET, MRI, or CT scan. Especially surgery of small lesions in recurrent disease for diagnostic or therapeutic purpose is often challenging. Material and Methods: We report a case series of 3 patients who were treated in our department due to a metastatic suspected lesion in PET-CT in follow up. For histological confirmation we performed a laparoscopy using a near infrared camera (NIR) for an improved visualization of the metastatic suspected lesion during surgical treatment. Previously the lesion was marked with an amount of Indocyanine Green (ICG) via computer tomography-guided percutaneous injection. The lesion was identified via NIR camera. While changing the camera in NIR mode, it show up as a blue spot due to the fluorescent signal. After correct identification it was removed and send to pathology. Results: In all 3 cases they confirmed the diagnosis of a metastatic lesion. Complication occur in just one case, where the metastatic lymph node infiltrated the external iliac vein, which led to a high blood loss. In this case a vascular interposition had to be done. Conclusions: Because of separate wavelengths, which are used for illumination and recording, only the marked area is visible, not the background.Due to correct identification, resection of the lesion was improved and healthy surrounding tissue could have been spared.
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Affiliation(s)
- Anne Kreklau
- Department of Obstetrics and Gynecology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | | | - Jürgen Fornaro
- Department of Radiology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Gesine Meili
- Department of Obstetrics and Gynecology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Andreas Günthert
- Department of Obstetrics and Gynecology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
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10
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Ochs K, Meili G, Diebold J, Arndt V, Günthert A. Incidence Trends of Cervical Cancer and Its Precancerous Lesions in Women of Central Switzerland from 2000 until 2014. Front Med (Lausanne) 2018; 5:58. [PMID: 29616221 PMCID: PMC5864899 DOI: 10.3389/fmed.2018.00058] [Citation(s) in RCA: 7] [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: 12/16/2017] [Accepted: 02/19/2018] [Indexed: 01/15/2023] Open
Abstract
Objective Cervical cancer (CC) screening by Pap smears has led to a decrease in the incidence of CC worldwide. Indeed, the incidence of CC in Switzerland is very low; however, there is a lack of data to evaluate the efficiency of the Pap smear as a screening tool. Until now, only Pap smears have been used and other methods such as the presence of an infection with HPV have not been integrated into the routine screening. The aim of this study is to evaluate trends in the incidence of CC and its precancerous lesions in Central Switzerland, which represents a rural region, with those in urban regions and the entire country of Switzerland. Methods All conizations and CC registered between 2000 and 2014 at the Institute of Pathology at the Cantonal Hospital of Lucerne have been included in our study. The incidence of CC and its precancerous lesions have been categorized according to age, stage, morphology, and study period. Age-standardized incidence in the Canton of Zurich and the entire country served as reference for the assessment of trends in CC incidence in the study region. Results In Central Switzerland, the number of conizations performed annually has more than doubled over the observed 15 years. There has been a significant increase in precancerous lesions, which were found in approximately 50% of conizations. The total number of CC diagnosed by conization increased by 37.5% and the total of CIN3 increased by 130%. Age-standardized incidence of CC and CIN3 increased from 2.4 to 3.3/100,000 and from 11.6 to 26.9/100,000, respectively. The incidence of CC was lower in Central Switzerland compared to incidence in the Canton of Zurich and in Switzerland generally. Conclusion Approximately 50% of all conizations were performed on women without serious precancerous lesions. For this reason, we recommend the adaptation of screening modalities and the use of risk stratification to avoid overtreatment. In light of the forthcoming implementation of an HPV vaccination program, our data provides important baseline information.
