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Melendez A, Gonzalez A, Salamat-Saberi N, Sauer R, Chuba N. Management of Cesarean Scar Pregnancy Via Laparoscopic and Transcervical Approaches. J Minim Invasive Gynecol 2022. [DOI: 10.1016/j.jmig.2022.09.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Strnad V, Krug D, Sedlmayer F, Piroth MD, Budach W, Baumann R, Feyer P, Duma MN, Haase W, Harms W, Hehr T, Fietkau R, Dunst J, Sauer R. DEGRO practical guideline for partial-breast irradiation. Strahlenther Onkol 2020; 196:749-763. [PMID: 32350554 PMCID: PMC7449998 DOI: 10.1007/s00066-020-01613-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 03/19/2020] [Indexed: 12/24/2022]
Abstract
Purpose This consensus statement from the Breast Cancer Working Group of the German Society for Radiation Oncology (DEGRO) aims to define practical guidelines for accelerated partial-breast irradiation (APBI). Methods Recent recommendations for relevant aspects of APBI were summarized and a panel of experts reviewed all the relevant literature. Panel members of the DEGRO experts participated in a series of conferences, supplemented their clinical experience, performed a literature review, and formulated recommendations for implementing APBI in clinical routine, focusing on patient selection, target definition, and treatment technique. Results Appropriate patient selection, target definition for different APBI techniques, and basic rules for appropriate APBI techniques for clinical routine outside of clinical trials are described. Detailed recommendations for APBI in daily practice, including dose constraints, are given. Conclusion Guidelines are mandatory to assure optimal results of APBI using different techniques.
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Affiliation(s)
- V Strnad
- University Hospital Erlangen, Erlangen, Germany.
| | - D Krug
- University Hospital Schleswig-Holstein, Kiel, Germany
| | - F Sedlmayer
- Paracelsus Medical University Hospital Salzburg, Salzburg, Austria
| | - M D Piroth
- Helios University Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany
| | - W Budach
- Heinrich-Heine-University Hospital Düsseldorf, Düsseldorf, Germany
| | - R Baumann
- St. Marien-Krankenhaus Siegen, Siegen, Germany
| | - P Feyer
- Vivantes Hospital Neukoelln, Berlin, Germany
| | - M N Duma
- University Hospital, Jena, Germany
| | - W Haase
- St.-Vincentius-Hospital Karlsruhe, Karlsruhe, Germany
| | - W Harms
- St. Claraspital Basel, Basel, Switzerland
| | - T Hehr
- Marienhospital Stuttgart, Stuttgart, Germany
| | - R Fietkau
- University Hospital Erlangen, Erlangen, Germany
| | - J Dunst
- University Hospital Schleswig-Holstein, Kiel, Germany
| | - R Sauer
- University Hospital Erlangen, Erlangen, Germany
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Hofheinz RD, Arnold D, Fokas E, Kaufmann M, Hothorn T, Folprecht G, Fietkau R, Hohenberger W, Ghadimi M, Liersch T, Grabenbauer GG, Sauer R, Rödel C, Graeven U. Impact of age on the efficacy of oxaliplatin in the preoperative chemoradiotherapy and adjuvant chemotherapy of rectal cancer: a post hoc analysis of the CAO/ARO/AIO-04 phase III trial. Ann Oncol 2019; 29:1793-1799. [PMID: 29873684 DOI: 10.1093/annonc/mdy205] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background The German rectal cancer trial CAO/ARO/AIO-04 has shown a significant benefit in 3-year disease-free survival (DFS) of adding oxaliplatin to a standard preoperative 5-fluorouracil (5-FU)-based chemoradiotherapy (CRT) and adjuvant chemotherapy in patients with locally advanced rectal cancer. The use of oxaliplatin as adjuvant treatment in elderly patients with colon cancer is controversial. We therefore investigated the impact of age on clinical outcome in the CAO/ARO/AIO-04 phase III trial. Patients and methods We carried out a post hoc analysis of the CAO/ARO/AIO-04 phase III trial evaluating primary and secondary end points according to age. Patient and tumor characteristics, NCI CTC adverse events grades 3-4 (version 3.0), dose intensities as well as survival and recurrence data were analyzed in three specified age groups (<60, 60-70, and ≥70 years). The influence of age as a continuous variable on DFS was modeled using a subpopulation treatment effect pattern plot (STEPP) analysis. Results A total of 1232 patients were assessable. With the exception of Eastern Cooperative Oncology Group status (P < 0.001), no differences in patient and tumor characteristics were noticed between age groups. Likewise, toxicity pattern, dose intensities of CRT and surgical results were similar in all age groups. After a median follow-up of 50 months, in patients aged <60 years a significant benefit of adding oxaliplatin to 5-FU-based CRT and adjuvant chemotherapy was observed for local (P = 0.013) and systemic recurrences (P = 0.023), DFS (P = 0.011), and even overall survival (OS; P = 0.044). The STEPP analysis revealed improved hazard ratios for DFS in patients aged 40-70 years compared with elderly patients treated with oxaliplatin. Conclusion The addition of oxaliplatin significantly improved DFS and OS in younger patients aged <60 years with advanced rectal cancer. Patients aged ≥70 years had no benefit. Clinical Trials Number NCT00349076.
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Affiliation(s)
- R-D Hofheinz
- Interdisciplinary Tumor Center, University Hospital Mannheim, University of Heidelberg, Heidelberg, Germany.
| | - D Arnold
- Department of Oncology and Hematology, Asklepios Clinic Altona, Hamburg, Germany
| | - E Fokas
- Department of Radiotherapy and Oncology, University of Frankfurt, German Cancer Research Center (DKFZ), Heidelberg; German Cancer Consortium (DKTK), Frankfurt, Germany
| | - M Kaufmann
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - T Hothorn
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - G Folprecht
- Department of Oncology, University Hospital Dresden, Dresden, Germany
| | - R Fietkau
- Department of Radiation Therapy, University of Erlangen-Nürnberg, Erlangen-Nürnberg, Germany
| | - W Hohenberger
- Department of General and Visceral Surgery, University of Erlangen-Nürnberg, Erlangen-Nürnberg, Germany
| | - M Ghadimi
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - T Liersch
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - G G Grabenbauer
- Department of Radiation Oncology and Radiotherapy, DiaCura & Klinikum, Coburg, Germany
| | - R Sauer
- Department of Radiation Therapy, University of Erlangen-Nürnberg, Erlangen-Nürnberg, Germany
| | - C Rödel
- Department of Radiotherapy and Oncology, University of Frankfurt, German Cancer Research Center (DKFZ), Heidelberg; German Cancer Consortium (DKTK), Frankfurt, Germany
| | - U Graeven
- Department of Hematology/Oncology and Gastroenterology, Kliniken Maria Hilf GmbH, Mönchengladbach, Germany
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Fokas E, Fietkau R, Hartmann A, Hohenberger W, Grützmann R, Ghadimi M, Liersch T, Ströbel P, Grabenbauer GG, Graeven U, Hofheinz RD, Köhne CH, Wittekind C, Sauer R, Kaufmann M, Hothorn T, Rödel C. Neoadjuvant rectal score as individual-level surrogate for disease-free survival in rectal cancer in the CAO/ARO/AIO-04 randomized phase III trial. Ann Oncol 2019; 29:1521-1527. [PMID: 29718095 DOI: 10.1093/annonc/mdy143] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Surrogate end points in rectal cancer after preoperative chemoradiation are lacking as their statistical validation poses major challenges, including confirmation based on large phase III trials. We examined the prognostic role and individual-level surrogacy of neoadjuvant rectal (NAR) score that incorporates weighted cT, ypT and ypN categories for disease-free survival (DFS) in 1191 patients with rectal carcinoma treated within the CAO/ARO/AIO-04 phase III trial. Patients and methods Cox regression models adjusted for treatment arm, resection status, and NAR score were used in multivariable analysis. The four Prentice criteria (PC1-4) were used to assess individual-level surrogacy of NAR for DFS. Results After a median follow-up of 50 months, the addition of oxaliplatin to fluorouracil-based chemoradiotherapy (CRT) significantly improved 3-year DFS [75.9% (95% confidence interval [CI] 72.30% to 79.50%) versus 71.3% (95% CI 67.60% to 74.90%); P = 0.034; PC 1) and resulted in a shift toward lower NAR groups (P = 0.034, PC 2) compared with fluorouracil-only CRT. The 3-year DFS was 91.7% (95% CI 88.2% to 95.2%), 81.8% (95% CI 78.4% to 85.1%), and 58.1% (95% CI 52.4% to 63.9%) for low, intermediate, and high NAR score, respectively (P < 0.001; PC 3). NAR score remained an independent prognostic factor for DFS [low versus high NAR: hazard ratio (HR) 4.670; 95% CI 3.106-7.020; P < 0.001; low versus intermediate NAR: HR 1.971; 95% CI 1.303-2.98; P = 0.001] in multivariable analysis. Notwithstanding the inherent methodological difficulty in interpretation of PC 4 to establish surrogacy, the treatment effect on DFS was captured by NAR, supporting satisfaction of individual-level PC 4. Conclusion Our study validates the prognostic role and individual-level surrogacy of NAR score for DFS within a large randomized phase III trial. NAR score could help oncologists to speed up response-adapted therapeutic decision, and further large phase III trial data sets should aim to confirm trial-level surrogacy.
