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SA 7.3 Limited axillary surgery concepts to determine nodal pathologic complete response. Breast 2023. [DOI: 10.1016/s0960-9776(23)00097-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
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COGNITION: a prospective precision oncology trial for patients with early breast cancer at high risk following neoadjuvant chemotherapy. ESMO Open 2022; 7:100637. [PMID: 36423362 PMCID: PMC9808485 DOI: 10.1016/j.esmoop.2022.100637] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/09/2022] [Accepted: 10/18/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND COGNITION (Comprehensive assessment of clinical features, genomics and further molecular markers to identify patients with early breast cancer for enrolment on marker driven trials) is a diagnostic registry trial that employs genomic and transcriptomic profiling to identify biomarkers in patients with early breast cancer with a high risk for relapse after standard neoadjuvant chemotherapy (NACT) to guide genomics-driven targeted post-neoadjuvant therapy. PATIENTS AND METHODS At National Center for Tumor Diseases Heidelberg patients were biopsied before starting NACT, and for patients with residual tumors after NACT additional biopsy material was collected. Whole-genome/exome and transcriptome sequencing were applied on tumor and corresponding blood samples. RESULTS In the pilot phase 255 patients were enrolled, among which 213 were assessable: thereof 48.8% were identified to be at a high risk for relapse following NACT; 86.4% of 81 patients discussed in the molecular tumor board were eligible for a targeted therapy within the interventional multiarm phase II trial COGNITION-GUIDE (Genomics-guided targeted post neoadjuvant therapy in patients with early breast cancer) starting enrolment in Q4/2022. An in-depth longitudinal analysis at baseline and in residual tumor tissue of 16 patients revealed some cases with clonal evolution but largely stable genetic alterations, suggesting restricted selective pressure of broad-acting cytotoxic neoadjuvant chemotherapies. CONCLUSIONS While most precision oncology initiatives focus on metastatic disease, the presented concept offers the opportunity to empower novel therapy options for patients with high-risk early breast cancer in the post-neoadjuvant setting within a biomarker-driven trial and provides the basis to test the value of precision oncology in a curative setting with the overarching goal to increase cure rates.
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Resectability of bilobar liver tumours after simultaneous portal and hepatic vein embolization versus portal vein embolization alone: meta-analysis. BJS Open 2022; 6:6844022. [PMID: 36437731 PMCID: PMC9702575 DOI: 10.1093/bjsopen/zrac141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/09/2022] [Accepted: 10/05/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Many patients with bi-lobar liver tumours are not eligible for liver resection due to an insufficient future liver remnant (FLR). To reduce the risk of posthepatectomy liver failure and the primary cause of death, regenerative procedures intent to increase the FLR before surgery. The aim of this systematic review is to provide an overview of the available literature and outcomes on the effectiveness of simultaneous portal and hepatic vein embolization (PVE/HVE) versus portal vein embolization (PVE) alone. METHODS A systematic literature search was conducted in PubMed, Web of Science, and Embase up to September 2022. The primary outcome was resectability and the secondary outcome was the FLR volume increase. RESULTS Eight studies comparing PVE/HVE with PVE and six retrospective PVE/HVE case series were included. Pooled resectability within the comparative studies was 75 per cent in the PVE group (n = 252) versus 87 per cent in the PVE/HVE group (n = 166, OR 1.92 (95% c.i., 1.13-3.25)) favouring PVE/HVE (P = 0.015). After PVE, FLR hypertrophy between 12 per cent and 48 per cent (after a median of 21-30 days) was observed, whereas growth between 36 per cent and 67 per cent was reported after PVE/HVE (after a median of 17-31 days). In the comparative studies, 90-day primary cause of death was similar between groups (2.5 per cent after PVE versus 2.2 per cent after PVE/HVE), but a higher 90-day primary cause of death was reported in single-arm PVE/HVE cohort studies (6.9 per cent, 12 of 175 patients). CONCLUSION Based on moderate/weak evidence, PVE/HVE seems to increase resectability of bi-lobar liver tumours with a comparable safety profile. Additionally, PVE/HVE resulted in faster and more pronounced hypertrophy compared with PVE alone.
