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De Santis M.,3. Medizinische Abteilung | Albers P.,Universitatsklinikum Dusseldorf | Bokemeyer C.,Universitares Cancer Center Hamburg
Onkologe | Year: 2012

The incidence of bladder cancer in Europe was estimated to be 133,700 cases in 2008 (104,600 males and 29,100 females) corresponding to 6.2 % of tumors in men and 1.9 % in women. The incidence of these tumors has therefore not substantially changed in 5 years (WHO Globocan project 2008). Cisplatin-containing combination chemotherapy has been the standard of care in the treatment of urothelial cancer (UC) since the late 1980s. Gemcitabine/cisplatin, MVAC, high-dose MVAC and the new triplet paclitaxel/cisplatin/gemcitabine are possible treatment options with different toxicity profiles. However, up to 50% of patients are unfit for cisplatin-containing chemotherapy, either due to a poor performance status (PS) and/or impaired renal function or due to co-morbidities that prevent high-volume hydration. These conditions increase with age. There is controversy about the definition of fit or unfit for cisplatin therapy. An international survey revealed five factors to be crucial: decreased PS, renal function impairment, peripheral neuropathy, hearing loss and heart failure. A standard chemotherapy has not yet been established for patients ineligible for cisplatin-based standard chemotherapy. Trials with clearly defined unfit patients or patients with multiple adverse prognostic factors are rare. The first randomized phase II/III trial in this setting compared carboplatin/vinblastin/methotrexate (M-CAVI) and carboplatin/gemcitabine (CG) in patients unfit for cisplatin. Overall survival (OS) was not statistically significantly different between the two treatment regimens with a median OS of 9.3 and 8.1 months for CG and M-CAVI, respectively. Severe acute toxicity was higher for the M-CAVI arm and therefore carboplatin/gemcitabine is the preferred treatment option in cisplatin ineligible patients. © Springer-Verlag Berlin Heidelberg 2012. Source


Langer F.,Universitares Cancer Center Hamburg
Viszeralmedizin: Gastrointestinal Medicine and Surgery | Year: 2013

Background: Venous thromboembolism (VTE), a composite of deep vein thrombosis and pulmonary embolism, is a preventable cause of morbidity and mortality in surgical patients. Method: National and international treatment guidelines and major clinical trials on mechanical or pharmacological VTE prophylaxis in surgical patients were reviewed. Results: The risk of perioperative VTE is dependent on patient-and surgery-related risk factors. Based on a thorough and individualized risk assessment, each surgical patient should be assigned a low, intermediate, or high risk of VTE. Whereas basic (e.g. early mobilization and avoidance of dehydration) and mechanical (i.e. graduated compression stockings) measures are appropriate for most low-risk patients, visceral surgical patients at intermediate or high risk of VTE should receive pharmacological thromboprophylaxis for at least 7-10 days. The risk of VTE should be balanced against the risk of bleeding. Low-molecular-weight heparin (LMWH) offers several advantages over lowdose unfractionated heparin and should be administered for prolonged periods in patients undergoing particularly high-risk (i.e. cancer) surgery. Conclusion: Perioperative VTE prophylaxis should be carried out in an individualized and risk-adapted manner. In visceral surgical patients with a moderate-to-high risk of VTE and a low risk of bleeding, pharmacological thromboprophylaxis with LMWH is a standard of care. © 2013 2013 S. Karger GmbH, Freiburg. Source


Approximately one third of patients with colorectal cancer (CRC) present with metastases confined to the liver only. In 15 % of these patients the metastases are primarily resectable. After resection of colorectal liver metastases the 5-year survival rate is 25 - 40 %. The EORTC trial of Nordlinger et al. has examined the role of perioperative/neoadjuvant chemotherapy of resectable liver metastases and found in the subgroup of resected patients a significant improvement in disease-free survival through chemotherapy. The results were not significant in the intent-to-treat population. Possible arguments pro neoadjuvant therapy of resectable liver metastases are the early eradication of disseminated tumour cells, the identification of a worse prognosis tumour biology in the individual patient and the higher dose density which can be achieved preoperatively versus postoperatively. Arguments against preoperative chemotherapy are the chemotherapy-induced hepatotoxicity and related increase in perioperative morbidity, the risk of achieving a complete remission of lesions which then cannot be detected intraoperatively and the uncertain optimal duration of chemotherapy. Especially surgical oncologists in Germany do not consider the neoadjuvant treatment of resectable liver metastases as a standard of care. In summary, because of the lack of level 1 evidence, patients with resectable liver metastases of colorectal cancer should be discussed within interdisciplinary tumour boards together with surgeons, gastroenterologists and medical oncologists. Potentially, overall survival data of the EORTC trial which is expected for late 2010 could change the level of evidence. © Georg Thieme Verlag KG Stuttgart · New York. Source


Schilling G.,Universitares Cancer Center Hamburg | Arnold D.,Universitares Cancer Center Hamburg
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz | Year: 2012

Multimodal treatment modalities enable an increasing number of patients with malignant diseases to become candidates for a cu-ratively intended treatment strategy. Furthermore, for numerous patients with incurable cancer disease, new therapeutic developments (including molecular "target-ed" agents) allow control of further progression of tumor growth for months up to years - and therefore, even those patients may be regarded as having a "chronic" disease. Taken together, both patient groups increase the number of "long-term cancer survivors" markedly. However, complex interdisciplinary therapeutic strategies and the increasing number of options for sequential treatments also result in higher rates of acute and chronic toxicities and sequelae. Even years after completion of the initial treatment, many cancer survivors still suffer from sequelae of both malignant disease and therapy. This refers to both psychosocial and somatic involvement. In consequence, a focus of (future) oncology care - beyond successful oncology treatment rates - is to carefully investigate the somatic and psychosocial aspects of long-term sequelae in order to treat them, or - using appropriate preventative measures - to limit or even prevent their occurrence. © Springer-Verlag 2012. Source


Langer F.,Universitares Cancer Center Hamburg
Hamostaseologie | Year: 2015

The clinical link between cancer and thrombosis has been recognized by Armand Trousseau in 1865. It has become clear that activation of coagulation and fibrinolysis plays an important role not only in the pathophysiology of Trousseau's syndrome, but also in the progression of solid malignancies. In particular, tissue factor is critical for both primary tumour growth and haematogenous metastasis. Haemostatic perturbations in cancer patients are, at least in part, controlled by defined genetic events in molecular tumourigenesis, including activating and inactivating mutations of oncogenes and tumour suppressor genes, respectively. While long-term treatment with low-molecular-weight heparin (LMWH) is considered standard therapy for established venous thromboembolism (VTE), pharmacological VTE prophylaxis in ambulatory cancer patients and the management of complex systemic coagulopathies remain a challenge and have to be decided on an individual basis and in a risk-adapted manner. Experimental and preclinical studies further suggest that LMWH may be beneficial in cancer therapy, but this innovative concept has not yet been proven beyond doubt in rigorously designed clinical trials. © Schattauer 2015. Source

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