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Affiliation(s)
- Katrin Ochs
- Department of Obstetrics and Gynecology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Gesine Meili
- Department of Obstetrics and Gynecology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Joachim Diebold
- Institute of Pathology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Volker Arndt
- Foundation National Institute for Cancer Epidemiology and Registration (NICER), Zurich, Switzerland
| | - Andreas Günthert
- Department of Obstetrics and Gynecology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
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11
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Schnürch HG, Ackermann S, Alt CD, Barinoff J, Böing C, Dannecker C, Gieseking F, Günthert A, Hantschmann P, Horn LC, Kürzl R, Mallmann P, Marnitz S, Mehlhorn G, Hack CC, Koch MC, Torsten U, Weikel W, Wölber L, Hampl M. Diagnosis, Therapy and Follow-up Care of Vulvar Cancer and its Precursors. Guideline of the DGGG and DKG (S2k-Level, AWMF Registry Number 015/059, November 2015. Geburtshilfe Frauenheilkd 2016; 76:1035-1049. [PMID: 27765958 DOI: 10.1055/s-0042-103728] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose: This is an official guideline, published and coordinated by the Arbeitsgemeinschaft Gynäkologische Onkologie (AGO, Study Group for Gynecologic Oncology) of the Deutsche Krebsgesellschaft (DKG, German Cancer Society) and the Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG, German Society for Gynecology and Obstetrics). The number of cases with vulvar cancer is on the rise, but because of the former rarity of this condition and the resulting lack of literature with a high level of evidence, in many areas knowledge of the optimal clinical management still lags behind what would be required. This updated guideline aims to disseminate the most recent recommendations, which are much clearer and more individualized, and is intended to create a basis for the assessment and improvement of quality care in hospitals. Methods: This S2k guideline was drafted by members of the AGO Committee on Vulvar and Vaginal Tumors; it was developed and formally completed in accordance with the structured consensus process of the Association of Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF). Recommendations: 1. The incidence of disease must be taken into consideration. 2. The diagnostic pathway, which is determined by the initial findings, must be followed. 3. The clinical and therapeutic management of vulvar cancer must be done on an individual basis and depends on the stage of disease. 4. The indications for sentinel lymph node biopsy must be evaluated very carefully. 5. Follow-up and treatment for recurrence must be adapted to the individual case.
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Affiliation(s)
| | | | - C D Alt
- Institut für Diagnostische und Interventionelle Radiologie, Universität Düsseldorf, Düsseldorf
| | - J Barinoff
- Klinik für Gynäkologie und Geburtshilfe, Markus Krankenhaus, Frankfurt am Main
| | - C Böing
- Katholisches Klinikum Oberhausen, Frauenklinik St. Clemens-Hospital, Oberhausen
| | - C Dannecker
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe der Universität München, Campus Großhadern, München, Munich
| | - F Gieseking
- Dysplasiezentrum in der Frauenarztpraxis Heussweg, Hamburg
| | - A Günthert
- Frauenklinik Luzerner Kantonsspital, Lucerne, Switzerland
| | - P Hantschmann
- Abteilung Gynäkologie und Geburtshilfe, Kreiskliniken Altötting - Burghausen, Altötting
| | - L C Horn
- Institut für Pathologie des Universitätsklinikums Leipzig, Leipzig
| | - R Kürzl
- ehem. Universitätsfrauenklinik Maistraße, Munich
| | - P Mallmann
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe der Universität Köln, Cologne
| | - S Marnitz
- Klinik und Poliklinik für Radioonkologie und Strahlentherapie der Universität Köln, Cologne
| | - G Mehlhorn
- Universitätsfrauenklinik Erlangen, Erlangen
| | - C C Hack
- Universitätsfrauenklinik Erlangen, Erlangen
| | - M C Koch
- Universitätsfrauenklinik Erlangen, Erlangen
| | - U Torsten
- Klinik für Gynäkologie und Zentrum für Beckenbodenerkrankungen, Vivantes Klinikum Neukölln, Berlin
| | - W Weikel
- Klinik für Gynäkologie und gynäkologische Onkologie, Universitätsfrauenklinik Mainz, Mainz
| | - L Wölber
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - M Hampl
- Klinik für Frauenheilkunde und Geburtshilfe des Universitätsklinikums Düsseldorf, Düsseldorf
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12