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Mesh-Pocket Supported Prepectoral Direct-to-Implant Breast Reconstruction: Preliminary Results of a Prospective Analysis. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01378-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Underestimated risk of involved margins in Skin (SMM)- and Nipple Sparing Mastectomies (NSM) – Data and Multimodal Approach for Improvement. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01379-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Dragon 1 Protocol Manuscript: Training, Accreditation, Implementation and Safety Evaluation of Portal and Hepatic Vein Embolization (PVE/HVE) to Accelerate Future Liver Remnant (FLR) Hypertrophy. Cardiovasc Intervent Radiol 2022; 45:1391-1398. [PMID: 35790566 PMCID: PMC9458562 DOI: 10.1007/s00270-022-03176-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 05/08/2022] [Indexed: 12/02/2022]
Abstract
STUDY PURPOSE The DRAGON 1 trial aims to assess training, implementation, safety and feasibility of combined portal- and hepatic-vein embolization (PVE/HVE) to accelerate future liver remnant (FLR) hypertrophy in patients with borderline resectable colorectal cancer liver metastases. METHODS The DRAGON 1 trial is a worldwide multicenter prospective single arm trial. The primary endpoint is a composite of the safety of PVE/HVE, 90-day mortality, and one year accrual monitoring of each participating center. Secondary endpoints include: feasibility of resection, the used PVE and HVE techniques, FLR-hypertrophy, liver function (subset of centers), overall survival, and disease-free survival. All complications after the PVE/HVE procedure are documented. Liver volumes will be measured at week 1 and if applicable at week 3 and 6 after PVE/HVE and follow-up visits will be held at 1, 3, 6, and 12 months after the resection. RESULTS Not applicable. CONCLUSION DRAGON 1 is a prospective trial to assess the safety and feasibility of PVE/HVE. Participating study centers will be trained, and procedures standardized using Work Instructions (WI) to prepare for the DRAGON 2 randomized controlled trial. Outcomes should reveal the accrual potential of centers, safety profile of combined PVE/HVE and the effect of FLR-hypertrophy induction by PVE/HVE in patients with CRLM and a small FLR. TRIAL REGISTRATION Clinicaltrials.gov: NCT04272931 (February 17, 2020). Toestingonline.nl: NL71535.068.19 (September 20, 2019).
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Quality of Life After Simultaneously Integrated Boost With Intensity-Modulated vs. Conventional Radiotherapy Followed by Sequential Boost for Adjuvant Treatment of Breast Cancer: 2-Year Results of the Multicenter Randomized IMRT-MC2 Trial. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bullöses Sweet-Syndrom nach einem Zeckenstich. AKTUELLE DERMATOLOGIE 2021. [DOI: 10.1055/a-1429-9757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ZusammenfassungWir berichten über einen Patienten, der eine Woche nach einem Zeckenstich Fieber und Papulovesikel entwickelte. Eine disseminierte Borrelien-Infektion sowie eine blasenbildende Erkrankung konnte ausgeschlossen werden. Sowohl klinisch als auch histologisch bestätigte sich ein bullöses Sweet-Syndrom, sodass eine systemische Steroidtherapie begonnen wurde. Darunter besserten sich die Beschwerden des Patienten rasch.Die Umfelddiagnostik ergab weder Hinweise auf eine hämatologische Erkrankung noch auf eine Medikamenteneinnahme als Auslöser. Dieser Fall deutet darauf hin, dass auch Arthropodenstiche als Trigger für ein Sweet-Syndrom in Betracht gezogen werden können.
