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  • 1
    Language: English
    In: Cancer, 01 October 1993, Vol.72(7), pp.2219-2223
    Description: : The clinical course of uveal melanoma differs greatly from that of cutaneous melanoma. : Twenty‐four patients with metastatic uveal melanoma (13 men and 11 women; median age at diagnosis, 56 years [range, 17–67 years]) were evaluated retrospectively. : Main sites of metastases were liver (87%), lung (46%), bone (29%), and skin (17%). Median relapse‐free survival time was 36 months (range, 5–240 months). Median survival time after clinical detection of metastases was 9 months (range, 1–54 months). Relapse‐free survival time was significantly greater in patients 50 years of age or younger. After manifestation of metastases, the clinical course was more favorable in patients in whom the liver was either not involved at all or not among the first sites of dissemination. These patients had a median survival time of 19 months, compared with 7 months for patients in whom the liver was involved initially. First‐line systemic treatment of metastatic disease yielded three cases of stable disease lasting 6–14 months, but no complete or partial response. Three patients received intraarterial liver perfusion as first‐ or second‐line treatment, resulting in one partial response, which lasted 6 months. : Treatment and prognosis results of patients with metastatic uveal melanoma were poor, especially when the disseminated to the liver; survival time of approximately 9 months can be expected.
    Keywords: Uveal Melanoma ; Intraocular Tumor ; Tumor Of The Eye ; Liver Metastasis
    ISSN: 0008-543X
    E-ISSN: 1097-0142
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  • 2
    Language: English
    In: Drugs, 2002, Vol.62(14), pp.2025-2038
    Description: Modern treatment of premenopausal breast cancer is based on well-established prognostic and predictive factors for disease outcome such as nodal status, hormone receptor expression, tumour size, tumour grading and patient age. The development of strategies according to such individual risk profiles has resulted in significant improvements both in overall and disease-free survival. An abundant number of new prognostic and predictive factors in addition to those already mentioned may help to increase our understanding of the biology of breast cancer and to individualise therapy in premenopausal patients. Although less than 10% of patients directly benefit, it is estimated that approximately each year the life of more than 4000 women in Germany will be saved or prolonged by adjuvant treatment. Whether dose intensive modifications and new antineoplastic drugs can improve disease outcome will be clarified when ongoing studies have increased observation time. At present, hormone ablation via surgical, radiotherapeutical or drug-induced castration in addition to selective estrogen response modifiers (SERM), such as tamoxifen, with or without chemotherapy remains the cornerstone of adjuvant treatment in premenopausal patients with breast cancer. In advanced disease, new highly effective hormonal and other target-oriented antineoplastic agents with few adverse effects have been recently introduced. However, overall survival in metastatic disease remains poor, even when intensive or high-dose chemotherapy is used. Special attention must be given to longer follow up and potential toxic long-term adverse effects of therapy when new regimens are applied in clinical trials.
    Keywords: Antineoplastic Agents, Hormonal -- Pharmacology ; Breast Neoplasms -- Drug Therapy ; Premenopause -- Drug Effects;
    ISSN: 0012-6667
    E-ISSN: 1179-1950
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  • 3
    Language: English
    In: Pain, 2000, Vol.84(1), pp.105-109
    Description: Opioid-related constipation is one of the most frequent side effects of chronic pain treatment. Enteral administration of naloxone blocks opioid action at the intestinal receptor level but has low systemic bioavailability due to marked hepatic first-pass metabolism. The aim of this study was to examine the effects of oral naloxone on opioid-associated constipation in an intraindividually controlled manner. Twenty-two chronic pain patients with oral opioid treatment and constipation were enrolled in this study. Constipation was defined as lack of laxation and/or necessity of laxative therapy in at least 3 out of 6 days. Laxation and laxative use were monitored for the first 6 days without intervention (‘control period’). Then, oral naloxone was started and titrated individually between 3×3 to 3×12 mg/day depending on laxation and withdrawal symptoms. After the 4-day titration period, patients were observed for further 6 days (‘naloxone period’). The Wilcoxon signed rank test was used to compare number of days with laxation and laxative therapy in the two study periods. Of the 22 patients studied, five patients did not reach the ‘naloxone period’ due to death, operation, systemic opioid withdrawal symptoms, or therapy-resistant vomiting. In the 6 day ‘naloxone’ compared to the ‘control period’, the mean number of days with laxation increased from 2.1 to 3.5 ( P 〈0.01) and the number of days with laxative medication decreased from 6 to 3.8 ( P 〈0.01). The mean naloxone dose in the ‘naloxone period’ was 17.5 mg/day. The mean pain intensity did not differ between these two periods. Moderate side effects of short duration were observed in four patients following naloxone single dose administrations between 6 and 20 mg, resulting in yawning, sweating, and shivering. Most of the patients reported mild or moderate abdominal propulsions and/or abdominal cramps shortly after naloxone administration. All side effects terminated after 0.5–6 h. This controlled study demonstrates that orally administered naloxone improves symptoms of opioid associated constipation and reduces laxative use. To prevent systemic withdrawal signs, therapy should be started with low doses and patients carefully monitored during titration.
