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Jackisch C.,Klinik fur Gynakologie und Geburtshilfe | Harbeck N.,Ludwig Maximilians University of Munich | Huober J.,Universitatsfrauenklinik Ulm | Von Minckwitz G.,Universitats Klinikum Frankfurt and Senologische Onkologie | And 21 more authors.
Breast Care | Year: 2015

The key topics of this year's 14th St. Gallen Consensus Conference on the diagnosis and therapy of primary breast cancer were again questions about breast surgery and axillary surgery, radio-oncology and systemic therapy options in consideration of tumor biology, and the clinical application of multigene assays. This year, the consensus conference took place in Vienna. From a German perspective, it makes sense to substantiate the results of the vote of the international panel representing 19 countries in light of the updated national therapy recommendations of the AGO (Arbeitsgemeinschaft Gynäkologische Onkologie). Therefore, 14 German breast cancer experts, 3 of whom are members of the International St. Gallen Panel, have commented on the voting results of the St. Gallen Consensus Conference 2015 in relation to clinical routine in Germany. © 2015 S. Karger GmbH, Freiburg.

Beckmann M.W.,Frauenklinik des Universitatsklinikums Erlangen | Schlieter H.,TU Dresden | Richter P.,TU Dresden | Wesselmann S.,Deutsche Krebsgesellschaft e.V.
Geburtshilfe und Frauenheilkunde | Year: 2016

Medical guidelines have become established as the standard for the comprehensive synopsis of all available information (scientific trials, expert opinion) on diagnosis and treatment recommendations. The transfer of guidelines to clinical practice and subsequent monitoring has however proven difficult. In particular the potential interaction between guideline developers and guideline users has not been fully utilised. This review article analyses the status quo and existing methodological and technical information solutions supporting the guideline life cycle. It is shown that there are numerous innovative developments that in isolation do not provide comprehensive support. The vision of the "Living Guidelines 2.0" is therefore presented. This outlines the merging of guideline development and implementation on the basis of clinical pathways and guideline-based quality control, and building on this, the generation of information for guideline development and research. © Georg Thieme Verlag KG.

Dorr H.G.,Universitatsklinikum Erlangen Nurnberg | Binder G.,University of Tubingen | Reisch N.,Ludwig Maximilians University of Munich | Gembruch U.,University of Bonn | And 3 more authors.
Geburtshilfe und Frauenheilkunde | Year: 2015

Purpose: This guideline of the German Society of Pediatric Endocrinology and Diabetology (DGKED) is designed to be experts opinion on the current concept of prenatal therapy for congenital adrenal hyperplasia due to 21-hydroxylase deficiency (CAH). Several scientific medical societies have also participated in the guideline. It aims to offer guidance to physicians when they counsel affected families about prenatal therapy. Methods: The experts commissioned by the medical societies developed a consensus in an informal process. The consensus was subsequently confirmed by the steering committees of the respective medical societies. Recommendations: Prenatal CAH therapy is an experimental therapy. We recommend designing and using standardized protocols for the prenatal diagnosis, therapy and long-term follow-up of women and children treated prenatally with dexamethasone. If long-term follow-up is not possible, then prenatal therapy should not be performed. © Georg Thieme Verlag KG Stuttgart New York.

Von Minckwitz G.,C o GBG Forschungs GmbH | Von Minckwitz G.,Universitats Frauenklinik Frankfurt | Schmitt W.D.,Charite University Hospital | Loibl S.,C o GBG Forschungs GmbH | And 18 more authors.
Clinical Cancer Research | Year: 2013

Purpose: The value of Ki67 measured on residual disease after neoadjuvant chemotherapy is not sufficiently described. Experimental Design: Participants of the GeparTrio study with primary breast cancer randomly received neoadjuvant response-guided [8 cycles TAC (docetaxel/doxorubicin/cyclophosphamide) in responding and TAC-NX (vinorelbine/capecitabine) in nonresponding patients] or conventional (6 cycles TAC) chemotherapy according to interim response assessment. Ki-67 levels were centrally measured immunohistochemically after neoadjuvant treatment if tumor tissue was available. Here, we analyze 1,151 patients having a pathologic complete response (pCR; n, 484), or residual disease with low (0-15%), intermediate (15.1-35%), or high (35.1-100%) posttreatment Ki67 levels in 488, 77, and 102 patients, respectively. Results: Patients with high posttreatment Ki67 levels showed higher risk for disease relapse (P < 0.0001) and death (P < 0.0001) compared with patients with low or intermediate Ki67 levels. Patients with low Ki67 levels showed a comparable outcome to patients with a pCR (P = 0.211 for disease-free and P = 0.779 for overall survival). Posttreatment Ki67 levels provided more prognostic information than pretreatment Ki67 levels or changes of Ki67 from pre- to posttreatment. Information on pCR plus posttreatment Ki67 levels surmount the prognostic information of pCR alone in hormone-receptorpositive disease [hazard ratios (HR), 1.82-5.88] but not in hormone-receptor-negative disease (HR: 0.61-1.73). Patients with conventional and response-guided treatment did not show a different distribution of posttreatment Ki67 (P = 0.965). Conclusions: Posttreatment Ki67 levels provide prognostic information for patients with hormone-receptor-positive breast cancer and residual disease after neoadjuvant chemotherapy. Levels were not prognostic for outcome after response-guided chemotherapy. High posttreatment Ki67 indicates the need for innovative postneoadjuvant treatments. © 2013 American Association for Cancer Research.

Kummel S.,Knappschaft GmbH | Kolberg H.C.,Klinik fur Gynakologie und Geburtshilfe | Luftner D.,Medizinische Klinik und Poliklinik II | Lux M.P.,Frauenklinik des Universitatsklinikums Erlangen | And 6 more authors.
Geburtshilfe und Frauenheilkunde | Year: 2011

The treatment options for primary and metastatic breast cancer patients as well as the characteristics considered for therapy decision continue to become more diverse. New target therapies in combination with established chemotherapy regimens extend the range, however, potentially promising combinations do not always result in a benefit for the patient. Latest pharmacogenomics results hint towards prognosis and predictive factors, which do not only focus on the individual properties of the tumor, they also consider the hereditary genetics of the patient. As a result, state of the art therapy decision includes classical clinical as well as modern molecular biomarkers, however, pharmacoeconomic aspects continue to increase in importance in physicians' treatment algorithms. This review builds on the recent congresses, which present new data on the treatment of breast cancer. The last included one is the Annual Meeting of the American Society of Clinical Oncology (ASCO) 2011. © Georg Thieme Verlag KG Stuttgart - New York.

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