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Kirtschig G, Becker K, Günthert A, Jasaitiene D, Cooper SM, Chi CC, Kreuter A, Rall KK, Aberer W, Riechardt S, Casabona F, Powell J, Brackenbury FA, Erdmann R, Lazzeri M, Barbagli G, Wojnarowska F. Response to Letter by Prof. C.B.B. Bunker. J Eur Acad Dermatol Venereol 2016; 31:e104-e105. [PMID: 27401731 DOI: 10.1111/jdv.13821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 05/18/2016] [Indexed: 11/30/2022]
Affiliation(s)
- G Kirtschig
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK.,Institute of General Medicine and Interprofessional Care, University of Tübingen, Tübingen, Germany
| | - K Becker
- Office for Paediatric surgery, Bonn, Germany
| | - A Günthert
- Deptartment of Obstetrics and Gynecology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - D Jasaitiene
- Department of Skin and Venereal Diseases, Republican Hospital of Panevezys, Panevezys, Lithuania
| | - S M Cooper
- Department of Dermatology, Oxford University Hospitals NHS Trust and University of Oxford, Oxford, UK
| | - C-C Chi
- Department of Dermatology, Chang Gung Memorial Hospital, Chiayi, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - A Kreuter
- Department of Dermatology, Venereology, and Allergology, HELIOS St. Elisabeth Hospital Oberhausen, University Witten/Herdecke, Oberhausen, Germany
| | - K K Rall
- Department of Gynaecology, Universitäts-Frauenklinik, Tübingen, Germany
| | - W Aberer
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - S Riechardt
- Departments of Urology and paediatric Urology, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany
| | - F Casabona
- S. C. Chirurgia Plastica, Chirurgia Plastica Rigenerativa, Ospedale Andrea Gallino, Genova-Pontedecimo, Italy
| | - J Powell
- Department of Dermatology, Hampshire Hospitals foundation Trust, Basingstoke, UK
| | | | - R Erdmann
- Division of Evidence-Based Medicine, Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Lazzeri
- Department of Urology, Istituto Clinico Humanitas IRCCS Clinical and Research Hospital, Rozzano Milano, Italy
| | - G Barbagli
- Centre for Reconstructive Urethral Surgery, Arezzo, Italy
| | - F Wojnarowska
- Department of Dermatology, Oxford University Hospitals NHS Trust and University of Oxford, Oxford, UK
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13
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Kirtschig G, Cooper S, Aberer W, Günthert A, Becker K, Jasaitiene D, Chi CC, Kreuter A, Rall K, Riechardt S, Casabona F, Powell J, Brackenbury F, Erdmann R, Lazzeri M, Barbagli G, Wojnarowska F. Evidence-based (S3) Guideline on (anogenital) Lichen sclerosus. J Eur Acad Dermatol Venereol 2016; 31:e81-e83. [DOI: 10.1111/jdv.13740] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
| | - S. Cooper
- Department of Dermatology; Oxford University Hospitals NHS Trust and University of Oxford; Oxford UK
| | - W. Aberer
- Department of Dermatology; Medical University of Graz; Graz Austria
| | - A. Günthert
- Department of Obstetrics and Gynecology; Cantonal Hospital of Lucerne; Lucerne Switzerland
| | - K. Becker
- Office for Paediatric surgery; Bonn Germany
| | - D. Jasaitiene
- Department of Skin and Venereal Diseases of Republican Hospital of Panevezys; Panevezys Lithuania
| | - C.-C. Chi
- Dermatology Department; Chang Gung Memorial Hospital; Chiayi, and College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - A. Kreuter
- Department of Dermatology, Venereology, and Allergology; HELIOS St. Elisabeth Hospital Oberhausen; Oberhausen Germany
| | - K. Rall
- Katharina Department of Gynaecology; Universitäts-Frauenklinik; Tübingen Germany
| | - S. Riechardt
- Department of Urology and paediatric Urology; Universitätsklinikum Hamburg Eppendorf; Hamburg Germany
| | - F. Casabona
- Dirigente Medico; S. C. Chirurgia Plastica; Chirurgia Plastica Rigenerativa; Ospedale Andrea Gallino; Via Andrea Gallino; Genova-Pontedecimo Italy
| | - J. Powell
- Department of Dermatology; Hampshire Hospitals foundation Trust; Basingstoke UK
| | | | - R. Erdmann
- Klinik für Dermatologie; Venereologie und Allergologie; Campus Charité Mitte; Division of Evidence Based Medicine; Berlin Germany
| | - M. Lazzeri
- Center for Reconstructive Urethral Surgery; Via dei Lecci, 22, 52100 Arezzo Italy
| | - G. Barbagli
- Center for Reconstructive Urethral Surgery; Via dei Lecci, 22, 52100 Arezzo Italy
| | - F. Wojnarowska
- Nuffield Department of Clinical Medicine; John Radcliffe Hospital; University of Oxford; Oxford UK
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14