    Keywords: Oral Naloxone ; Opioid-Associated Constipation ; Medicine
    ISSN: 0304-3959
    E-ISSN: 1872-6623
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  • 4
    Language: English
    In: Oncology Research and Treatment, March 2008, Vol.31(3), pp.85-89
    Description: Background: Oncology is a resource-intensive medical discipline where, so far, effectiveness rather than efficiency of a treatment has stood in the foreground. The aim of our study was, therefore, to determine the resource allocation and to assess the efficiency of oncology in Germany for the period of 2002–2004. Materials and Methods: With the aid of the official German Health Report, the expenditures for health in 2004 and the gain in years of life according to ICD 10 disease categories were analyzed. Based on the incremental costs and years of life gained, the cost calculation per year of life gained was made. Results: Malignant neoplasms appear in 5th place in health expenditures at a cost of 15 billion 1. With costs per year of life gained of 140,750 1, malignant neoplasms range ahead of respiratory diseases (52,500 1)digestive diseases (27,455 1), and injuries (14,538 1). Costs involving malignant neoplasm per year of life gained range between 39,000 1(malignancies of the lip, oral cavity, and the pharynx), and 126,000 1(digestive organ cancer). Conclusion: In Germany, oncology incurs higher costs per year of life gained as compared to several other diseases. Also, in malignant neoplasm considerable differences can be observed regarding resource allocation and efficiency.
    Keywords: Original Article · Originalarbeit ; Resource Allocation ; Years of Life Gained ; Cost-Effectiveness Analysis ; Costs of Illness ; Medicine
    ISSN: 2296-5270
    ISSN: 0378584X
    E-ISSN: 2296-5262
    E-ISSN: 14230240
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  • 5
    Book chapter
    Book chapter
    Berlin, Heidelberg: Springer Berlin Heidelberg
    Language: German
    In: Die Onkologie, pp.346-361
    Description: Krebs führte nach Schätzungen der WHO im Jahre 2002 weltweit zu 7,1 Mio. Todesfällen. Mehr als die Gesamtzahl von 5,6 Mio. Todesfällen an HIV/Aids/Malaria und Tuberkulose (WHO 2003). In Deutschland besteht kein nationales Cancer-Control-Programm. Beispiele sind in Dänemark, Norwegen, Großbritannien, Frankreich, Kanada und Chile realisiert. Wahrscheinlich werden etwa 80% aller Tumorerkrankungen durch exogene Faktoren verursacht. Diese Schätzung beruht hauptsächlich auf retrospektiven epidemiologischen Assoziations- und Korrelationsstudien. Durch solche Studien wurde beispielsweise der Zusammenhang zwischen Tabakkonsum und der Entstehung des Bronchialkarzinoms sowie verschiedener anderer Tumorerkrankungen gesichert. Umgekehrt ergaben sich nur für wenige Tumorlokalisationen (Gastrointestinaltrakt, Brust, Prostata) Hinweise für hereditäre Tumorursachen (Lichtenstein et al. 2000). Ergebnisse prospektiv geplanter Interventionsstudien mit klarem aussagefähigem Endpunkt liegen nur begrenzt vor. In einigen dieser Interventionsstudien konnte durch eine definierte Nahrungszusammensetzung (Obst/ Gemüse) und durch die Applikation von Nahrungsmitteladditiva (Vitamine/Mineralien) die Tumorinzidenz und -mortalität statistisch signifikant reduziert werden. In chemopräventiven Studien mit Anwendung pharmakologischer Substanzen (z. B. Retinoide) ist dies bislang nicht zweifelsfrei gelungen. Ebenfalls problematisch ist die Abschätzung der individuellen Risikokonstellation für die Entstehung einer bestimmten Tumorerkrankung.