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Retrospective multicenter analysis comparing conventional with oncoplastic breast conservation: oncologic and surgical outcome in women with high risk breast cancer from the OPBC-01/iTOP2 study. Breast 2021. [DOI: 10.1016/s0960-9776(21)00222-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Breast surgery after neoadjuvant treatment. Breast 2021. [DOI: 10.1016/s0960-9776(21)00068-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Preoperative portal vein or portal and hepatic vein embolization: DRAGON collaborative group analysis. Br J Surg 2021; 108:834-842. [PMID: 33661306 DOI: 10.1093/bjs/znaa149] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/20/2020] [Accepted: 11/30/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The extent of liver resection for tumours is limited by the expected functional reserve of the future liver remnant (FRL), so hypertrophy may be induced by portal vein embolization (PVE), taking 6 weeks or longer for growth. This study assessed the hypothesis that simultaneous embolization of portal and hepatic veins (PVE/HVE) accelerates hypertrophy and improves resectability. METHODS All centres of the international DRAGON trials study collaborative were asked to provide data on patients who had PVE/HVE or PVE on 2016-2019 (more than 5 PVE/HVE procedures was a requirement). Liver volumetry was performed using OsiriX MD software. Multivariable analysis was performed for the endpoints of resectability rate, FLR hypertrophy and major complications using receiver operating characteristic (ROC) statistics, regression, and Kaplan-Meier analysis. RESULTS In total, 39 patients had undergone PVE/HVE and 160 had PVE alone. The PVE/HVE group had better hypertrophy than the PVE group (59 versus 48 per cent respectively; P = 0.020) and resectability (90 versus 68 per cent; P = 0.007). Major complications (26 versus 34 per cent; P = 0.550) and 90-day mortality (3 versus 16 per cent respectively, P = 0.065) were comparable. Multivariable analysis confirmed that these effects were independent of confounders. CONCLUSION PVE/HVE achieved better FLR hypertrophy and resectability than PVE in this collaborative experience.
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Abstract SP058: Exceptional responders to neoadjuvant chemotherapy - Pro. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-sp58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Increasing use of neoadjuvant systemic treatment (NST) and improved efficacy of treatment regimens have led to increasing numbers of patients without any detectable residual cancer upon surgery (pathologic complete response, pCR, ypT0, ypN0). For these exceptional responders to NST, invasive surgery may cause more harm than benefit and thus should be tailored to this response.
For nodal disease, axillary lymph node dissection (ALND) used to be the standard of care for all patients but ALND causes relevant morbidity (i.g. lymphedema, pain, restricted mobility). Sentinel lymph node biopsy (SLNB) causes less morbidity but its use for patients receiving NST has been controversial. Based on rates of missed cancer (false-negative rate, FNR) compared to ALND, several current national guidelines recommend use of SLNB for patients undergoing NST with initial nodal negative disease (FNR about 7%; Shirzadi et al 2019, J Res Med Sci) and use of targeted axillary dissection (TAD; removal of clipped nodes plus SLNB) for patients with initial nodal positive disease converting to nodal negative disease after NST (FNR about 2%; Caudle et al 2016, J Clin Onc). However, while already implemented in clinical practice recurrence and survival data are still lacking for SLNB/TAD after NST.
For the primary tumor in the breast, breast conserving surgery (BCS) is the current standard of care. The use of NST instead of adjuvant treatment has allowed for more patients to be treated with BCS instead of mastectomy with equal survival (EBCTCG 2018, Lancet Onc). Although BCS is a low morbidity procedure compared to other oncologic surgeries, also BCS causes morbidity relevant to patients: (1) About 30% of patients undergoing BCS and SLNB report moderate, persistent pain two years after surgery (Gärtner et al 2009, JAMA); (2) the reduction in patient-reported quality of life up to 8 years after surgery is comparable between patients undergoing BCS or mastectomy (Flanagan et al 2019, Ann Surg Onc). In the light of increasing ypT0 rates, current research evaluates alternative diagnostic procedures than BCS to identify these exceptional responders to NST who achieve ypT0. Imaging (ultrasound, mammography, MRI, PET-CT) is insufficiently accurate to reliably exclude residual disease (FNR about 20% for US and mammography) and/ or specificity is suboptimal (MRI, PET-CT) (Fowler et al 2017, Radiology). Vacuum-assisted biopsies (VAB) showed promising results in some pilot trials (FNR about 5%; Heil et al 2016, Eur J Cancer and Kuerer et al 2018, Ann Surg) which could however not be confirmed in larger multicenter trials (FNR about 18%; Heil, Pfob et al 2020, Ann Surg). Recent exploratory analyses using machine learning algorithms to combine VAB with patient and tumor data could decrease the FNR to ~3% while maintaining good specificity (Pfob et al 2020, ASCO meeting). However, we do not know yet to which extend these FNR would influence local recurrence or survival rates when omitting breast surgery for these exceptional responders to NST.