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Tempfer C, Horn LC, Ackermann S, Beckmann MW, Dittrich R, Einenkel J, Günthert A, Haase H, Kratzsch J, Kreissl MC, Polterauer S, Ebert AD, Schneider KTM, Strauss HG, Thiel F. Gestational and Non-gestational Trophoblastic Disease. Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Registry No. 032/049, December 2015). Geburtshilfe Frauenheilkd 2016; 76:134-144. [PMID: 26941444 DOI: 10.1055/s-0041-111788] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Purpose: The aim was to establish an official interdisciplinary guideline, published and coordinated by the German Society of Gynecology and Obstetrics (DGGG). The guideline was developed for use in German-speaking countries. In addition to the Germany Society of Gynecology and Obstetrics, the guideline has also been approved by the Swiss Society of Gynecology and Obstetrics (SGGG) and the Austrian Society of Gynecology and Obstetrics (OEGGG). The aim was to standardize diagnostic procedures and the management of gestational and non-gestational trophoblastic disease in accordance with the principles of evidence-based medicine, drawing on the current literature and the experience of the colleagues involved in compiling the guideline. Methods: This s2k guideline represents the consensus of a representative panel of experts with a range of different professional backgrounds commissioned by the DGGG. Following a review of the international literature and international guidelines on trophoblastic tumors, a structural consensus was achieved in a formalized, multi-step procedure. This was done using uniform definitions, objective assessments, and standardized management protocols. Recommendations: The recommendations of the guideline cover the epidemiology, classification and staging of trophoblastic tumors; the measurement of human chorionic gonadotropin (hCG) levels in serum, and the diagnosis, management, and follow-up of villous trophoblastic tumors (e.g., partial mole, hydatidiform mole, invasive mole) and non-villous trophoblastic tumors (placental site nodule, exaggerated placental site, placental site tumor, epitheloid trophoblastic tumor, and choriocarcinoma).
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Affiliation(s)
- C Tempfer
- Universitätsfrauenklinik der Ruhr-Universität Bochum, Bochum
| | - L-C Horn
- Institut für Pathologie, Universitätsklinikum Leipzig, Leipzig
| | | | - M W Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - R Dittrich
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - J Einenkel
- Universitätsfrauenklinik, Universitätsklinikum Leipzig, Leipzig
| | - A Günthert
- Frauenklinik, Luzerner Kantonsspital, Lucerne, Switzerland
| | - H Haase
- Frauenselbsthilfe nach Krebs, e. V
| | - J Kratzsch
- Institut für Laboratoriumsmedizin, Klinische Chemie und Molekulare Diagnostik, Universitätsklinikum Leipzig, Leipzig
| | - M C Kreissl
- Klinik für Nuklearmedizin, Klinikum Augsburg, Augsburg
| | - S Polterauer
- Universitätsfrauenklinik, Medizinische Universität Wien, Vienna, Austria
| | - A D Ebert
- Praxis für Gynäkologie und Geburtshilfe, Berlin
| | - K T M Schneider
- Abteilung für Geburtshilfe und Perinatalmedizin, Klinium rechts der Isar, Technische Universität München, Munich
| | - H G Strauss
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Halle (Saale), Halle (Saale)
| | - F Thiel
- Frauenklinik, Alb Fils Kliniken, Göppingen
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15
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Kirtschig G, Becker K, Günthert A, Jasaitiene D, Cooper S, Chi CC, Kreuter A, Rall KK, Aberer W, Riechardt S, Casabona F, Powell J, Brackenbury F, Erdmann R, Lazzeri M, Barbagli G, Wojnarowska F. Evidence-based (S3) Guideline on (anogenital) Lichen sclerosus. J Eur Acad Dermatol Venereol 2015. [PMID: 26202852 DOI: 10.1111/jdv.13136] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Lichen sclerosus (LS) is an inflammatory skin disease that usually involves the anogenital area. All patients with symptoms or signs suspicious of lichen sclerosus should be seen at least once initially by a physician with a special interest in the disease in order to avoid delay in diagnosis, as early treatment may cure the disease in some and reduce or prevent scarring. The diagnosis is made clinically in most cases. Biopsies should only be performed under certain circumstances. The gold standard for treatment remains potent to very potent topical steroids; however, mild and moderate disease in boys and men may be cured by circumcision. Certain triggers should be avoided. http://www.euroderm.org/images/stories/guidelines/2014/S3-Guideline-on-Lichen-sclerosus.pdf http://www.awmf.org/fachgesellschaften/mitgliedsgesellschaften/visitenkarte/fg/deutsche-gesellschaft-fuer-gynaekologie-und-geburtshilfe-dggg.html.