    Keywords: Medicine & Public Health ; Oncology ; Radiotherapy ; Internal Medicine ; Hematology ; Pathology ; Surgery ; Medicine
    ISBN: 9783540797241
    ISBN: 3540797246
    Source: SpringerLink Books
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  • 6
    Language: German
    In: Medizinische Klinik (Munich, Germany : 1983), 15 June 2002, Vol.97(6), pp.327-34
    Description: Patients with brain metastases from colorectal cancer are supposed to have the lowest median survival compared to other locations of metastases from this cancer. Patients with brain metastases usually receive highly palliative treatment and are excluded from studied investigating new therapeutic concepts.... Between November 1996 and October 2000, 13 out of 113 patients from our clinic with colorectal cancer had brain metastases (11.5%). We describe their heterogeneous clinical course and present a review of the literature. The median survival time after the diagnosis of brain metastases was 9.0 months for all patients, less than 1 month for three patients who received only supportive care, 40 months for a patient who was treated with radiosurgical resection, 3 months for two patients who received whole brain radiation,... The clinical course of our 13 patients varied significantly. Thus, patients with brain metastases of colorectal cancer may profit from modern multimodal therapeutic concepts. A therapeutic nihilism should be avoided.
    Keywords: Brain Neoplasms -- Secondary ; Colorectal Neoplasms -- Therapy
    ISSN: 0723-5003
    Source: MEDLINE/PubMed (U.S. National Library of Medicine)
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  • 7
    Language: German
    In: Medizinische Klinik, 2002, Vol.97(6), pp.327-334
    Description: Hintergrund: Die Überlebenszeit nach Auftreten zerebraler Metastasen bei kolorektalen Karzinomen wird aufgrund der bisher vorliegenden Literatur meist als äußerst gering eingeschätzt. Dies führt dazu, dass Patienten, wenn überhaupt, hoch palliativen Therapiekonzepten zugeführt und aus Studienprotokollen im Allgemeinen ausgeschlossen werden. Jedoch gibt es zunehmend Berichte über Krankheitsverläufe, bei denen durch Anwendung moderner multimodaler Therapiekonzepte ein Überleben erreicht werden kann, das dem anderer Metastasierungslokalisationen bei Patienten mit kolorektalen Karzinomen entspricht. In unserer Klinik wurden zwischen November 1996 und Oktober 2000 113 Patienten mit metastasiertem kolorektalen Karzinom behandelt. Bei 13 Patienten wurden durch CT- und/oder MRT-Untersuchungen zerebrale Metastasen nachgewiesen. Anhand dieser 13 Patienten wird der heterogene Verlauf nach Diagnose der zerebralen Metastasierung kolorektaler Karzinome dargestellt. Die mittlere Überlebenszeit beträgt derzeit 9,0 Monate (Spanne 1–40 Monate), fünf Patienten leben mit Krankheitszeichen. Zwischen Resektion des kolorektalen Karzinoms und Diagnose der zerebralen Metastasen lagen durchschnittlich 26,5 Monate. Lediglich bei einer Patientin erfolgte die Exstirpation einer parietal gelegenen Metastase vor Kenntnis des Primärtumors. Die Gruppe der neurochirurgisch operierten sieben Patienten erreichte bisher eine Überlebenszeit von 10,4 Monaten bei vier noch lebenden Patienten. Zwei Patienten, bei denen eine Ganzhirnbestrahlung durchgeführt wurde, lebten jeweils 3 Monate. Ein Patient weist nach stereotaktischer Bestrahlung die in dieser Untersuchung ermittelte, bislang längste Überlebenszeit von 40 Monaten auf. Bei den drei Patienten, die lediglich supportiven Maßnahmen zugeführt wurden, lag die Überlebenszeit unter 1 Monat. Bei unseren Patienten mit zerebralen Metastasen von kolorektalen Karzinomen zeigte sich ein heterogener klinischer Verlauf. Die Überlebenszeit der Patienten ist durch multimodale Therapiekonzepte quantitativ und qualitativ beeinflussbar. Mehrjährige Langzeitverläufe stellen keine Seltenheit dar. Dies ist in Übereinstimmung mit neueren Literaturangaben. Patients with brain metastases from colorectal cancer are supposed to have the lowest median survival compared to other locations of metastases from this cancer. Patients with brain metastases usually receive highly palliative treatment and are excluded from studies investigating new therapeutic concepts. However, there appears to be a subgroup of patients with brain metastases originating from colorectal cancer who have a median survival comparable to that of other metastatic sites. Between November 1996 and October 2000, 13 out of 113 patients from our clinic with colorectal cancer had brain metastases (11.5%). We describe their heterogeneous clinical course and present a review of the literature. The median survival time after the diagnosis of brain metastases was 9.0 months for all patients, less than 1 month for three patients who received only supportive care, 40 months for a patient who was treated with radiosurgical resection, 3 months for two patients who received whole brain radiation, and 10.4 months for seven patients who underwent surgical resection. The median interval between the diagnosis of primary cancer and the diagnosis of brain metastases was 26.5 months (2–84). In one case brain metastasis was the initial manifestation of colorectal cancer. Five patients are still alive with a survival time between 6–40 months. The clinical course of our 13 patients varified significantly. Thus, patients with brain metastases of colorectal cancer may profit from modern multimodal therapeutic concepts. A therapeutic nihilism should be avoided.