In summary, several less invasive and therefore less morbidity causing procedures are currently evaluated to identify exceptional responders to NST to spare them surgery-associated morbidity in the axilla and breast. TAD to identify ypN0 patients showed an FNR <2% in prospective trials and survival outcome analyses in these cohorts are underway. VAB combined with patient and tumor data to identify ypT0 patients showed promising results (FNR around 3%) in exploratory analyses but needs further prospective validation before trials with oncological endpoints should be considered. The topic is worth to be studied further to decrease potentially unnecessary treatment burden for patients, providers, and health care systems.
Citation Format: J Heil. Exceptional responders to neoadjuvant chemotherapy - Pro [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr SP058.
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First 2-Year Results of the Multicenter, Randomized IMRT-MC2 Trial (MINT): Intensity-Modulated Radiotherapy with Simultaneous Integrated Boost versus 3-D-Conformal Radiotherapy with Consecutive Boost for Breast Cancer Patients. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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First proof-of-concept evaluation of the FUSION-X-US-II prototype for the performance of automated breast ultrasound in healthy volunteers. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Präpektorale Implantateinlage in der plastisch-rekonstruktiven Mammachirurgie unter Verwendung des TiLOOP Bra Pocket – erste Daten der PRO-Pocket Studie. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Can the eligibility criteria of the ACOSOG Z0011 trial be extended to patients undergoing mastectomy and presenting T3-T4 tumors? An analysis of non-sentinel axillary metastases. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Artificial intelligence to accurately identify and select breast cancer patients with a pathologic complete response for omission of surgery after neoadjuvant systemic therapy: an international multicenter analysis. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Evaluation genderspezifischer Faktoren und Assoziationen für die Wahl zur Facharztweiterbildung in der Gynäkologie und Geburtshilfe – Ergebnisse einer Befragung unter Medizinstudierenden im klinischen Studienabschnitt. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Wie hat sich die Anwendung von adjuvanter zu neoadjuvanter Chemotherapie beim frühen Mammakarzinom verändert? – Daten von 104 deutschen Brustzentren 2008-2017. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Diagnostic accuracy and clinical utility of axillary ultrasound in the evaluation of axillary lymph node status in early breast cancer patients. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Management of the axilla for high-risk early breast cancer (EBC) before and after neoadjuvant chemotherapy (NACT): an analysis of the multicentre GeparOcto trial. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1714551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
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Patients should be the tipping point of individualizing breast cancer surgery: Commentary on 'Eliminating the breast cancer surgery paradigm after neoadjuvant systemic therapy: current evidence and future challenges'. Ann Oncol 2020; 31:1264. [PMID: 32473970 DOI: 10.1016/j.annonc.2020.05.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/10/2020] [Indexed: 10/24/2022] Open