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Affiliation(s)
- G Kirtschig
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK.,Institute of General Practice and Interprofessional Care, University of Tübingen, Tübingen, Germany
| | - K Becker
- (representing the Deutsche Gesellschaft für Kinderchirurgie), Office for Paediatric surgery, Bonn, Germany
| | - A Günthert
- (representing the Deutsche Gesellschaft für Gynäkologie und Geburtshilfe, DGGG), Deptartment of Obstetrics and Gynecology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - D Jasaitiene
- (representing the Lithuanian Association of Dermatovenereologists), Department of Skin and Venereal Diseases of Republican Hospital of Panevezys, Panevezys, Lithuania
| | - S Cooper
- Department of Dermatology, Oxford University Hospitals NHS Trust and University of Oxford, Oxford, UK
| | - C-C Chi
- Department of Dermatology, Chang Gung Memorial Hospital, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - A Kreuter
- Department of Dermatology, Venereology, and Allergology, HELIOS St. Elisabeth Hospital Oberhausen, Oberhausen, Germany
| | - K K Rall
- Research Centre and Department for Women's Health, University Hospital Tübingen, Tübingen, Germany
| | - W Aberer
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - S Riechardt
- (representing the Deutsche Gesellschaft für Urologie), Department of Urology and paediatric Urology, University of Hamburg, Hamburg, Germany
| | - F Casabona
- Dirigente Medico, S. C. Chirurgia Plastica, Chirurgia Plastica Rigenerativa, Ospedale Andrea Gallino, Genova-Pontedecimo, Italy
| | - J Powell
- Department of Dermatology, Hampshire Hospitals foundation Trust, Hampshire, UK
| | - F Brackenbury
- (patient representative) www.lichensclerosus.org, Association for Lichen Sclerosus and Vulval Health, Oxford, UK
| | - R Erdmann
- (development of the search strategy and performance of the literature search), Klinik für Dermatologie, Venerologie und Allergologie, Division of Evidence Based Medicine, Charite - Universitätsmedizin Berlin, Berlin, Germany
| | - M Lazzeri
- Centro Chirurgico Toscano, Arezzo, Italy
| | - G Barbagli
- Centro Chirurgico Toscano, Arezzo, Italy
| | - F Wojnarowska
- Nuffield Department of Clinical Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
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Emons G, Günthert A, Thiel FC, Camara O, Strauss HG, Breitbach GP, Kölbl H, Reimer T, Finas D, Rensing K. Phase II study of fulvestrant 250 mg/month in patients with recurrent or metastatic endometrial cancer: a study of the Arbeitsgemeinschaft Gynäkologische Onkologie. Gynecol Oncol 2013; 129:495-9. [PMID: 23500091 DOI: 10.1016/j.ygyno.2013.02.039] [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] [Received: 12/12/2012] [Revised: 02/26/2013] [Accepted: 02/28/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of this study is to evaluate the activity and toxicity of fulvestrant, a pure estrogen receptor antagonist in patients with advanced or recurrent endometrial cancer, expressing estrogen and/or progesterone receptors (ER/PR). METHODS Eligible patients with advanced or recurrent endometrial cancer not amenable to curative surgery and/or radiotherapy were treated with fulvestrant at a dose of 250 mg by IM injection every 4 weeks for at least 12 weeks. Therapy was continued until disease progression, death, intolerable side effects or end of study. Response was assessed in patients with at least one target lesion according to WHO-criteria. RESULTS Thirty-five patients were enrolled in this study and received at least one injection of fulvestrant (intention to treat-population, ITT). Twenty six patients received the intended 3 injections of fulvestrant (per protocol population, PP). There was no complete response but 4 partial responses (11.4% ITT) and 8 stable diseases. The median time to progression was 2.3 months (ITT). Overall survival was 13.2 months (ITT). Treatment was well tolerated. CONCLUSIONS Fulvestrant at a dose of 250 mg IM every 4 weeks has marginal activity and good tolerability in patients with ER and/or PR positive advanced or recurrent endometrial cancer. A loading dose strategy and the use of 500 mg/4 weeks might improve the efficacy of this treatment.