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Affiliation(s)
- E Fokas
- Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt, Germany; German Cancer Research Center (DKFZ), Heidelberg; German Cancer Consortium (DKTK), Partner Site: Frankfurt, Germany.
| | - R Fietkau
- Department of Radiation Therapy, University of Erlangen-Nürnberg, Erlangen, Germany
| | - A Hartmann
- Institute of Pathology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - W Hohenberger
- Department of General and Visceral, University of Erlangen-Nürnberg, Erlangen, Germany
| | - R Grützmann
- Department of General and Visceral, University of Erlangen-Nürnberg, Erlangen, Germany
| | - M Ghadimi
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - T Liersch
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - P Ströbel
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | - G G Grabenbauer
- Department of Radiation Oncology and Radiotherapy, DiaCura & Klinikum Coburg, Coburg, Germany
| | - U Graeven
- Department of Hematology/Oncology, Kliniken Maria Hilf GmbH Mönchengladbach, Mönchengladbach, Germany
| | - R-D Hofheinz
- Department of Medical Oncology, University Hospital Mannheim, Mannheim, Germany
| | - C-H Köhne
- Department of Medical Oncology, University of Oldenburg, Oldenburg, Germany
| | - C Wittekind
- Institute of Pathology, University of Leipzig, Leipzig, Germany
| | - R Sauer
- Department of Radiation Therapy, University of Erlangen-Nürnberg, Erlangen, Germany
| | - M Kaufmann
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - T Hothorn
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - C Rödel
- Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt, Germany; German Cancer Research Center (DKFZ), Heidelberg; German Cancer Consortium (DKTK), Partner Site: Frankfurt, Germany
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Kosmala R, Fokas E, Flentje M, Sauer R, Liersch T, Graeven U, Fietkau R, Hohenberger W, Arnold D, Hofheinz R, Ghadimi M, Raab H, Ströbel P, Staib L, Grabenbauer G, Folprecht G, Uter W, Gall C, Rödel C, Polat B. OC-0384 QoL after multimodal treatment of rectal cancer with/without oxaliplatin (phase 3, CAO/ARO/AIO-04). Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30804-7] [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: 10/26/2022]
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Sprenger T, Beißbarth T, Sauer R, Tschmelitsch J, Fietkau R, Liersch T, Hohenberger W, Staib L, Gaedcke J, Raab HR, Rödel C, Ghadimi M. Long-term prognostic impact of surgical complications in the German Rectal Cancer Trial CAO/ARO/AIO-94. Br J Surg 2018; 105:1510-1518. [DOI: 10.1002/bjs.10877] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 02/11/2018] [Accepted: 03/09/2018] [Indexed: 12/29/2022]
Abstract
Abstract
Background
The influence of postoperative complications on survival in patients with locally advanced rectal cancer undergoing combined modality treatment is debatable. This study evaluated the impact of surgical complications on oncological outcomes in patients with locally advanced rectal cancer treated within the randomized CAO/ARO/AIO-94 (Working Group of Surgical Oncology/Working Group of Radiation Oncology/Working Group of Medical Oncology of the Germany Cancer Society) trial.
Methods
Patients were assigned randomly to either preoperative chemoradiotherapy (CRT) followed by total mesorectal excision (TME) or postoperative CRT between 1995 and 2002. Anastomotic leakage and wound healing disorders were evaluated prospectively, and their associations with overall survival, and distant metastasis and local recurrence rates after a long-term follow-up of more than 10 years were determined. Medical complications (such as cardiopulmonary events) were not analysed in this study.
Results
A total of 799 patients were included in the analysis. Patients who had anterior or intersphincteric resection had better 10-year overall survival than those treated with abdominoperineal resection (63·1 versus 51·3 per cent; P < 0·001). Anastomotic leakage was associated with worse 10-year overall survival (51 versus 65·2 per cent; P = 0·020). Overall survival was reduced in patients with impaired wound healing (45·7 versus 62·2 per cent; P = 0·009). At 10 years after treatment, patients developing any surgical complication (anastomotic leakage and/or wound healing disorder) had impaired overall survival (46·6 versus 63·8 per cent; P < 0·001), a lower distant metastasis-free survival rate (63·2 versus 72·0 per cent; P = 0·030) and more local recurrences (15·5 versus 6·4 per cent; P < 0·001). In a multivariable Cox regression model, lymph node metastases (P < 0·001) and surgical complications (P = 0·008) were the only independent predictors of reduced overall survival.
Conclusion
Surgical complications were associated with adverse oncological outcomes in this trial.
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Affiliation(s)
- T Sprenger
- Department of General, Visceral and Paediatric Surgery, University Medical Centre Göttingen, Göttingen, Germany
| | - T Beißbarth
- Department of Medical Statistics, University Medical Centre Göttingen, Göttingen, Germany
| | - R Sauer
- Department of Radiotherapy, University Medical Centre Erlangen, Erlangen, Germany
| | - J Tschmelitsch
- Department of Surgery, Krankenhaus der Barmherzigen Brüder, St Veit an der Glan, Austria
| | - R Fietkau
- Department of Radiotherapy, University Medical Centre Erlangen, Erlangen, Germany
| | - T Liersch
- Department of General, Visceral and Paediatric Surgery, University Medical Centre Göttingen, Göttingen, Germany
| | - W Hohenberger
- Department of Surgery, University Medical Centre Erlangen, Erlangen, Germany
| | - L Staib
- Department of General and Visceral Surgery, Klinikum Esslingen, Esslingen, Germany
| | - J Gaedcke
- Department of General, Visceral and Paediatric Surgery, University Medical Centre Göttingen, Göttingen, Germany
| | - H-R Raab
- University Department of General and Visceral Surgery, Klinikum Oldenburg, Oldenburg, Germany
| | - C Rödel
- Department of Radiotherapy and Oncology, University Medical Centre Frankfurt, Frankfurt/Main, Germany
| | - M Ghadimi
- Department of General, Visceral and Paediatric Surgery, University Medical Centre Göttingen, Göttingen, Germany
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Fokas E, Fietkau R, Hartmann A, Hohenberger W, Grützmann R, Ghadimi M, Liersch T, Ströbel P, Grabenbauer G, Wittekind C, Sauer R, Kaufmann M, Hothorn T, Rödel C. OC-0278: NAR score as surrogate for disease-free survival in the CAO/ARO/AIO-04 phase 3 rectal cancer trial. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30588-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sauer R, Kiewe P, Desole M, Schuler M, Theissig F, Roth A, Mairinger T. Lymphozytäre Myokarditis unter Nivolumabtherapie bei metastasiertem klarzelligen Nierenzellkarzinom. Pathologe 2017; 38:535-539. [DOI: 10.1007/s00292-017-0349-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Sauer R, Griff S, Blau A, Franke A, Mairinger T, Grah C. Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia diagnosed by transbronchial lung cryobiopsy: a case report. J Med Case Rep 2017; 11:95. [PMID: 28385164 PMCID: PMC5383988 DOI: 10.1186/s13256-017-1254-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 03/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Micronodular lesions are common findings in lung imaging. As an important differential diagnosis, we describe a case of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia; it is notable that the diagnosis of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia is often delayed. This case provides supporting evidence to establish lung biopsy by cryotechnique as the option of first choice when considering a diagnostic strategy for micronodular lung lesions. CASE PRESENTATION We report a case of a 65-year-old white woman who presented with obstructive symptoms of chronic coughing and dyspnea confirmed by conventional lung function tests. A computed tomography scan presented disseminated micronodules in all the lobes of her lungs. With the help of bronchoscopic cryobiopsy it was possible to obtain a high yield sample of lung parenchyma. On histologic examination, the micronodules correlated with a diffuse neuroendocrine cell hyperplasia. In the context of clinical symptoms, radiological aspects, and histomorphological aspects we made the diagnosis of a diffuse idiopathic pulmonary neuroendocrine cell hyperplasia. Obstructive symptoms were treated with inhaled steroids and beta-2-mimetics continuously. A comparison between current computed tomography scans of our patient and scans of 2014 revealed no significant changes. Last ambulatory checks occurred in January and May of 2016. The course of disease and the extent of limitation of lung function have remained stable. CONCLUSIONS The diagnosis of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia is best made in a multidisciplinary review including clinical presentation, lung imaging, and histomorphological aspects. This report and current literature indicate that transbronchial lung cryobiopsy can be used as a safe and practicable tool to obtain high quality biopsies of lung parenchyma in order to diagnose micronodular lesions of the lung.