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126TiP Tailored axillary surgery with or without axillary lymph node dissection followed by radiotherapy in patients with clinically node-positive breast cancer (SAKK 23/16 / IBCSG 57-18 / ABCSG-53 / GBG 101 - TAXIS): A multicenter randomized phase III trial. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.03.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Prospective, multicenter registry trial to evaluate the clinical feasibility of targeted axillary dissection (TAD) in patients (pts) with breast cancer (BC) and core biopsy proven axillary involvement (cN+). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz240.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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EORTC 1409 GITCG / ESSO 01 - A prospective colorectal liver metastasis database with an integrated quality assurance program (CLIMB): Primary analysis of variations in European clinical practices and surgical complications after complex liver metastasis surgeries. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Changes of breast and axillary surgery patterns in patients with primary breast cancer during the past decade. Arch Gynecol Obstet 2018; 299:1043-1053. [PMID: 30478667 DOI: 10.1007/s00404-018-4982-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 11/16/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE Breast-conserving therapy (BCT) is the standard procedure for most patients with primary breast cancer (BC). By contrast, axillary management is still under transition to find the right balance between avoiding of morbidity, maintaining oncological safety, and performing a staging procedure. The rising rate of primary systemic therapy creates further challenges for surgical management. METHODS Patients with primary, non-metastatic BC treated between 01.01.2003 and 31.12.2016 under guideline-adherent conditions were included in this study. For this prospectively followed cohort, breast and axillary surgery patterns are presented in a time-trend analysis as annual rate data (%) for several subgroups. RESULTS Overall, 6700 patients were included in the analysis. While BCT rates remained high (mean 2003-2016: 70.4%), the proportion of axillary lymph node dissection has declined considerably from 80.1% in 2003 to 16.0% in 2016, while the proportion for sentinel lymph node biopsy (SLND) has increased correspondingly from 10.3 to 76.4%. Among patients with cT1-2, cN0 breast cancer receiving BCT with positive SLND, the rate of axillary completion has decreased from 100% in 2008 to 24.4% in 2016. CONCLUSIONS In the past decade, SLNB has been established as the standard procedure for axillary staging of clinically node-negative patients. Surgical morbidity has been further reduced by the rapid implementation of new evidence from the ACOSOG Z0011 trial into clinical routine. The results reflect the transition towards more individually tailored, less invasive treatment for selected patient subgroups, especially in regards to axillary lymph node management.
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Chemotherapie-Anwendung beim frühen Mammakarzinom in Deutschland – aktuelle Daten aus 179 Brustkrebszentren (2008 – 2015). Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Veränderung des axillären Managements bei Brustkrebspatientinnen mit 1 – 2 tumorbefallenen Sentinel-Lymphknoten. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Der Einfluss des Patientinnenalters auf Therapie und Prognose des Mammakarzinoms. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Evaluation des Nutzens von intraoperativer Präparateradiografie zur Randbeurteilung bei brusterhaltender Therapie maligner Brusttumore. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Initial results of the FUSION-X-US prototype combining 3D automated breast ultrasound and tomosynthesis. Eur J Cancer 2018. [DOI: 10.1016/s0959-8049(18)30694-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Time trends (2006–2015) of quality indicators in EUSOMA-certified breast centres. Eur J Cancer 2017; 85:15-22. [DOI: 10.1016/j.ejca.2017.07.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 05/31/2017] [Accepted: 07/25/2017] [Indexed: 12/21/2022]
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Veränderungen in der Anwendung und beim Outcome von Chemotherapie beim frühen Mammakarzinom in der letzten Dekade. Geburtshilfe Frauenheilkd 2017. [DOI: 10.1055/s-0037-1606152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Using ultrasound and palpation for predicting axillary lymph node status following neoadjuvant chemotherapy – Results from the multi-center SENTINA trial. Breast 2017; 31:202-207. [DOI: 10.1016/j.breast.2016.11.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 11/10/2016] [Accepted: 11/11/2016] [Indexed: 10/20/2022] Open
