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Steinau an der Straße, Germany

Gobel H.,Tumorzentrum | Stier A.,Klinikfur Allgemein und Viszeralchirurgie | Barwitzki D.,Institute For Qualitatsmanagement Und Organisationsentwicklung | Herold M.,Medizinische Klinik
Onkologe | Year: 2012

Defining an interdisciplinary therapeutic concept is the cornerstone of a tumor board. If integrated within a cancer centre, each department can easily participate in the tumor board to allow a consensus treatment concept regardless of the treating physician. Creating a longstanding interdisciplinary approach is the only guarantee to enable individualized therapy on the basis of currently valid and scientifically verified tumor therapies. However, being a general hospital (university associated teaching hospital providing major medical care) the HELIOS Clinic in Erfurt had to face a substantial challenge in undergoing the process of certification for these oncological standards by the German Oncological Society. This procedure involved not onlya reviewof current decisional and therapeutic structures but even more the optimization and development of new patient pathways, therapeutic algorithms and future partnerships. Besides documenting structural quality it is highly important to verify treatment outcome. Treatment outcome, quality and follow-up effectiveness can only be measured by a longstanding cooperation with a clinical cancer registry which is the basis for patient-oriented scientific research. © Springer-Verlag 2012.

Kramer M.W.,Klinik fur Urologie und Urologische Onkologie | Heinisch A.,Klinik fur Urologie und Urologische Onkologie | Wegener G.,Tumorzentrum | Abbas M.,Institute For Pathologie | And 6 more authors.
Urologe - Ausgabe A | Year: 2014

Background. Numerous studies have shown a positive correlation between elevated C-reactive protein (CRP) and systemic spread of malignancies. The goal of the current study was to assess the predictive significance of preoperative CRP in patients undergoing radical cystectomy (RC). Material and methods. Preoperative CRP values were measured in 194 patients undergoing RC because of urothelial carcinoma between 1996 and 2005. Elevated CRP level was defined as ≥5 mg/l. Results. Preoperative increased CRP values were detected in 89 (45.9%) patients and these patients were more likely to have advanced tumor stages (pT3-4), positive resection margins and positive lymph nodes. Advanced urinary diversions were more common in patients with normal CRP values. In multivariate analysis, CRP was identified as an independent prognostic indicator for poor cancer-specific survival. Conclusion. The results confirm previous reports that showed a prognostic significance of preoperative CRP elevation. © Springer-Verlag 2013.

Waalkes S.,Klinik fur Urologie und Urologische Onkologie | Eggers H.,Klinik fur Urologie und Urologische Onkologie | Rustemeier J.,Universitatsklinikum Marburg | Wegener G.,Tumorzentrum | And 6 more authors.
Urologe - Ausgabe A | Year: 2011

Objectives: Obesity increases the risk of developing renal cell carcinoma (RCC). We assessed whether different body mass index (BMI) levels and the body surface area (BSA) at the time of surgery had an effect on aggressiveness and long-term prognosis of RCC. Methods: The study included 1,595 RCC patients with complete information about their BMI who had undergone surgery for renal cell cancer at the University Hospitals in Hannover (MHH) and Marburg between 1990 and 2005. The mean follow-up was 5.0 years. Results: A higher BMI and a higher than average BSA were significantly associated with younger age. A high BMI value was additionally related to a lower tumor grade, the clear cell histological subtype, and metastasis at the time of diagnosis. Overweight patients had a significantly lower risk of cancer-related death; their median 5-year tumor-specific survival rate was 76.9% (BMI>30) and 72.6% (BMI 25-30) as opposed to 63.5% for patients with a BMI below 25 (p<0.001). However, the positive correlation between a high BMI and tumor-specific survival could be confirmed in multivariable analyses for localized clear cell RCC only. Conclusion: We identified BMI as an independent prognostic marker of improved cancer-specific survival in patients with RCC, particularly with organ-confined clear cell cancer. © Springer-Verlag 2011.

Gautschi O.,Tumorzentrum | Stadelmann C.,Tumorzentrum | Aebersold-Keller F.,Tumorzentrum | Konig K.,University of Cologne | And 15 more authors.
Oncology Research and Treatment | Year: 2015

Background: The role of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKI) in the treatment of patients with advanced non-small cell lung cancer (NSCLC) and unknown EGFR mutation status has recently been questioned. Patients and Methods: We conducted a retrospective study of patients with unknown EGFR mutation status and long-term response (LTR) to gefitinib in the Swiss Iressa expanded access program (EAP). We assessed patient characteristics, and performed Sanger sequencing and next generation sequencing on archived tumor tissue. We hypothesized that EGFR mutations are prevalent in patients with LTR. Results: Of 430 patients in the EAP, 18 (4%) fulfilled our definition of LTR, and 16 of them had archived tumor tissue. Patient characteristics were as expected for age, sex, and smoking history. Median duration of therapy was 38 months (range 24-142 months). Sanger sequencing revealed EGFR exon 18-21 mutations in 6 (38%) of the tumors. Next generation sequencing revealed no further EGFR-mutated cases, but reported in 15 (94%) of the tumors mutations in other genes (ALK, BRAF, DDR2, KEAP1, MET, PTEN, STK11) previously associated with NSCLC. Conclusion: Larger studies are needed to define the prognostic values of different driver mutations in patients with NSCLC. © 2015 S. Karger GmbH, Freiburg.

Gautschi O.,Tumorzentrum | Milia J.,University Paul Sabatier | Cabarrou B.,Institute Claudius Regaud | Bluthgen M.-V.,Institute Gustave Roussy | And 21 more authors.
Journal of Thoracic Oncology | Year: 2015

Introduction: Approximately 2% of lung adenocarcinomas have BRAF (v-Raf murine sarcoma viral oncogene homolog B) mutations, including V600E and other types. Vemurafenib, dabrafenib, and sorafenib as BRAF inhibitors are currently tested in clinical trials, but access for patients is limited. The aim of this study was to document the clinical course of patients treated outside of clinical trials. Methods: We conducted a retrospective multicenter cohort study in Europe of patients with advanced BRAF-mutant lung cancer treated with known BRAF inhibitors. Data were anonymized and centrally assessed for age, gender, smoking, histology, stage, local molecular diagnostic results, systemic therapies, and survival. Best response was assessed locally by RECIST1.1. Results: We documented 35 patients treated in 17 centers with vemurafenib, dabrafenib, or sorafenib. Median age was 63 years (range 42-85); gender was balanced; 14 (40%) were never smokers; all (100%) had adenocarcinoma; 29 (83%) had V600E; 6 (17%) had other mutations; one of them had a concomitant KRAS mutation. Thirty (86%) patients had chemotherapy in the first line. Overall survival with first-line therapy was 25.3 months for V600E and 11.8 months for non-V600E. Thirty-one patients received one BRAF inhibitor, and four received a second inhibitor. Overall response rate with BRAF therapy was 53%, and disease control rate was 85%. Median progression-free survival with BRAF therapy was 5.0 months, and overall survival was 10.8 months. Conclusions: These results confirm the activity of targeted therapy in patients with BRAF-mutant lung adenocarcinoma. Further trials are warranted to study combination therapies and drug resistance mechanisms. © 2015 by the International Association for the Study of Lung Cancer.

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