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Affiliation(s)
- R. Sauer
- Institute of Pathology, HELIOS Klinikum Emil von Behring, Walterhöferstr. 11, Berlin, 14165 Germany
| | - S. Griff
- Institute of Pathology, HELIOS Klinikum Emil von Behring, Walterhöferstr. 11, Berlin, 14165 Germany
| | - A. Blau
- Department of Respiratory Medicine, Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - A. Franke
- Group Practice of Respiratory Medicine, Klosterstraße 34/35, Berlin, Germany
| | - T. Mairinger
- Institute of Pathology, HELIOS Klinikum Emil von Behring, Walterhöferstr. 11, Berlin, 14165 Germany
| | - C. Grah
- Department of Respiratory Medicine, Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
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Wurps H, Schönfeld N, Bauer TT, Bock M, Duve C, Sauer R, Mairinger T, Griff S. Intra-patient comparison of parietal pleural biopsies by rigid forceps, flexible forceps and cryoprobe obtained during medical thoracoscopy: a prospective series of 80 cases with pleural effusion. BMC Pulm Med 2016; 16:98. [PMID: 27387441 PMCID: PMC4937596 DOI: 10.1186/s12890-016-0258-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 04/06/2016] [Accepted: 06/06/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is only few data available on the use of cryotechnique during medical thoracoscopy. METHODS Medical thoracoscopy was performed in consecutive patients with pleural effusion. Prospectively, biopsies were taken by rigid forceps, flexible forceps and cryoprobe. Specimen size, depth and diagnostic yield were compared. RESULTS 80 Patients were included. 408 biopsies were taken (205 rigid biopsies, 104 flexible biopsies, 99 cryobiopsies). Mean surface area of rigid biopsies was 22.6 ± 20.4 mm(2) (flexible biopsies: 7.1 ± 9.3 mm(2), cryobiopsies: 14.4 ± 12.8 mm(2)). Rigid biopsies were significantly larger than cryobiopsies (p < 0.001) and flexible biopsies (p < 0.001), crybiopsies were significantly larger than flexible biopsies (p < 0.01). A deep biopsy containing fatty tissue was harvested in 63 % of rigid biopsies (cryobiopsy: 49.5 % flexible biopsy: 39.5 %). In 79/80 cases (98.7 % 95 % CI cannot be calculated) a diagnosis was obtained by rigid biopsy (cryobiopsy: 73/80 cases (91.3 % 95 % CI 86.0 - 96.5 %), flexible biopsy: 74/80 cases (92.5 % 95 % CI 88.6 - 97.4 %)). Diagnostic yield achieved with cryobiopsies was inferior to the yield of rigid biopsies (Difference: 12.7 %), but non-inferior to flexible biopsies (Difference: 6.5 %). CONCLUSION Cryobiopsies in medical thoracoscopy are safe with high diagnostic yield, non-inferior to flexible biopsies with increased tissue quantity and quality. Cryotechnique can develop an important role in medical thoracoscopy in the near future when rigid thoracoscopy is not available.
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Affiliation(s)
- H Wurps
- Department of Respiratory Medicine, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany.
| | - N Schönfeld
- Department of Respiratory Medicine, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - T T Bauer
- Department of Respiratory Medicine, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - M Bock
- Department of Respiratory Medicine, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - C Duve
- Department of Respiratory Medicine, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - R Sauer
- Department of Pneumology and Institute of Pathology, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - T Mairinger
- Department of Pneumology and Institute of Pathology, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - S Griff
- Department of Pneumology and Institute of Pathology, HELIOS Klinikum Emil von Behring, Berlin, Germany
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Harms W, Budach W, Dunst J, Feyer P, Fietkau R, Haase W, Krug D, Piroth MD, Sautter-Bihl ML, Sedlmayer F, Souchon R, Wenz F, Sauer R. DEGRO practical guidelines for radiotherapy of breast cancer VI: therapy of locoregional breast cancer recurrences. Strahlenther Onkol 2016; 192:199-208. [PMID: 26931319 PMCID: PMC4833793 DOI: 10.1007/s00066-015-0939-7] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 12/22/2015] [Indexed: 02/07/2023]
Abstract
Objective To update the practical guidelines for radiotherapy of patients with locoregional breast cancer recurrences based on the current German interdisciplinary S3 guidelines 2012. Methods A comprehensive survey of the literature using the search phrases “locoregional breast cancer recurrence”, “chest wall recurrence”, “local recurrence”, “regional recurrence”, and “breast cancer” was performed, using the limits “clinical trials”, “randomized trials”, “meta-analysis”, “systematic review”, and “guidelines”. Conclusions Patients with isolated in-breast or regional breast cancer recurrences should be treated with curative intent. Mastectomy is the standard of care for patients with ipsilateral breast tumor recurrence. In a subset of patients, a second breast conservation followed by partial breast irradiation (PBI) is an appropriate alternative to mastectomy. If a second breast conservation is performed, additional irradiation should be mandatory. The largest reirradiation experience base exists for multicatheter brachytherapy; however, prospective clinical trials are needed to clearly define selection criteria, long-term local control, and toxicity. Following primary mastectomy, patients with resectable locoregional breast cancer recurrences should receive multimodality therapy including systemic therapy, surgery, and radiation +/− hyperthermia. This approach results in high local control rates and long-term survival is achieved in a subset of patients. In radiation-naive patients with unresectable locoregional recurrences, radiation therapy is mandatory. In previously irradiated patients with a high risk of a second local recurrence after surgical resection or in patients with unresectable recurrences, reirradiation should be strongly considered. Indication and dose concepts depend on the time interval to first radiotherapy, presence of late radiation effects, and concurrent or sequential systemic treatment. Combination with hyperthermia can further improve tumor control. In patients with isolated axillary or supraclavicular recurrence, durable disease control is best achieved with multimodality therapy including surgery and radiotherapy. Radiation therapy significantly improves local control and should be applied whenever feasible.
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Affiliation(s)
- Wolfgang Harms
- Abteilung für Radioonkologie, St. Claraspital, Kleinriehenstrasse 30, 4016, Basel, Switzerland.
| | - W Budach
- Heinrich-Heine-University, Duesseldorf, Germany
| | - J Dunst
- University Hospital Schleswig-Holstein, Kiel, Germany
| | - P Feyer
- Vivantes Hospital Neukoelln, Berlin, Germany
| | - R Fietkau
- University Hospital Erlangen, Erlangen, Germany
| | - W Haase
- Formerly St.-Vincentius-Hospital, Karlsruhe, Germany
| | - D Krug
- University Hospital Heidelberg, Heidelberg, Germany
| | - M D Piroth
- HELIOS-Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany
| | | | - F Sedlmayer
- Paracelsus Medical University Hospital, Salzburg, Austria
| | - R Souchon
- Formerly University Hospital Tuebingen, Tuebingen, Germany
| | - F Wenz
- University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - R Sauer
- University Hospital Erlangen, Erlangen, Germany
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Glaab T, Hänsel M, Sauer R, Rubin RA, Buhl R. Treatment with Tiotropium plus Olodaterol Respimat improves physical functioning of COPD patients in a real life setting. Pneumologie 2016. [DOI: 10.1055/s-0036-1572084] [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: 10/22/2022]
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13
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Bölling T, Braun-Munzinger G, Burdach S, Calaminus G, Craft A, Delattre O, Deley MCL, Dirksen U, Dockhorn-Dworniczak B, Dunst J, Engel S, Faldum A, Fröhlich B, Gadner H, Göbel U, Gosheger G, Hardes J, Hawkins DS, Hjorth L, Hoffmann C, Kovar H, Kruseova J, Ladenstein R, Leuschner I, Lewis IJ, Oberlin O, Paulussen M, Potratz J, Ranft A, Rössig C, Rübe C, Sauer R, Schober O, Schuck A, Timmermann B, Tirode F, van den Berg H, van Valen F, Vieth V, Willich N, Winkelmann W, Whelan J, Womer RB. Development of curative therapies for Ewing sarcomas by interdisciplinary cooperative groups in Europe. Klin Padiatr 2015; 227:108-15. [PMID: 25985445 DOI: 10.1055/s-0035-1545263] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Curative therapies for Ewing sarcoma have been developed within cooperative groups. Consecutive clinical trials have systematically assessed the impact and timing of local therapy and the activity of cytotoxic drugs and their combinations. They have led to an increase of long-term disease-free survival to around 70% in patients with localized disease. Translational research in ES remains an area in which interdisciplinary and international cooperation is essential for future progress. This article reviews current state-of-the art therapy, with a focus on trials performed in Europe, and summarizes novel strategies to further advance both the cure rates and quality of survival.