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Affiliation(s)
- Günter Emons
- Dept. of Obstetrics and Gynecology, Georg-August-University, Robert-Koch-Strasse 40, Göttingen, Germany.
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Kuhn A, Genoud S, Robinson D, Herrmann G, Günthert A, Brandner S, Raio L. Sonographic transvaginal bladder wall thickness: does the measurement discriminate between urodynamic diagnoses? Neurourol Urodyn 2010; 30:325-8. [PMID: 20949598 DOI: 10.1002/nau.20997] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Accepted: 07/21/2010] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Measurement of bladder wall thickness (BWT) using transvaginal ultrasound has previously been shown to discriminate between women with confirmed detrusor overactivity and those with urodynamic stress incontinence. Aim of the current study was to determine if vaginally measured BWT correlates with urodynamic diagnoses in a female population. PATIENTS AND METHODS Between December 2008 and February 2010, adult female consecutive patients undergoing urogynaecologic investigation for lower urinary symptoms were approached to participate in this study. Ethical consent for the current study was obtained. Patients underwent multichannel urodynamics and transvaginal ultrasound measuring the bladder in three location with an emptied bladder. RESULTS 123 patients were included in the study with a median age of 69 years (range 40-93), median parity of 2 (range 0-3) and a median body mass index of 29.5 kg/m(2) (range 23-38). Urodynamic stress incontinence was diagnosed in 59 patients, DO in 40 and obstruction in 24 cases. Bladder wall thickness was significantly higher in DO patients and in obstruction than in urodynamic stress incontinence. Detrusor pressure at maximum flow rate (pdet/Q(max) ) correlated significantly with BWT. CONCLUSION Bladder wall thickness shows a significantly positive correlation to pdet/Q(max) and to urodynamic diagnoses of stress incontinence, DO and obstruction.
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Affiliation(s)
- Annette Kuhn
- Urogynaecology, Department of Obstetrics and Gynaecology, University of Bern and University Hospital, Bern, Switzerland.
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Günthert A, Block M, Mueller M, Emons G, Gründker C. P1014 Antiproliferative effects of antiestrogens and inhibitors of growth factor receptor signaling on endometrial cancer cells. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)62500-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Block M, Fister S, Gründker C, Emons G, Günthert A. Mechanismen GnRH-induzierter Resensibilisierung von Mammakarzinomzel-len mit sekundärer Antiöstrogenresistenz. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1089132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Fister S, Günthert A, Emons G, Gründker C. Antagonisten des Gonadotropin-Releasing Hormons Typ II induzieren Apoptose durch die Aktivierung der stress-induzierten MAPK p38 in gynäkologischen Karzinomen. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-988688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Fister S, Schlotawa L, Günthert A, Emons G, Gründker C. Erhöhung der Doxorubicin-induzierten Apoptose nach Knock down der GnRH-I Rezeptor Expression in humanen Endometrium-, Ovarial- und Mammakarzinomzellen. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-988689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Emons G, Kaufmann M, Günthert A, Gründker C, Loibl S, Tzekova VI, Velikova MT, Tomov S, Sindermann H, Engel J, Schally AV. Phase I study of ZEN-008 (AN-152), a targeted cytotoxic LHRH analog, in female patients with cancers expressing LHRH receptors. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.3571] [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
