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Brookman-May S.,University of Regensburg | Kendel F.,Charite - Medical University of Berlin | Hoschke B.,Carl Thiem Hospital Cottbus | Wieland W.F.,University of Regensburg | And 3 more authors.
Scandinavian Journal of Urology and Nephrology | Year: 2011

Objective. This study evaluated the impact of body mass index (BMI) and the influence of preoperative weight loss (WL) in each BMI category on survival in patients with surgically treated renal cell carcinoma (RCC). Material and methods. In total, 834 patients undergoing nephrectomy for RCC were retrospectively reviewed. Overall survival (OS) and cancer-specific survival (CSS) were estimated by Kaplan-Meier analysis. Univariate and multivariate analyses were accomplished to assess the influence of preoperatively assessed clinical parameters, including BMI and WL, on survival. The mean postsurgical follow-up was 85 months (median 79 months, range 12-191 months). Results. Of the patients studied, 251 (30%) presented with a BMI < 25 kg/m, while 362 patients (44%) were overweight (BMI ≥ 25 to < 30 kg/m) and 221 patients (26%) were obese (BMI ≥ 30 kg/m). Fifty-two patients (6.2%) experienced WL. While BMI did not significantly influence OS and CSS, WL had a significant impact on survival in patients with a BMI < 30 kg/m, in contrast to obese patients presenting with a BMI of ≥30 kg/m. Further analysis showed overweight to influence significantly disorders in wound healing, but neither other complications nor postoperative mortality. Conclusions. This is the first study providing information regarding the influence of BMI in relation to WL in patients with surgically treated RCC. While BMI did not significantly influence the survival of patients in the present series, WL had a significant impact on survival of patients presenting with a BMI < 30 kg/m. Hence, preoperative assessment of WL should be considered for the assessment of individual prognosis. © 2011 Informa Healthcare.

Maurer J.,University of Regensburg | Hipp M.,University of Regensburg | Schafer C.,Hospital St. Elisabeth Straubing | Kolbl O.,University of Regensburg
Strahlentherapie und Onkologie | Year: 2011

Background: In the past, xerostomia was considered one of the most important determining factors of quality of life (QoL) after radiotherapy (RT) of the head and neck region. In addition, more recent studies have shown that RT-induced dysphagia has an essential influence on the QoL. Patients and Methods: Between September 2005 and August 2007, 35 patients with locally advanced squamous cell carcinoma of the head and neck region were included in the prospective study. Patients were treated by IMAT (intensity-modulated arc therapy) or IMRT (intensity-modulated radiotherapy) planned on 3D imaging. A total of 28 patients (80%) received concomitant chemotherapy. The evaluation of QoL (EORTC QLQ - C30, H&N C-35) and toxicities (CTC 2.0) were assessed at the beginning of, during, and after RT as well as up to 12 months after the end of therapy. Results: At the end of therapy, 86% of the patients experienced difficulties in swallowing (62% CTC II-III°). Twelve months after the end of treatment, 15% still suffered from dysphagia CTC II-III°. Concomitant chemotherapy exacerbated the incidence and gravity of dysphagia, resulting in increasing dietary problems. QoL (EORTC) was significantly affected by dysphagia. In particular, the global state of health and QoL were influenced at the end of treatment (p = 0.033) and at a later stage (p = 0.050). Conclusion: The findings of this study suggest that more emphasis should be placed on structured clinical diagnostics, therapy, and rehabilitation of deglutition problems. This means in particular to not only spare the parotids while planning the irradiation, but also to take into consideration the important structures for deglutition, like the retropharyngeal muscles. © 2011 Urban & Vogel.

Maurer J.,University of Regensburg | Schafer C.,Hospital St. Elisabeth Straubing | Maurer O.,University of Regensburg | Kolbl O.,University of Regensburg
Strahlentherapie und Onkologie | Year: 2012

Background. Undergoing radiotherapy is often associated with severe impairment of quality of life in cancer patients. Especially psychosocial aspects like anxiety and depression play a major role. The aim of this study was to closely analyze anxiety and depression during the course of radiotherapy treatment.Methods. A total of 60 patients, who received radiotherapy because of a tumor disease between June 2005 and April 2006, were included in the prospective study; 57 (95%) patients were primarily treated with radiotherapy. In 72% of the cases the intention to treat was curable, in 18% palliative. Anxiety and depression (HADS-D) were assessed at three points in time: before (A) and after (B) radiotherapy treatment (RT), and 6 weeks after finishing RT at the follow-up appointment (C).Results. Before therapy (A), 41% of the treated patients showed positive or marginally positive symptoms of anxiety and 33% symptoms of depression. The symptoms of anxiety significantly decreased during the course of therapy. The proportion of patients with a positive score of anxiety dropped from 16% at the beginning of RT (A) to 9% after the RT (B; p=0.04). In addition, there was an increase in the number of patients who scored negatively with regard to anxiety from 59% (A) to 72% (B; p=0.04). With regard to the median score of anxiety, no statistically significant change (p<0.05) was observed during therapy, while for depression, the number of positively tested patients also decreased significantly during the course of therapy from the beginning of RT (A, 14%) to the first follow-up appointment (C, 9%; p=0.02). Furthermore, the number of negatively tested patients rose by 8% (p=0.02). During the whole course of the study, the median score of depression decreased from 6 (A) to 5 points (C; p=0.01).Conclusion. More than one third of the treated patients suffered from positive or marginally positive symptoms of anxiety and depression. This present study showed a decrease of anxiety and depression symptoms during the course of radiotherapy. © Springer-Verlag 2012.

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