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Affiliation(s)
- T Bölling
- Department Osnabrueck, Center for Radiotherapy Rheine-Osnabrueck, Osnabrueck, Germany
| | - G Braun-Munzinger
- Pediatric Hematology and Oncology Muenster, University Children's Hospital Muenster, Germany
| | - S Burdach
- Department of Pediatrics, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - G Calaminus
- Pediatric Hematology and Oncology Muenster, University Children's Hospital Muenster, Germany
| | - A Craft
- Royal Victoria Infirmary, Newcastle, United Kingdom
| | - O Delattre
- Inserm U830, Laboratory of Genetics and Biology of Cancers, Institut Curie, Paris, France
| | - M-C L Deley
- Université Paris-Sud, Le Kremlin-Bicêtre, and Gustave Roussy Institute, Villejuif, France
| | - U Dirksen
- Pediatric Hematology and Oncology Muenster, University Children's Hospital Muenster, Germany
| | | | - J Dunst
- Department of Radiation Oncology, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck, Germany
| | - S Engel
- Pediatric Hematology and Oncology Muenster, University Children's Hospital Muenster, Germany
| | - A Faldum
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - B Fröhlich
- Pediatric Hematology and Oncology Muenster, University Children's Hospital Muenster, Germany
| | - H Gadner
- St. Anna Kinderkrebsforschung e.V., Children's Cancer Research Institute, and Department of Pediatrics, Medical University Vienna
| | - U Göbel
- Clinic of Pediatric Oncology, Hematology and Clinical Immunology, Heinrich-Heine-University, Duesseldorf, Germany
| | - G Gosheger
- Department of Orthopedic Surgery, University Hospital Muenster, Muenster, Germany
| | - J Hardes
- Department of Orthopedic Surgery, University Hospital Muenster, Muenster, Germany
| | - D S Hawkins
- Seattle Children's Hospital and Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington, USA
| | - L Hjorth
- Skåne University Hospital, Lund University, Lund, Sweden
| | - C Hoffmann
- Pediatric Hematology and Oncology Muenster, University Children's Hospital Muenster, Germany
| | - H Kovar
- St. Anna Kinderkrebsforschung e.V., Children's Cancer Research Institute, and Department of Pediatrics, Medical University Vienna
| | - J Kruseova
- Department of Paediatric Haematology and Oncology Charles University, 2nd School of Medicine, Prague, Czech Republic
| | - R Ladenstein
- St. Anna Kinderkrebsforschung e.V., Children's Cancer Research Institute, and Department of Pediatrics, Medical University Vienna
| | - I Leuschner
- Kiel Paediatric Tumor Registry, Department of Paediatric Pathology, Christian-Albrechts-University Kiel, Kiel, Germany
| | - I J Lewis
- Alder Hey Children's National Health Service Foundation Trust, Liverpool, UK
| | - O Oberlin
- Gustave Roussy Institute, Villejuif, France
| | - M Paulussen
- Vestische Kinder-und Jugendklinik Datteln, Witten/Herdecke University, Datteln, Germany
| | - J Potratz
- Pediatric Hematology and Oncology Muenster, University Children's Hospital Muenster, Germany
| | - A Ranft
- Pediatric Hematology and Oncology Muenster, University Children's Hospital Muenster, Germany
| | - C Rössig
- Pediatric Hematology and Oncology Muenster, University Children's Hospital Muenster, Germany
| | - C Rübe
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg, Germany
| | - R Sauer
- Department of Radiation Therapy, University of Erlangen, Erlangen, Germany
| | - O Schober
- Department of Nuclear Medicine, University of Münster, Münster, Germany
| | - A Schuck
- Department of Radiotherapy, University Hospital Muenster, Muenster, Germany
| | - B Timmermann
- Clinic for Particle Therapy, West German Proton Therapy Center Essen, West German Cancer Center, University Hospital Essen
| | - F Tirode
- Inserm U830, Laboratory of Genetics and Biology of Cancers, Institut Curie, Paris, France
| | - H van den Berg
- Emma Children Hospital AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - F van Valen
- Institute of Experimental Musculoskeletal Medicine, University Hospital Muenster, Muenster, Germany
| | - V Vieth
- Department of Clinical Radiology, University Hospital Muenster, Muenster, Germany
| | - N Willich
- Department of Radiotherapy, University Hospital Muenster, Muenster, Germany
| | - W Winkelmann
- Department of Orthopedic Surgery, University Hospital Muenster, Muenster, Germany
| | - J Whelan
- NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - R B Womer
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Wurps H, Bock M, Sauer R, Schönfeld N, Blum T, Mairinger T, Griff S, Bauer TT. Kryobiopsie in der internistischen Thorakoskopie: eine sichere und diagnostisch wertvolle Methode. Pneumologie 2015. [DOI: 10.1055/s-0035-1544628] [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: 10/24/2022]
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Sautter-Bihl ML, Sedlmayer F, Budach W, Dunst J, Feyer P, Fietkau R, Haase W, Harms W, Piroth MD, Souchon R, Wenz F, Sauer R. How nescience may obscure evidence. Strahlenther Onkol 2014; 190:861-3. [PMID: 25238991 DOI: 10.1007/s00066-014-0755-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- M-L Sautter-Bihl
- Klinik für Radioonkologie und Strahlentherapie, Städtisches Klinikum Karlsruhe gGmbH, 76133, Karlsruhe, Moltkestr. 90, Germany,
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Keck B, Wach S, Taubert H, Zeiler S, Ott OJ, Kunath F, Hartmann A, Bertz S, Weiss C, Hönscheid P, Schellenburg S, Rödel C, Baretton GB, Sauer R, Fietkau R, Wullich B, Krause FS, Datta K, Muders MH. Neuropilin-2 and its ligand VEGF-C predict treatment response after transurethral resection and radiochemotherapy in bladder cancer patients. Int J Cancer 2014; 136:443-51. [PMID: 24862180 DOI: 10.1002/ijc.28987] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [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: 01/13/2014] [Revised: 03/30/2014] [Accepted: 04/25/2014] [Indexed: 12/11/2022]
Abstract
The standard treatment for invasive bladder cancer is radical cystectomy. In selected patients, bladder-sparing therapy can be performed by transurethral resection (TURBT) and radio-chemotherapy (RCT) or radiotherapy (RT). Our published in vitro data suggest that the Neuropilin-2 (NRP2)/VEGF-C axis plays a role in therapy resistance. Therefore, we studied the prognostic impact of NRP2 and VEGF-C in 247 bladder cancer patients (cN0M0) treated with TURBT and RCT (n = 198) or RT (n = 49) and a follow-up time up to 15 years. A tissue microarray was analyzed by immunohistochemistry. NRP2 expression emerged as a prognostic factor in overall survival (OS; HR: 3.42; 95% CI: 1.48 - 7.86; p = 0.004) and was associated with a 3.85-fold increased risk of an early cancer specific death (95% CI: 0.91 - 16.24; p = 0.066) in multivariate analyses. Cancer specific survival (CSS) dropped from 166 months to 85 months when NRP2 was highly expressed (p = 0.037). Patients with high VEGF-C expression have a 2.29-fold increased risk of shorter CSS (95% CI: 1.03-5.35; p = 0.043) in univariate analysis. CSS dropped from 170 months to 88 months in the case of high VEGF-C expression (p = 0.041). Additionally, NRP2 and VEGF-C coexpression is a prognostic marker for OS in multivariate models (HR: 7.54; 95% CI: 1.57-36.23; p = 0.012). Stratification for muscle invasiveness (T1 vs. T2-T4) confirmed the prognostic role of NRP2 and NRP2/VEGF-C co-expression in patients with T2-T4 but also with high risk T1 disease. In conclusion, immunohistochemistry for NRP2 and VEGF-C has been determined to predict therapy outcome in bladder cancer patients prior to TURBT and RCT.