3571 Background: Human ovarian, endometrial, and breast cancers commonly express receptors for luteinizing hormone releasing hormone (LHRH-R). LHRH-R can be used for targeted chemotherapy with ZEN-008 (AN-152), in which doxorubicin (DOX) is linked to [D-Lys(6)]- LHRH. Preclinical studies showed a significantly reduced cardiotoxic potential of ZEN-008 compared with DOX, as well as activity in multi-drug resistant tumor models. This study assessed dose limiting toxicities (DLTs), maximum tolerated dose (MTD), and pharmacokinetics (PK) of ZEN- 008 given once every 3 weeks in female patients. Methods: Patients (pts) with tumors proven immunohistochemically to be LHRH- R positive and had progressive disease following chemotherapy were eligible if prior therapy did not exceed 70% of the recommended maximum lifetime dose for DOX. Starting at 10 mg/m2, doses were doubled between pts until side effects of CTCAE grade 2 or higher, then escalation following a modified Fibonacci scheme, with 3–6 pts/group. Safety monitoring included pituitary and cardiac function. Response evaluation followed the RECIST criteria. HPLC with fluorescence detection was used for plasma PK of ZEN-008 and free DOX. Results: Seventeen pts (13 with ovarian, 2 with breast cancer) received ZEN-008 by intravenous infusion over 2 hours at dosages of 10, 20, 40, 80 mg/m2 (1 pt and 2 cycles each). At 160 mg/m2 6 pts had 24 cycles, 1 pt ongoing at 3+ cycles), and at 267 mg/m2 7 pts had a total of 30 cycles, 1 pt ongoing at 4+ cycles). Short-lasting leukopenia/neutropenia of CTCAE Grade 4 was dose limiting in 2 pts at 267 mg/m2. One pt at this dose level had an allergic skin reaction during infusion, subsequent cycles with anti-allergic pre-medication were tolerated. At 160 mg/m2 1 pt with ovarian cancer had CR (lymph node metastasis), at 267 mg/m2 1 pat with ovarian cancer had a transient PR, and 3 pts had stable disease for 5+ cycles. PK analyses showed dose- dependent plasma levels of ZEN-008 and only minor (10–30%) release of DOX. Conclusions: Leukocytopenia was identified as a rapidly reversible DLT in heavily pretreated pts at a ZEN-008 dose of 267 mg/m2, given three-weekly, which is therefore also considered recommended Phase II dosage. Evidence of therapeutic activity was found at 160 and 267 mg/m2. [Table: see text]
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Affiliation(s)
- G. Emons
- George August University, Goettingen, Germany; J.W. Goethe University, Frankfurt, Germany; University Hospital, Sofia, Bulgaria; University Hospital, Pleven, Bulgaria; Zentaris GmbH, Frankfurt a. Main, Germany; V.A. Hospitals, Miami, FL
| | - M. Kaufmann
- George August University, Goettingen, Germany; J.W. Goethe University, Frankfurt, Germany; University Hospital, Sofia, Bulgaria; University Hospital, Pleven, Bulgaria; Zentaris GmbH, Frankfurt a. Main, Germany; V.A. Hospitals, Miami, FL
| | - A. Günthert
- George August University, Goettingen, Germany; J.W. Goethe University, Frankfurt, Germany; University Hospital, Sofia, Bulgaria; University Hospital, Pleven, Bulgaria; Zentaris GmbH, Frankfurt a. Main, Germany; V.A. Hospitals, Miami, FL
| | - C. Gründker
- George August University, Goettingen, Germany; J.W. Goethe University, Frankfurt, Germany; University Hospital, Sofia, Bulgaria; University Hospital, Pleven, Bulgaria; Zentaris GmbH, Frankfurt a. Main, Germany; V.A. Hospitals, Miami, FL
| | - S. Loibl
- George August University, Goettingen, Germany; J.W. Goethe University, Frankfurt, Germany; University Hospital, Sofia, Bulgaria; University Hospital, Pleven, Bulgaria; Zentaris GmbH, Frankfurt a. Main, Germany; V.A. Hospitals, Miami, FL
| | - V. I. Tzekova
- George August University, Goettingen, Germany; J.W. Goethe University, Frankfurt, Germany; University Hospital, Sofia, Bulgaria; University Hospital, Pleven, Bulgaria; Zentaris GmbH, Frankfurt a. Main, Germany; V.A. Hospitals, Miami, FL
| | - M. T. Velikova
- George August University, Goettingen, Germany; J.W. Goethe University, Frankfurt, Germany; University Hospital, Sofia, Bulgaria; University Hospital, Pleven, Bulgaria; Zentaris GmbH, Frankfurt a. Main, Germany; V.A. Hospitals, Miami, FL