    Keywords: Key Words: Brain metastases ; Cerebral metastases ; Colorectal cancer ; Whole brain radiation ; Neurosurgical resection
    ISSN: 0723-5003
    E-ISSN: 2193-6226
    E-ISSN: 16156722
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  • 8
    Language: English
    In: Journal of Cancer Research and Clinical Oncology, 2000, Vol.126(7), pp.412-417
    Description: In patients with diabetes mellitus, contradictory results have been reported indicating both increased and reduced risks of malignancies. In the present trial all insulin-treated diabetic patients ( n  = 2720) attending our centre since 1995 were studied. Of these patients, 28 (type 1/type 2: n  = 1/27, 23 women) developed malignancies during insulin therapy: 11 patients developed cancer of the breast, 4 patients cancer of the pancreas, 3 patients cancer of the kidneys and 10 patients developed other malignancies. The characteristics of these patients [mean ± SD (range)] were as follows: age 68.8 ± 8.6 (52.0–87.0) years, diabetes duration 13.1 ± 8.1 (0.5–29.0) years, duration of insulin therapy at the time of the diagnosis of malignancy 4.3 ± 5.7 (0.5–24.0) years, insulin dosage 0.67 ± 0.43 (0.11–1.72) IU/kg body weight, mean HbA1c 9.6 ± 1.9 (6.8–14.9)% (HPLC, Diamat, normal range 4.4%–5.9%). The prevalences of nephropathy, retinopathy (non-proliferative: n  = 7) and peripheral neuropathy were 35.7%, 25.0% and 46.4% respectively. When the features of the 27 patients with type 2 diabetes were compared with the characteristics of the type 2 diabetic patients ( n  = 117, 63 women) studied in a population-based survey of insulin-treated diabetic patients, also performed in the area of Jena [JEVIN; Schiel R et al. (1997a)] there were no significant differences in the duration of insulin therapy (JEVIN: 4.7 ± 4.3 years, P  = 0.64), insulin dosage (JEVIN: 0.55 ± 0.27 IU/kg body weight, P  = 0.08), mean HbA1c (JEVIN: 9.0 ± 2.1%, P  = 0.16) and the prevalences of long-term complications of diabetes. The quality of diabetes control in insulin-treated patients suffering from malignancies is comparable to that of a selection-free population of diabetic patients. Furthermore, in comparison to non-diabetic subjects our diabetic patients showed no altered risk for malignancies as a function of insulin dosage, the duration of diabetes or insulin therapy, the quality of diabetes control or the prevalence of long-term complications of the disease.