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Affiliation(s)
- B Keck
- Department of Urology, University Hospital Erlangen, Germany
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Graeven U, Liersch T, Fietkau R, Hohenberger W, Hothorn T, Arnold D, Raab H, Wittekind C, Hess C, Staib L, Becker H, Sauer R, Rödel C. Preoperative Chemoradiotherapy and Postoperative Chemotherapy with 5-Fluorouracil and Oxaliplatin Versus 5-Fluorouracil Alone in Locally Advanced Rectal Cancer: Results of the German CAO/ARO/AIO-04 Randomized Phase III Trial. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu193.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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18
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Wurps H, Sauer R, Schönfeld N, Ammenwerth W, Blum T, Mairinger T, Griff S, Bauer TT. Der diagnostische Wert der Kryobiopsie in der internistischen Thorakoskopie. Pneumologie 2014. [DOI: 10.1055/s-0034-1368023] [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: 10/25/2022]
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19
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Klautke G, Sauer R. Neoadjuvante Kurzzeitbestrahlung mit anschließender Chemotherapie oder simultane Radiochemotherapie bei lokal nicht sicher kurativ resektablen Rektumkarzinomen. Strahlenther Onkol 2014; 190:317-8. [DOI: 10.1007/s00066-013-0549-1] [Citation(s) in RCA: 3] [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: 12/11/2022]
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20
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Sedlmayer F, Sautter-Bihl ML, Budach W, Dunst J, Fastner G, Feyer P, Fietkau R, Haase W, Harms W, Souchon R, Wenz F, Sauer R. DEGRO practical guidelines: radiotherapy of breast cancer I: radiotherapy following breast conserving therapy for invasive breast cancer. Strahlenther Onkol 2014; 189:825-33. [PMID: 24002382 PMCID: PMC3825416 DOI: 10.1007/s00066-013-0437-8] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background and purpose The aim of the present paper is to update the practical guidelines for postoperative adjuvant radiotherapy of breast cancer published in 2007 by the breast cancer expert panel of the German Society for Radiooncology (Deutsche Gesellschaft für Radioonkologie, DEGRO). The present recommendations are based on a revision of the German interdisciplinary S-3 guidelines published in July 2012. Methods A comprehensive survey of the literature concerning radiotherapy following breast conserving therapy (BCT) was performed using the search terms “breast cancer”, “radiotherapy”, and “breast conserving therapy”. Data from lately published meta-analyses, recent randomized trials, and guidelines of international breast cancer societies, yielding new aspects compared to 2007, provided the basis for defining recommendations according to the criteria of evidence-based medicine. In addition to the more general statements of the DKG (Deutsche Krebsgesellschaft), this paper addresses indications, target definition, dosage, and technique of radiotherapy of the breast after conservative surgery for invasive breast cancer. Results Among numerous reports on the effect of radiotherapy during BCT published since the last recommendations, the recent EBCTCG report builds the largest meta-analysis so far available. In a 15 year follow-up on 10,801 patients, whole breast irradiation (WBI) halves the average annual rate of disease recurrence (RR 0.52, 0.48–0.56) and reduces the annual breast cancer death rate by about one sixth (RR 0.82, 0.75–0.90), with a similar proportional, but different absolute benefit in prognostic subgroups (EBCTCG 2011). Furthermore, there is growing evidence that risk-adapted dose augmentation strategies to the tumor bed as well as the implementation of high precision RT techniques (e.g., intraoperative radiotherapy) contribute substantially to a further reduction of local relapse rates. A main focus of ongoing research lies in partial breast irradiation strategies as well as WBI hypofractionation schedules. The potential of both in replacing normofractionated WBI has not yet been finally clarified. Conclusion After breast conserving surgery, no subgroup even in low risk patients has yet been identified for whom radiotherapy can be safely omitted without compromising local control and, hence, cancer-specific survival. In most patients, this translates into an overall survival benefit.
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Affiliation(s)
- F Sedlmayer
- Department of Radiotherapy and Radiation Oncology, LKH Salzburg, Paracelsus Medical University Hospital, Muellner Haupstr. 48, Salzburg, Austria,
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Souchon R, Sautter-Bihl ML, Sedlmayer F, Budach W, Dunst J, Feyer P, Fietkau R, Haase W, Harms W, Wenz F, Sauer R. DEGRO practical guidelines: radiotherapy of breast cancer II. Strahlenther Onkol 2013; 190:8-16. [DOI: 10.1007/s00066-013-0502-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pox C, Aretz S, Bischoff SC, Graeven U, Hass M, Heußner P, Hohenberger W, Holstege A, Hübner J, Kolligs F, Kreis M, Lux P, Ockenga J, Porschen R, Post S, Rahner N, Reinacher-Schick A, Riemann JF, Sauer R, Sieg A, Scheppach W, Schmitt W, Schmoll HJ, Schulmann K, Tannapfel A, Schmiegel W. [S3-guideline colorectal cancer version 1.0]. Z Gastroenterol 2013; 51:753-854. [PMID: 23955142 DOI: 10.1055/s-0033-1350264] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- C Pox
- Medizinische Klinik, Knappschaftskrankenhaus GmbH Bochum, Ruhr-Universität Bochum, Bochum
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Van Nieuwkoop L, Poot S, Sauer R, van Nieuwkoop C, van der Geest L. PARE0012 How to develop an independent youth organisation? risks, challenges and benefits. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.3192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sedlmayer F, Sautter-Bihl M, Budach W, Dunst J, Feyer P, Fietkau R, Haase W, Harms W, Rödel C, Souchon R, Wenz F, Sauer R. Erratum to: Is the simultaneously integrated boost (SIB) technique for early breast cancer ready to be adopted for routine adjuvant radiotherapy? Strahlenther Onkol 2013. [DOI: 10.1007/s00066-013-0349-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Herrmann T, Sauer R. Professor Árpád Mayer zum 70. Geburtstag. Strahlenther Onkol 2013; 189:339. [DOI: 10.1007/s00066-013-0319-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sautter-Bihl ML, Hohenberger W, Fietkau R, Rödel C, Schmidberger H, Sauer R. Rectal cancer : when is the local recurrence risk low enough to refrain from the aim to prevent it? Strahlenther Onkol 2013; 189:105-10. [PMID: 23299826 DOI: 10.1007/s00066-012-0299-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Recently, preliminary results of the OCUM study (optimized surgery and MRI-based multimodal therapy of rectal cancer) were published and raised concern in the scientific community. In this observational study, the circumferential resection margin status assessed in preoperative MRI (mrCRM) was used to decide for either total mesorectal excision (TME) alone or neoadjuvant radiochemotherapy (nRCT). In contrast to current guidelines, neither T3 stage (with negative CRM) nor clinically positive lymph nodes were an indication for nRCT. Pathologically node-positive patients received chemotherapy (ChT). Overall, 230 patients were included, of whom 96 CRM-positive patients received nRCT. The CRM was accurately predicted in MRI, the rate of mesorectal plane resection was high. Recurrence rates have not yet been reported, but an impressive rate of down-staging for both T and N stage after nRCT was observed, while acute side effects were minimal. Nonetheless, the authors conclude that a substantial number of patients could be "spared severe radiation toxicity" and propagate their concept for prospectively replacing current guidelines. This is based on the hypothesis that CRM is a valid surrogate parameter for the risk of local recurrence and in case of a negative CRM, nRCT becomes dispensable. Moreover, it is assumed that lymph node status is no more relevant. Both assumptions are a contradiction to recent data from randomized studies as specified below. As 5-year locoregional recurrence rate (LRR) of only of 5-8% and < 5% in low risk rectal cancer can be achieved by the addition of RT, the noninferiority of surgery alone can not be presumed unless the expected 5-year LRR is ≤ 5-8%, whereas any excess of this range renders the study design inacceptable. Unless a publication explicitly specifies 5-year LRR, results are not exploitable for clinical decisions.
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Bruggmoser G, Bauchowitz S, Canters R, Crezee H, Ehmann M, Gellermann J, Lamprecht U, Lomax N, Messmer M, Ott O, Abdel-Rahman S, Schmidt M, Sauer R, Thomsen A, Wessalowski R, van Rhoon G. Guideline for the clinical application, documentation and analysis of clinical studies for regional deep hyperthermia. Strahlenther Onkol 2012; 188 Suppl 2:198-211. [DOI: 10.1007/s00066-012-0176-2] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Matuschek C, Bölke E, Roth SL, Orth K, Lang I, Bojar H, Janni JW, Audretsch W, Nestle-Kraemling C, Lammering G, Speer V, Gripp S, Gerber PA, Buhren BA, Sauer R, Peiper M, Schauer M, Dommach M, Struse-Soll K, Budach W. Long-term outcome after neoadjuvant radiochemotherapy in locally advanced noninflammatory breast cancer and predictive factors for a pathologic complete remission : results of a multivariate analysis. Strahlenther Onkol 2012; 188:777-81. [PMID: 22878547 DOI: 10.1007/s00066-012-0162-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 05/16/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND An earlier published series of neoadjuvant radiochemotherapy (NRT-CHX) in locally advanced noninflammatory breast cancer (LABC) has now been updated with a follow-up of more than 15 years. Long-term outcome data and predictive factors for pathologic complete response (pCR) were analyzed. PATIENTS AND METHODS During 1991-1998, 315 LABC patients (cT1-cT4/cN0-N1) were treated with NRT-CHX. Preoperative radiotherapy (RT) consisted of external beam radiation therapy (EBRT) of 50 Gy (5 × 2 Gy/week) to the breast and the supra-/infraclavicular lymph nodes combined with an electron boost in 214 cases afterwards or-in case of breast conservation-a 10-Gy interstitial boost with (192)Ir afterloading before EBRT. Chemotherapy was administered prior to RT in 192 patients, and concomitantly in 113; 10 patients received no chemotherapy. The update of all follow-up ended in November 2011. Age, tumor grade, nodal status, hormone receptor status, simultaneous vs. sequential CHX, and the time interval between end of RT and surgery were examined in multivariate terms with pCR and overall survival as end point. RESULTS The total pCR rate after neoadjuvant RT-CHX reached 29.2%, with LABC breast conservation becoming possible in 50.8% of cases. In initially node-positive cases (cN+), a complete nodal response (pN0) after NRT-CHX was observed in 56% (89/159). The multivariate analysis revealed that a longer time interval to surgery increased the probability for a pCR (HR 1.17 [95% CI 1.05-1.31], p < 0.01). However, in large tumors (T3-T4) a significantly reduced pCR rate (HR 0.89 [95% CI 0.80-0.99], p = 0.03) was obtained. Importantly, pCR was the strongest prognostic factor for long-term survival (HR 0.28 [95% CI 0.19-0.56], p < 0.001). CONCLUSION pCR identifies patients with a significantly better prognosis for long-term survival. However, a long time interval to surgery (> 2 months) increases the probability of pCR after NRT-CHX.