| | - S. Tomov
- George August University, Goettingen, Germany; J.W. Goethe University, Frankfurt, Germany; University Hospital, Sofia, Bulgaria; University Hospital, Pleven, Bulgaria; Zentaris GmbH, Frankfurt a. Main, Germany; V.A. Hospitals, Miami, FL
| | - H. Sindermann
- George August University, Goettingen, Germany; J.W. Goethe University, Frankfurt, Germany; University Hospital, Sofia, Bulgaria; University Hospital, Pleven, Bulgaria; Zentaris GmbH, Frankfurt a. Main, Germany; V.A. Hospitals, Miami, FL
| | - J. Engel
- George August University, Goettingen, Germany; J.W. Goethe University, Frankfurt, Germany; University Hospital, Sofia, Bulgaria; University Hospital, Pleven, Bulgaria; Zentaris GmbH, Frankfurt a. Main, Germany; V.A. Hospitals, Miami, FL
| | - A. V. Schally
- George August University, Goettingen, Germany; J.W. Goethe University, Frankfurt, Germany; University Hospital, Sofia, Bulgaria; University Hospital, Pleven, Bulgaria; Zentaris GmbH, Frankfurt a. Main, Germany; V.A. Hospitals, Miami, FL
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Fister S, Günthert A, Emons G, Gründker C. Antagonistic analogs of gonadotropin-releasing hormone type II (GnRH-II) induce apoptotic cell death in human breast cancer cells in vitro and in vivo. Exp Clin Endocrinol Diabetes 2007. [DOI: 10.1055/s-2007-972205] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Eicke N, Günthert A, Emons G, Gründker C. GnRH-II agonist [D-Lys6]GnRH-II inhibits the EGF-induced mitogenic signal transduction in human endometrial and ovarian cancer cells. Int J Oncol 2006. [DOI: 10.3892/ijo.29.5.1223] [Citation(s) in RCA: 6] [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: 11/06/2022] Open
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Emons G, Hesse O, Günthert A, Gruendker C, Kaufmann M, Loibl S, Hamid-Werner M. ZEN-008: eine Phase I Studie mit einem zytotoxischen GnRH-Analogon (AN-152) bei Patientinnen mit fortgeschrittenen, GnRH-Rezeptor I exprimierenden Karzinomen. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952647] [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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Fister S, Gründker C, Emons G, Günthert A. GnRH Analoga hemmen die Aktivierung von AKT in Mammakarzinomzellen mit sekundärer Tamoxifen-Resistenz. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952817] [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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Günthert A, Faber M, Emons G. Atrophe Vulvadystrophie bei jungen Frauen – ein reversibles Krankheitsbild als Nebenwirkung von oralen Antikonzeptiva? Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952323] [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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Günthert A, Ackermann S, Beckmann M, Camara O, Rensing K, Schröder W, Steiner E, Emons G. Phase II-Studie mit wöchentlich Docetaxel in Patientinnen mit fortgeschrittenem Endometriumkarzinom, AGO Uterus-4. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952397] [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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Fister S, Günthert A, Rivier J, Emons G, Gründker C. Wirkung von Antagonisten des Gonadotropin-Releasing Hormons Typ II (GnRH-II) auf das Wachstum humaner Ovarialkarzinome in vitro und in vivo. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952816] [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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Günthert A, Gründker C, Emons G. Analoga von Gonadotropin-Releasinghormon (GnRH) I und GnRH II hemmen die EGF-induzierte Signaltransduktion in Mammakarzinomzellen und resensibilisieren resistente Zellen für 4OH-Tamoxifen. Geburtshilfe Frauenheilkd 2005. [DOI: 10.1055/s-2005-920778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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