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Changes in chemotherapy usage and outcome of early breast cancer patients in the last decade. Breast Cancer Res Treat 2016; 160:491-499. [PMID: 27744486 PMCID: PMC5090013 DOI: 10.1007/s10549-016-4016-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 10/08/2016] [Indexed: 11/23/2022]
Abstract
Background During the last decade, neoadjuvant chemotherapy (NACT) of early breast cancer (EBC) evolved from a therapy intended to enable operability to a standard treatment option aiming for increasing cure rates equivalent to adjuvant chemotherapy (ACT). In parallel, improvements in the quality control of breast cancer care have been established in specialized breast care units. Patients and methods This study analyzed chemotherapy usage in patients with EBC treated at the Heidelberg University Breast Unit between January 2003 and December 2014. Results Overall, 5703 patients were included in the analysis of whom 2222 (39 %) received chemotherapy, 817 (37 %) as NACT, and 1405 (63 %) as ACT. The chemotherapy usage declined from 48 % in 2003 to 34 % in 2014 of the cohort. Further, the proportion of NACT raised from 42 to 65 % irrespective of tumor subtype. In addition, frequency of pathologic complete response (pCR) defined as no tumor residues in breast and axilla (ypT0 ypN0) at surgery following NACT increased from 12 % in 2003 to 35 % in 2014. The greatest effect was observed in HER2+ breast cancer with an increase in patients achieving pCR from 24 to 68 %. Conclusions The results mirror the refined indication for chemotherapy in EBC and its preferred usage as NACT in Germany. The increase in pCR rate over time suggests improvement in outcome accomplished by a multidisciplinary decision-making process and stringent measures for quality control. Electronic supplementary material The online version of this article (doi:10.1007/s10549-016-4016-4) contains supplementary material, which is available to authorized users.
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Kann eine pathologische Komplettremission nach neoadjuvanter Chemotherapie bei Brustkrebspatientinnen mithilfe einer minimal invasiven Biopsie diagnostiziert werden? Ergebnisse einer prospektiven Pilotstudie. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Ergebnisqualität von Brustkrebs-Subtypen in der klinischen Routine – eine große, prospektive Kohortenstudie. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Examensvorbereitungskurs für die Zweite Ärztliche Prüfung im Fach Gynäkologie und Geburtshilfe – Ein Proof-of-Concept an der Universitätsfrauenklinik Heidelberg. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Evaluation des MD Anderson Prognostic Index (MDAPI) zur lokoregionären Risikostratifikation in der neoadjuvanten Therapiesituation. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Intensiviertes Früherkennungs- und Nachsorgeprogramm oder prophylaktische Operation? Entscheidungen von Frauen aus Familien mit familiärem Brust- und Eierstockkrebs. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Abstract P1-07-12: Prognosis of clinico-pathological breast cancer subtypes in routine clinical care. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p1-07-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background / Aim: To analyze oncological outcome of breast cancer (BC) subtypes in routine clinical care in specialized breast care units (BCU).
Patients and methods: A prospectively followed cohort of 4110 female cases with primary, non-bilateral, non-metastatic BC treated between 01.01.2003 and 31.12.2012 has been analyzed for the whole cohort and separately for the five routinely used clinico-pathological subtypes (i.e. Luminal A, Luminal B (=Her2 neg.), Luminal B (=Her2 pos.), HER-2, triple negative). The median follow-up of the cohort was 51 month. We calculated estimates for local control rate (LCR), disease-free survival (DFS), distant disease-free survival (DDFS), overall survival (OS) and relative overall survival (ROS).