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Affiliation(s)
- C Matuschek
- Medical Faculty, Department of Radiation Oncology, Heinrich Heine University of Duesseldorf, Germany
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Weiss C, Sauer R. Organerhaltende Radiochemotherapie – eine geprüfte Alternative zur initialen Zystektomie bei Patienten mit muskelinvasivem Harnblasenkarzinom im Vergleich zur alleinigen Radiotherapie. Strahlenther Onkol 2012; 188:713-6. [DOI: 10.1007/s00066-012-0152-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Sautter-Bihl ML, Sedlmayer F, Budach W, Dunst J, Feyer P, Fietkau R, Haase W, Harms W, Rödel C, Souchon R, Wenz F, Sauer R. One life saved by four prevented recurrences? Update of the Early Breast Cancer Trialists confirms: postoperative radiotherapy improves survival after breast conserving surgery. Strahlenther Onkol 2012; 188:461-3. [PMID: 22441440 DOI: 10.1007/s00066-012-0092-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Sauer R, Creeze H, Hulshof M, Issels R, Ott O. Concerning the final report “Hyperthermia: a systematic review” of the Ludwig Boltzmann Institute for Health Technology Assessment, Vienna, March 2010. Strahlenther Onkol 2012; 188:209-13. [DOI: 10.1007/s00066-012-0072-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Sauer R, Coulam CB, Jeyendran RS. Chromatin intact human sperm recovery is higher following glass wool column filtration as compared with density gradient centrifugation. Andrologia 2011; 44 Suppl 1:248-51. [DOI: 10.1111/j.1439-0272.2011.01171.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Roedel C, Becker H, Fietkau R, Graeven U, Hohenberger W, Hothorn T, Lang-Welzenbach M, Liersch T, Staib L, Christiansen H, Wittekind C, Sauer R. Preoperative chemoradiotherapy and postoperative chemotherapy with 5-fluorouracil and oxaliplatin versus 5-fluorouracil alone in locally advanced rectal cancer: First results of the German CAO/ARO/AIO-04 randomized phase III trial. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.18_suppl.lba3505] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [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
LBA3505 Background: The German CAO/ARO/AIO-94 trial established preoperative chemoradiotherapy (CRT), surgery, and postoperative chemotherapy with 5-FU as standard treatment for locally advanced rectal cancer. With this approach local relapse rates are below 10%. The development of distant metastasis is the predominant mode of failure. Integrating more effective systemic treatment into combined modality therapy was the goal of CAO/ARO/AIO-04. Methods: Between 7/2006-2/2010, patients with rectal cancer within 12 cm from the anal verge and clinical evidence of perirectal fat or lymph node involvement were randomly assigned to receive preoperative CRT, surgery, and adjuvant chemotherapy with 5-FU according to CAO/ARO/AIO-94 (arm 1), or preoperative CRT (50.4 Gy in 28 fractions) with 5-FU (250 mg/m2/days 1-14 and 22-35) and oxaliplatin (50 mg/m2/days 1, 8, 22, 29), surgery, and 8 cycles of adjuvant chemotherapy according to modified FOLFOX6 regimen (arm 2). Disease-free survival was the primary endpoint. We present early secondary endpoints, including acute toxicity, treatment compliance, and pCR-rates. Results: 637 patients were randomly assigned to arm 1 and 628 to arm 2. Full dose preoperative RT and full dose concurrent chemotherapy was delivered in 97% and 74% of patients in both arms, respectively. Preoperative grade 3/4 toxicity occurred in 21.6% in arm 1 and in 22.9% in arm 2. The R0-resection rate was 95.4% in both arms, and abdominoperineal resections were limited to 11.9% and 12.2% in arms 1 and 2, respectively. Overall postoperative complications were not different between both arms (21.0% and 21.9%). The pCR rate (ypT0N0) was 13.1% in arm 1 and 17.6% in arm 2 (p = 0.033, Cochran-Mantel-Haenszel Chi-Squared Test without continuity correction for conditional independence of pCR rate in the two treatment arms in each stratum). Conclusions: Inclusion of oxaliplatin to 5-FU based CRT was well tolerated and associated with increased pCR-rates compared with 5-FU-CRT alone. Longer follow-up is necessary to evaluate the primary endpoint, disease-free survival.
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Affiliation(s)
- C. Roedel
- University of Frankfurt, Frankfurt, Germany; Department of General and Visceral Surgery, University Medical Center, Georg-August University, Göttingen, Germany; University of Erlangen, Erlangen, Germany; Kliniken Maria Hilf GmbH, Monchengladbach, Germany; University of Muenchen, Muenchen, Germany; Klinikum Esslingen, Esslingen, Germany; Department of Radiation Oncology, University Hospital Goettingen, Goettingen, Germany; University of Leipzig, Leipzig, Germany
| | - H. Becker
- University of Frankfurt, Frankfurt, Germany; Department of General and Visceral Surgery, University Medical Center, Georg-August University, Göttingen, Germany; University of Erlangen, Erlangen, Germany; Kliniken Maria Hilf GmbH, Monchengladbach, Germany; University of Muenchen, Muenchen, Germany; Klinikum Esslingen, Esslingen, Germany; Department of Radiation Oncology, University Hospital Goettingen, Goettingen, Germany; University of Leipzig, Leipzig, Germany
| | - R. Fietkau
- University of Frankfurt, Frankfurt, Germany; Department of General and Visceral Surgery, University Medical Center, Georg-August University, Göttingen, Germany; University of Erlangen, Erlangen, Germany; Kliniken Maria Hilf GmbH, Monchengladbach, Germany; University of Muenchen, Muenchen, Germany; Klinikum Esslingen, Esslingen, Germany; Department of Radiation Oncology, University Hospital Goettingen, Goettingen, Germany; University of Leipzig, Leipzig, Germany
| | - U. Graeven
- University of Frankfurt, Frankfurt, Germany; Department of General and Visceral Surgery, University Medical Center, Georg-August University, Göttingen, Germany; University of Erlangen, Erlangen, Germany; Kliniken Maria Hilf GmbH, Monchengladbach, Germany; University of Muenchen, Muenchen, Germany; Klinikum Esslingen, Esslingen, Germany; Department of Radiation Oncology, University Hospital Goettingen, Goettingen, Germany; University of Leipzig, Leipzig, Germany
| | - W. Hohenberger
- University of Frankfurt, Frankfurt, Germany; Department of General and Visceral Surgery, University Medical Center, Georg-August University, Göttingen, Germany; University of Erlangen, Erlangen, Germany; Kliniken Maria Hilf GmbH, Monchengladbach, Germany; University of Muenchen, Muenchen, Germany; Klinikum Esslingen, Esslingen, Germany; Department of Radiation Oncology, University Hospital Goettingen, Goettingen, Germany; University of Leipzig, Leipzig, Germany
| | - T. Hothorn
- University of Frankfurt, Frankfurt, Germany; Department of General and Visceral Surgery, University Medical Center, Georg-August University, Göttingen, Germany; University of Erlangen, Erlangen, Germany; Kliniken Maria Hilf GmbH, Monchengladbach, Germany; University of Muenchen, Muenchen, Germany; Klinikum Esslingen, Esslingen, Germany; Department of Radiation Oncology, University Hospital Goettingen, Goettingen, Germany; University of Leipzig, Leipzig, Germany
| | - M. Lang-Welzenbach
- University of Frankfurt, Frankfurt, Germany; Department of General and Visceral Surgery, University Medical Center, Georg-August University, Göttingen, Germany; University of Erlangen, Erlangen, Germany; Kliniken Maria Hilf GmbH, Monchengladbach, Germany; University of Muenchen, Muenchen, Germany; Klinikum Esslingen, Esslingen, Germany; Department of Radiation Oncology, University Hospital Goettingen, Goettingen, Germany; University of Leipzig, Leipzig, Germany
| | - T. Liersch
- University of Frankfurt, Frankfurt, Germany; Department of General and Visceral Surgery, University Medical Center, Georg-August University, Göttingen, Germany; University of Erlangen, Erlangen, Germany; Kliniken Maria Hilf GmbH, Monchengladbach, Germany; University of Muenchen, Muenchen, Germany; Klinikum Esslingen, Esslingen, Germany; Department of Radiation Oncology, University Hospital Goettingen, Goettingen, Germany; University of Leipzig, Leipzig, Germany
| | - L. Staib