    Keywords: Key words Type 1 diabetes mellitus ; Type 2 diabetes mellitus ; Cancer ; Neoplasia ; HbA1c ; Nephropathy ; Retinopathy ; Peripheral neuropathy
    ISSN: 0171-5216
    E-ISSN: 1432-1335
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  • 9
    Language: English
    In: Journal of Cancer Research and Clinical Oncology, 1999, Vol.125(11), pp.637-640
    Description: The authors report that 4 out of a series of 56 patients (7.1%) treated with gemcitabine developed an unexplained non-cardiogenic pulmonary distress syndrome most likely related to gemcitabine. One further patient developed ventricular arrhythmia immediately after gemcitabine exposure, leading to cardiac arrest. Between 1995 and 1998 56 patients with locally advanced or metastatic carcinoma were treated with gemcitabine. The patients suffered from breast cancer ( n  = 17), pancreatic cancer ( n  = 17), lung cancer ( n  = 12), cancer of unknown primary ( n  = 5), ovarian cancer ( n  = 2), oral cavity cancer ( n  = 2) and cancer of the bladder ( n  = 1). Their median age was 55 years, and there were 33 female and 23 male patients. Fifteen patients had been pretreated with radiation therapy: 2 had received radiation therapy involving the mediastinum as treatment for non-small-cell lung cancer and cancer of unknown origin respectively, 11 patients had had prior neoadjuvant or adjuvant radiation therapy of the chest wall for breast cancer and 2 patients had received radiation therapy for head/neck cancer. All patients received gemcitabine on days 1, 8 and 15 and this was repeated on day 29 at a dose of 1000 mg/m 2 as a 30-min infusion in 250 ml isotonic NaCl. In 4 patients gemcitabine treatment was combined with cisplatinum, in 7 patients with a somatostatin analogue and in 1 patient with epirubicin. All other patients received gemcitabine as a single agent. We assume that the pulmonary or cardiac toxicity of 5 patients was related to gemcitabine. In 3 patients re-exposure resulted in repeated toxicity. One patient did not receive gemcitabine again because of the life-threatening nature of the primary response. Two patients had received prior radiation to the mediastinum with 62 Gy and 50 Gy respectively, 3 years and 1 year before gemcitabine application. In our experience pulmonary toxicity after gemcitabine treatment is more common than initially anticipated. Gemcitabine should be used with caution in patients who have received prior radiation to the mediastinum.
    Keywords: Key words Gemcitabine ; Toxicity ; Radiotherapy ; 2′ ; 2′-Difluorodeoxycytidine
    ISSN: 0171-5216
    E-ISSN: 1432-1335
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  • 10
    Language: English
    In: Journal of Cancer Research and Clinical Oncology, 2003, Vol.129(6), pp.361-366
    Description: To determine the feasibility, time to progression, and event-free survival, twenty-two women with metastatic breast cancer received two cycles of high-dose chemotherapy (HDCT) followed by peripheral blood stem cell transplantation (PBSCT) early after first-line induction chemotherapy. The median age of the ten (45.5%) pre- and 12 (54.5%) postmenopausal women was 48 (range: 33–60) years. Sixteen patients (72.7%) had at least two or more metastatic sites involved. Protocol induction and mobilization chemotherapy including granulocyte-colony stimulating-factor (G-CSF) consisted of two cycles with adriamycin (60 mg/m 2 ) i.v. and paclitaxel (200 mg/m 2 ) i.v. After collection of at least 4×10 6 /kg bodyweight peripheral blood stem cells, the first HDCT-course of adriamycin (60 mg/m 2 ), paclitaxel (200 mg/m 2 ) cyclophosphamide (4 g/m 2 ), and thiotepa (800 mg/m 2 ) (ATCT) was given to at least stable disease (SD) patients. Six to eight weeks later, the second HDCT-ATCT was administered. Each HDCT-cycle was followed by PBSCT with a median of 3.81×10 6 /kg bodyweight CD-34 positive cells (range: 1.85–10.38). All women showed median leukocyte engraftment (〉1,000×10 9 /l) on day +9.4 (range: 7–13) and median platelet engraftment (〉20,000×10 9 /l) on day +12.3 (range: 8–15). There were no apparent differences in the clinical course and non-hematologic toxicity between the two HDCT-cycles. Of the 21 patients evaluable for response, eight (38.1%) patients achieved complete remission (CR), ten (47.6%) patients showed a partial remission (PR), two patients (9.5%) no change, and one patient (4.8%) progressive disease. After a median observation time of 36 (range 28–55) months, six (28.6%) women are alive, four (19.0%) of them in continuous CR, including two women with stable bone lesions, respectively, and 15 (71.4%) died due to progressive disease. Median time to progression (TTP) was 8 (range 4–19) months. A high initial response rate of early HDCT, including the most active drugs adriamycin and paclitaxel, can be achieved with tolerable toxicity in metastatic breast cancer. New approaches for maintaining primary tumor response achieved with efficacious high-dose chemotherapy are warranted.
    Keywords: Metastatic breast cancer ; High-dose chemotherapy ; Adriamycin ; Paclitaxel ; Autologous stem cell transplantation
    ISSN: 0171-5216
    E-ISSN: 1432-1335
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