5 year outcome results referred to 5 different endpoints (using Kaplan-Meier method) of all patients with primary, non-metastatic, non-bilateral breast cancer treated at Heidelberg Breast Care Unit between 01.01.2003 and 31.12.2012 All patients (including in-situ)Patients with invasive cancer (excluding in-situ) n=4102 (including 499 in-situ cases)n = 3603LCR [%] (95% CI)96.1 (95.6 ; 96.6)96.1 (95.7 ; 96.5)DFS [%] (95% CI)85.0 (84.2 ; 85.8)83.7 (82.8 ; 84.6)DDFS [%] (95% CI)86.9 (86.1 ; 87.7)85.7 (84.8 ; (86.6)OS [%] (95% CI)91.3 (90.5 ; 92.2)90.5 (89.6 ; 91.4)ROS [%] (95% CI)95.5 (94.3 ; 96.7)94.7 (93.4 ; 96.0)CI, confidence interval; LCR, local recurrence rate; DFS, disease-free survival; DDFS, distant disease-free survival; OS, observed overall survival; ROS, relative (age adjusted) overall survival
Outcome results referred to 5 different endpoints (using Kaplan-Meier method) according to clinico-pathological tumor subtype or in-situ tumor. Results in percent at 5 years (95% CI).invasive cancer (n = 34541) Lum A-likeLum B1-likeLum B2-likeHER2+Triple negativeCIS (n = 499)LCR [%] (95% CI)99.1 (98.7 ; 99.5)95.2 (-)**95.0 (86.3 ; 100)90.5 (-)89.6 (87.1 ; 92.1)96.2 (94.3 ; 98.1)DFS [%] (95% CI)92.2 (90.9 ; 93.5)80.1 (78.6 ; 81.6)79.0 (71.0 ; 86.0)77.0 (-)69.1 (66.4 ; 71.8)93.0 (91.3 ; 94.7)DDFS [%] (95% CI)92.9 (91.6 ; 94.2)82.2 (80.5 ; 83.9)82.8 (76.5 ; 89.1)83.3 (-)72.2 (70.7 ; 73.7)95.6 (94.4 ; 96.8)OS [%] (95% CI)95.1 (94.1 ; 96.1)88.7 (86.6 ; 90.8)92.5 (87.5 ; 97.5)85.6 (79.9 ; 91.3)78.5 (76.4 ; 80.6)96.9 (95.2 ; 98.6)ROS [%] (95% CI)100.0 (98.5 ; 100)93.4 (90.7 ; 96.1)96.0 (91.2 ; 100)88.8 (81.4 ; 96.2)80.1 (75.1 ; 85.1)100.0 (97.8 ; 100)
Results: LCR, DFS, DDFS, OS and ROS over 5 years for the whole cohort of invasive cases were 96.1%, 83.7%, 85.7%, 90.5% and 94.7%, respectively. Luminal A tumors were the most frequent (44.7%) and showed the best outcome with LCR, OS and ROS over 5 years at 99.1%, 95.1% and 100.0%, respectively; while triple negative tumors presented the poorest outcome with LCR, OS and ROS over 5 years at 89.6%, 78.5% and 80.1%, respectively.
Conclusions: This outcome analysis of a large cohort of patients with primary BC diagnosed, treated and prospectively followed on a routine basis at a specialized BCU in Germany confirmed general and detailed clinico-pathological subtype outcome data of clinical trials.
Citation Format: Hennigs A, Heil J, Gondos A, Riedel F, Marme F, Sinn H-P, Schirmacher P, Kauczor H-U, Debus J, Golatta M, Schtz F, Sohn C, Schneeweiss A. Prognosis of clinico-pathological breast cancer subtypes in routine clinical care. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-07-12.
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Abstract P5-02-01: Diagnosis of pathological complete response by vacuum-assisted minimal invasive biopsy after neoadjuvant chemotherapy in breast cancer - Results from a prospective pilot study. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p5-02-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose:
To explore the ability of vacuum-assisted-biopsy (VAB) to diagnose pathological complete response (pCR) or residual tumor in breast cancer patients after neoadjuvant chemotherapy (NACT).
Patients and methods: 50 patients (22 with clinical / imaging complete response 28 with clinical / imaging residual tumor) were included in this review-board approved prospective pilot study between 08/14 and 02/15. Vacuum-assisted-biopsy (VAB) was performed after NACT and before surgery. Negative predictive values (NPV) and false-negative-rates (FNR) to predict a pCR in surgical specimen (=diagnose pCR through VAB) were the main outcome measures.