- University of Frankfurt, Frankfurt, Germany; Department of General and Visceral Surgery, University Medical Center, Georg-August University, Göttingen, Germany; University of Erlangen, Erlangen, Germany; Kliniken Maria Hilf GmbH, Monchengladbach, Germany; University of Muenchen, Muenchen, Germany; Klinikum Esslingen, Esslingen, Germany; Department of Radiation Oncology, University Hospital Goettingen, Goettingen, Germany; University of Leipzig, Leipzig, Germany
| | - H. Christiansen
- University of Frankfurt, Frankfurt, Germany; Department of General and Visceral Surgery, University Medical Center, Georg-August University, Göttingen, Germany; University of Erlangen, Erlangen, Germany; Kliniken Maria Hilf GmbH, Monchengladbach, Germany; University of Muenchen, Muenchen, Germany; Klinikum Esslingen, Esslingen, Germany; Department of Radiation Oncology, University Hospital Goettingen, Goettingen, Germany; University of Leipzig, Leipzig, Germany
| | - C. Wittekind
- University of Frankfurt, Frankfurt, Germany; Department of General and Visceral Surgery, University Medical Center, Georg-August University, Göttingen, Germany; University of Erlangen, Erlangen, Germany; Kliniken Maria Hilf GmbH, Monchengladbach, Germany; University of Muenchen, Muenchen, Germany; Klinikum Esslingen, Esslingen, Germany; Department of Radiation Oncology, University Hospital Goettingen, Goettingen, Germany; University of Leipzig, Leipzig, Germany
| | - R. Sauer
- University of Frankfurt, Frankfurt, Germany; Department of General and Visceral Surgery, University Medical Center, Georg-August University, Göttingen, Germany; University of Erlangen, Erlangen, Germany; Kliniken Maria Hilf GmbH, Monchengladbach, Germany; University of Muenchen, Muenchen, Germany; Klinikum Esslingen, Esslingen, Germany; Department of Radiation Oncology, University Hospital Goettingen, Goettingen, Germany; University of Leipzig, Leipzig, Germany
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Roedel C, Becker H, Fietkau R, Graeven U, Hohenberger W, Hothorn T, Lang-Welzenbach M, Liersch T, Staib L, Christiansen H, Wittekind C, Sauer R. Preoperative chemoradiotherapy and postoperative chemotherapy with 5-fluorouracil and oxaliplatin versus 5-fluorouracil alone in locally advanced rectal cancer: First results of the German CAO/ARO/AIO-04 randomized phase III trial. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.lba3505] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Liersch T, Weiss C, Dellas K, Hipp M, Sauer R, Rödel C, Arnold D. Effect of pathohistologic complete remission (pCR) rate on the prediction of long-term prognosis following chemoradiotherapy (XRT) with cetuximab (Cet), capecitabine (CAP), and oxaliplatin (OX; Cet-CAPOX) in patients (pts) with locally advanced rectal cancer (LARC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e14035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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36
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Sauer R, Liersch T, Merkel S, Becker H, Hohenberger W, Witzigmann H, Hess CF, Fietkau R, Wittekind C, Roedel C. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: Results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3516] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
ABSTRACTWe report five photoluminescence lines N1 through N5 in silicon which emerge after sequential nitrogen and carbon implantation. Studied is in particular the 0.7456 eV (N1) electronic-vibronic spectrum. Single nitrogen and carbon atoms in the defect are identified by isotope shifts of the no-phonon transition and of a local mode satellite with vibration quantum energy ħω= 122.9 meV. Uniaxial stress or Zeeman measurements yield monoclinic I (C1h) or trigonal (C3v) symmetry, respectively, of the optical defect. Comparing the energy of the local mode and its isotope effects with recent literature data on the nitrogen 963 cm−1 IR vibrational absorption line we discuss a defect model involving a substitutional nitrogen atom modified by an interstitial carbon atom.
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Mauckner G, Hamann J, Rebitzer W, Baier T, Thonke K, Sauer R, Halbleiterphysik A. Origin of the Infrared Band From Porous Silicon. ACTA ACUST UNITED AC 2011. [DOI: 10.1557/proc-358-489] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
ABSTRACTThe photoluminescence (PL) infrared (IR)-band of p-doped porous Si (PS) films is studied by steady-state and time-resolved PL and by photoluminescence excitation (PLE) in detail. In analogy to the S-band in the visible the IR-band shifts to higher energies with reduced average nanocrystal size. The IR- and S-bands are very different in their decay behavior and in their recombination lifetimes. The temperature-dependent PL intensity shows non-exponential decay with lifetime distributions in the nsec-µsec range in contrast to the stretched exponential decay shape of the S-band corresponding to lifetime distributions in the μsec -msec range. The origin of the IR-band is likely related to radiative recombination at deep defects in Si nanocrystals with quantum-upshifted band gaps.
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Sternschulte H, Albrecht T, Thonke K, Sauer R, Grieβer M, Grasserbauer M. Cathodoluminescence Studies of Bound Excitons and Near Band Gap Emission Lines in Boron- and Phosphorus-Doped CVD-Diamonds. ACTA ACUST UNITED AC 2011. [DOI: 10.1557/proc-423-693] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AbstractCathodoluminescence measurements at cryogenic temperatures are reported on boron- and phosphorus-doped CVD-diamond films grown on silicon substrates. Boron and phosphorus concentrations were determined by SIMS measurements; for boron, they reached from unintentional background doping levels up to 3500 ppm. At increasing boron concentrations, the radiative recombination of boron bound excitons (BEto) at 5.22 eV photon energy systematically broadens and shifts down to 4.99 eV whereas the free exciton emission (FEto) disappears for 40 ppm and higher. In the phosphorus-doped films we observe new lines at 5.16 eV and 4.99 eV which we ascribe to TO- and (TO+Or)-phonon assisted transitions of an exciton bound to a shallow impurity other than boron, possibly phosphorus or a phosphorus-related shallow complex.
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Schildkopf P, Ott OJ, Frey B, Wadepohl M, Sauer R, Fietkau R, Gaipl US. Biological rationales and clinical applications of temperature controlled hyperthermia--implications for multimodal cancer treatments. Curr Med Chem 2011; 17:3045-57. [PMID: 20629627 DOI: 10.2174/092986710791959774] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Accepted: 06/29/2010] [Indexed: 11/22/2022]
Abstract
Hyperthermia (HT)--heating the tumor in the range of 40.0- 44.0 °C--combined with radiation (RT) and/or chemotherapy (CT) is a well proven treatment for malignant tumors. The improvement of the techniques for monitoring and adapting of the desired temperatures even in deep seated tumors has led to a renaissance of, now quality-controlled, HT in multimodal tumor therapy approaches. Randomized clinical trials have shown improved disease-free survival and local tumor control without an increase in toxicity for the combined treatment. In this review, we will focus on biological rationales of HT comprising direct cytotoxicity, systemic effects, chemosensitization, radiosensitization, and immune modulation. The latter is a prerequisite for the control of recurrent tumors and micrometastases. Immunogenic tumor cell death forms induced by HT will be introduced. Modulations of the cytotoxic properties of chemotherapeutic agents by HT as well as synergistic effects of HT with RT will be presented in the context of the main aims of anti-tumor therapy. Furthermore, modern techniques for thermal mapping like magnet resonance imaging will be outlined. The effectiveness of HT will be demonstrated by reviewing recent clinical trials applying HT in addition to CT and/or RT. We conclude that hyperthermia is a very potent radio- as well as chemosensitizer, which fosters the induction of immunogenic dead tumor cells leading to local and in special cases also to systemic tumor control.
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Affiliation(s)
- P Schildkopf
- Department of Radiation Oncology, University Hospital Erlangen, Universitatsstr 27, 91054 Erlangen, Germany
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41
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Welte T, Beck E, Steffen H, Teber I, Eller J, Sauer R, Rosenstock B, Bethke T, Rabe KF. Wirksamkeit des PDE4-Inhibitors Roflumilast bei Patienten mit COPD und chronischer Bronchitis. Pneumologie 2010. [DOI: 10.1055/s-0030-1251411] [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]
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Schmiegel W, Pox C, Reinacher-Schick A, Adler G, Arnold D, Fleig W, Fölsch UR, Frühmorgen P, Graeven U, Heinemann V, Hohenberger W, Holstege A, Junginger T, Kopp I, Kühlbacher T, Porschen R, Propping P, Riemann JF, Rödel C, Sauer R, Sauerbruch T, Schmitt W, Schmoll HJ, Seufferlein T, Zeitz M, Selbmann HK. S3 guidelines for colorectal carcinoma: results of an evidence-based consensus conference on February 6/7, 2004 and June 8/9, 2007 (for the topics IV, VI and VII). Z Gastroenterol 2010; 48:65-136. [PMID: 20072998 DOI: 10.1055/s-0028-1109936] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- W Schmiegel
- Department of Medicine, Knappschafts Hospital, Ruhr University of Bochum.
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Scholz F, Thapa SB, Fikry M, Hertkorn J, Wunderer T, Lipski F, Reiser A, Xie Y, Feneberg M, Thonke K, Sauer R, Dürrschnabel M, Yao LD, Gerthsen D. Epitaxial growth of coaxial GaInN-GaN hetero-nanotubes. ACTA ACUST UNITED AC 2009. [DOI: 10.1088/1757-899x/6/1/012002] [Citation(s) in RCA: 5] [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: 11/12/2022]
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Abstract
Neoadjuvant radiochemotherapy has become established treatment for rectal cancer. It is indicated when primary R0 resection is not an option, in cases of higher risk of locoregional relapse following surgical treatment alone, and when initially impossible conservation of the anal sphincter becomes possible in conjunction with neoadjuvant radiochemotherapy. The indication for radiochemotherapy in the upper third of the rectum is still controversial. Reevaluation of the tumor situation following neoadjuvant treatment is necessary before decisions on operative strategy. Modern imaging techniques are limited in this respect, as they hardly allow differentiation between living tumor tissue and lesions. In case of doubt clarity is possible only through surgical exploration, taking R1 resection into account. Overall the recognition of lymph node metastasis is not a sufficient indicator of local relapse. The frequency of postoperative complications following neoadjuvant radiochemotherapy is independent of the operative method. The effect of neoadjuvant radiochemotherapy on long-term survival and formation of distant metastases is still not clarified. Current studies seek clarification through the use of new chemotherapies and modified treatment regimes. Further, the correct time interval between the end of neoadjuvant radiochemotherapy and the following surgical therapy has yet to be determined. This applies also to the management of patients following complete remission.
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Affiliation(s)
- W Hohenberger
- Chirurgische Klinik, Universität Erlangen-Nürnberg, Krankenhausstrasse 12, Erlangen, Germany.
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Watanabe M, Roussev R, Ahlering P, Sauer R, Coulam C, Jeyendran RS. Correlation between neutral alpha-glucosidase activity and sperm DNA fragmentation. Andrologia 2009; 41:316-8. [DOI: 10.1111/j.1439-0272.2009.00950.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Stief C, Zaak D, Stöckle M, Studer U, Knuechel R, Rödel C, Sauer R, Rubben H. [Standards and perspectives in diagnosis and therapy of bladder carcinoma]. Urologe A 2009; 45 Suppl 4:90-6. [PMID: 16896761 DOI: 10.1007/s00120-006-1134-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
MESH Headings
- Administration, Intravesical
- Antineoplastic Agents/administration & dosage
- Carcinoma, Papillary/diagnosis
- Carcinoma, Papillary/mortality
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/therapy
- Carcinoma, Transitional Cell/diagnosis
- Carcinoma, Transitional Cell/mortality
- Carcinoma, Transitional Cell/pathology
- Carcinoma, Transitional Cell/therapy
- Combined Modality Therapy
- Cystectomy
- Cystoscopy
- Disease-Free Survival
- Germany
- Hematoporphyrin Photoradiation
- Humans
- Immunotherapy
- Neoplasm Staging
- Prognosis
- Quality Assurance, Health Care/standards
- Reference Standards
- Urinary Bladder/pathology
- Urinary Bladder Neoplasms/diagnosis
- Urinary Bladder Neoplasms/mortality
- Urinary Bladder Neoplasms/pathology
- Urinary Bladder Neoplasms/therapy
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Affiliation(s)
- C Stief
- Urologische Klinik und Poliklinik, Klinikum der Ludwig-Maximilians-Universität, Marchioninistrasse 15, 81377 München.
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Sauer R, Fridrich R, Thiel G, Enderlin F. Zur Differentialdiagnose der Abstoßungsreaktion transplantierter Nieren mit Hilfe nuklearmedizinischer Verfahren. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1229234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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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Sauer R, Fridrich R, Fahrländer H. Zur Diagnostik chronischer Lebererkrankungen mit Hilfe der Radiokolloid-Szintigraphie*. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1229660] [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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Keller U, Grabenbauer G, Kuechler A, Sauer R, Distel L. Technical report: Radiation sensitivity testing by fluorescencein‐situhybridization: how many metaphases have to be analysed? Int J Radiat Biol 2009; 80:615-20. [PMID: 15370973 DOI: 10.1080/09553000410001724568] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE The technique of three-colour fluorescence in-situ hybridization (FISH) is generally regarded as 'gold standard' for detecting chromosomal aberrations. The question was: how many metaphases should be counted to get reliable results? MATERIAL AND METHODS Peripheral blood lymphocytes were irradiated in vitro (2.0 Gy). Metaphase chromosomes (1, 2, 4) were labelled by means of three-colour FISH and chromosomal aberrations (breaks per metaphase [B/M], complex chromosomal rearrangements per metaphase [CCR/M]) were analysed. To evaluate the correlation between the number of metaphases counted and the reliable detection of the rate of break events, B/M and CCR/M were scored using 250-1,000 metaphases in steps of 50 unirradiated cells, and from 50 to 200 metaphases in steps of 10 after 2 Gy. RESULTS Analysing spontaneously occurring aberrations, B/M values based on 500 and 750 counted metaphases agreed well with those B/M values from 1,000 scored metaphases. After counting 150 metaphases after 2 Gy, the confidence interval of B/M values was about 44% smaller and the confidence interval of CCR/M values was about 41% smaller compared with values obtained after counting 100 metaphases. CONCLUSIONS Scoring the number of spontaneous aberrations, reliable results can be obtained after counting 500 metaphases. After 2 Gy, a minimum of 150 metaphases should be analysed.
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Affiliation(s)
- U Keller
- Department of Radiation Oncology, Friedrich-Alexander-University Erlangen-Nuremberg, Universitaetsstr. 27, D-91054 Erlangen, Germany
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Ott OJ, Rödel C, Weiss C, Wittlinger M, St Krause F, Dunst J, Fietkau R, Sauer R. Radiochemotherapy for bladder cancer. Clin Oncol (R Coll Radiol) 2009; 21:557-65. [PMID: 19564101 DOI: 10.1016/j.clon.2009.05.005] [Citation(s) in RCA: 24] [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: 04/06/2009] [Accepted: 05/08/2009] [Indexed: 01/28/2023]
Abstract
Standard treatment for muscle-invasive bladder cancer is cystectomy. Multimodality treatment, including transurethral resection of the bladder tumour, radiation therapy, chemotherapy and deep regional hyperthermia, has been shown to produce survival rates comparable with those of cystectomy. With these programmes, cystectomy has been reserved for patients with incomplete response or local relapse. During the past two decades, organ preservation by multimodality treatment has been investigated in prospective series from single centres and co-operative groups, with more than 1000 patients included. Five-year overall survival rates in the range of 50-60% have been reported, and about three-quarters of the surviving patients maintained their bladder. Clinical criteria helpful in determining patients for bladder preservation include such variables as small tumour size (<5 cm), early tumour stage, a visibly and microscopically complete transurethral resection, absence of ureteral obstruction, and no evidence of pelvic lymph node metastases. On multivariate analysis, the completeness of transurethral resection of a bladder tumour was found to be one of the strongest prognostic factors for overall survival. Patients at greater risk of new tumour development after initial complete response are those with multifocal disease and extensive associated carcinoma in situ at presentation. Close co-ordination among all disciplines is required to achieve optimal results. Future investigations will focus on optimising radiation techniques, including all possibilities of radiosensitisation (e.g. concurrent radiochemotherapy, deep regional hyperthermia), and incorporating more effective systemic chemotherapy, and the proper selection of patients based on predictive molecular makers.
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Affiliation(s)
- O J Ott
- Department of Radiation Oncology, University Hospitals Erlangen, Universitätsstrasse 27, Erlangen, Germany.
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