Results:
The cohort (n=50) consisted of 15 (30%) triple negative (TNBC), 13 (26%) HER2 positive (HER2+) and 22 (44%) hormone receptor positive / HER2 negative (HR+/HER2-) cancers. pCR in surgical specimen was diagnosed in 23 (46%) cases of the whole cohort. The NPV of the VAB diagnosis of pCR was 94.4% (95% CI: [0.84; 1.00]). The FNR was 3.7% (95% CI: [0; 0.12]) and specificity 73.9% (95% CI: [0.54; 0.94]). Taking only those biopsies into account that pathology confirmed to be representative of the (former) tumor region, improved the outcome of VAB to a specificity of 100% while the NPV (94.4% (95% CI: [0.84; 1.00]) and the FNR (4.8% (95% CI: [0.00; 0.15]) stayed the same.
Conclusion:
Overall accuracy of VAB diagnosis of pCR questions the necessity of surgical intervention to diagnose a pCR. A confirmative, multi-center, intra-individually-controlled clinical trial including patients with clinical complete, near complete or partial response to NACT to validate the above mentioned results is warranted.
Citation Format: Hennigs A, Heil J. Diagnosis of pathological complete response by vacuum-assisted minimal invasive biopsy after neoadjuvant chemotherapy in breast cancer - Results from a prospective pilot study. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-02-01.
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The effect of EUSOMA certification on quality of breast cancer care. Eur J Surg Oncol 2015; 41:1423-9. [DOI: 10.1016/j.ejso.2015.06.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 06/04/2015] [Accepted: 06/12/2015] [Indexed: 12/12/2022] Open
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1830 Diagnosis of pathological complete response to neoadjuvant chemotherapy in breast cancer by minimal invasive biopsy techniques. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30781-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Akzeptanz des intensivierten Früherkennungs- und Nachsorgeprogramms (IFNP) für familiären Brust- und Eierstockkrebs an der Universitätsfrauenklinik Heidelberg – Erste Ergebnisse. Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1555088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Hormone Therapy and its Effect on the Prognosis in Breast Cancer Patients. Geburtshilfe Frauenheilkd 2015; 75:588-596. [PMID: 26166840 DOI: 10.1055/s-0035-1546149] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 05/02/2015] [Accepted: 05/19/2015] [Indexed: 12/23/2022] Open
Abstract
Introduction: Use of hormone therapy (HT) has declined dramatically in recent years. Some studies have reported that HT use before a diagnosis of breast cancer (BC) may be a prognostic factor in postmenopausal patients. This study aimed to examine the prognostic relevance of HT use before BC diagnosis. Methods: Four BC cohort studies in Germany were pooled, and 4492 postmenopausal patients with HT use data were identified. Patient data and tumor characteristics were compared between users and nonusers, along with overall survival (OS), distant metastasis-free survival (DMFS), and local recurrence-free survival (LRFS). Cox proportional hazards models were stratified by study center and adjusted for age at diagnosis, tumor stage, grading, nodal status, and hormone receptors. Results: Women with HT use before the diagnosis of BC were more likely to have a lower tumor stage, to be estrogen receptor-negative, and to have a lower grading. With regard to prognosis there were effects seen for OS, DMFS and LRFS, specifically in the subgroup of women with a positive hormone receptor. In these subgroups, BC patients had a better prognosis with previous HT use. Conclusions: HT use before a diagnosis of BC is associated with a more favorable prognosis in women with a positive hormone receptor status. It may be recommended that the prognostic factor HT should be documented and analyzed as a confounder for prognosis in studies of postmenopausal hormone-responsive breast cancers.
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Abweichungen von Tumorboard-Empfehlungen des Mammografie-Screenings Rhein-Neckar und des Universitäts-Brustzentrums Heidelberg. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Akzeptanz des intensivierten Früherkennungs- und Nachsorgeprogramms (IFNP) für familiären Brust- und Eierstockkrebs an der Universitätsfrauenklinik Heidelberg – erste Ergebnisse. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Einfluss von Nachresektion auf das Lokalrezidivrisiko bei Patientinnen mit Mammakarzinom nach brusterhaltender Therapie. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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The impact of HER2 phenotype of circulating tumor cells in metastatic breast cancer: a study in 107 patients. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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