Universitats Frauenklinik Tubingen

Calwer, Germany

Universitats Frauenklinik Tubingen

Calwer, Germany

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Current epidemiologic and economic evaluations make clear the importance of the creation of centers for breast cancer treatment quality. In concrete terms the parameters of structural and procedural improvements demonstrate these improvements. Although a nationwide German network of certified breast cancer treatment centers can already be seen for the most part as complete and acceptance of the benchmarking concept is proven high in the participating centers, there still is a need to optimize the network's possibilities through mammographic screening and interventional diagnostics to postoperative and follow-up care. Continued specialization, procedural guide lining, and certification resp. renewed certification are essential to stabilize the improvements already attained and to optimize breast cancer treatment throughout the whole country. © 2010 Springer-Verlag.


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.


Wallwiener M.,University of Heidelberg | Brucker S.Y.,Universitats Frauenklinik Tubingen | Wallwiener D.,Universitats Frauenklinik Tubingen
Archives of Gynecology and Obstetrics | Year: 2012

Purpose This review summarizes the rationale for the creation of breast centres and discusses the studies conducted in Germany to obtain proof of principle for a voluntary, external benchmarking programme and proof of concept for third-party dual certification of breast centres and their mandatory quality management systems to the German Cancer Society (DKG) and German Society of Senology (DGS) Requirements of Breast Centres and ISO 9001 or similar. In addition, we report the most recent data on benchmarking and certification of breast centres in Germany. Methods Review and summary of pertinent publications. Literature searches to identify additional relevant studies. Updates from the DKG/DGS programmes. Results and conclusions Improvements in surrogate parameters as represented by structural and process quality indicators suggest that outcome quality is improving. The voluntary benchmarking programme has gained wide acceptance among DKG/DGS-certified breast centres. This is evidenced by early results from one of the largest studies in multidisciplinary cancer services research, initiated by the DKG and DGS to implement certified breast centres. The goal of establishing a nationwide network of certified breast centres in Germany can be considered largely achieved. Nonetheless the network still needs to be improved, and there is potential for optimization along the chain of care from mammography screening, interventional diagnosis and treatment through to follow-up. Specialization, guideline-concordant procedures as well as certification and recertification of breast centres remain essential to achieve further improvements in quality of breast cancer care and to stabilize and enhance the nationwide provision of high-quality breast cancer care. © 2012 Springer-Verlag.


Kummel S.,Knappschaft GmbH | Kolberg H.C.,Marienhospital Bottrop | 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.


Lux M.P.,Friedrich - Alexander - University, Erlangen - Nuremberg | Reichelt C.,Novartis | Wallwiener D.,Universitats Frauenklinik Tubingen | Kreienberg R.,Universitatsklinikum Ulm | And 3 more authors.
Onkologie | Year: 2010

Background: The ABCSG-12 trial investigated the efficacy of gonadotropin-releasing hormone (GnRH)analogs in combination with tamoxifen or anastrozole ± zoledronic acid (4 mg, q6m for 3 years) in 1,803 premenopausal women with hormone receptor-positive (HR+) breast cancer. After 48 months of follow-up, there was a 36% improvement in the disease-free survival (DFS) (recurrence-free survival 35%) using zoledronic acid. Based on these data, the costutility of zoledronic acid was calculated for the German healthcare system. Materials and Methods: Costs of surveillance, adverse effects, recurrence, contralateral breast cancer, metastasis, and end-of-life care were determined based on the Einheitlicher Bewertungsmaβstab (EBM 2009) and the diagnosis-related groups (DRG) system. Utilities were surveyed with a questionnaire (n = 95). Estimation of the cost-utility was made by calculating the incremental costeffectiveness ratio (ICER) per quality-adjusted life year (QALY), using a Markov model. Results: Including zoledronic acid as adjuvant therapy for 3 years resulted in total costs of € 2,262. The use of zoledronic acid is dominant when clinical efficacy and quality of life are taken into consideration (- € 45.83/QALY) (95% confidence interval (CI) - € 1,838 to E 2,375; 0.02-0.41 QALY). The sensitivity analyses present with a probability of 90% that the cost per QALY gained are <€ 22,000. Conclusion: In the German healthcare system, zoledronic acid is a cost-effective option for premenopausal patients with HR+ breast cancer. Copyright © 2010 S. Karger AG, Basel.


Dimpfl T.,Klinikum Kassel GmbH | Reisenauer C.,Universitats Frauenklinik Tubingen | Tunn R.,Deutsches Beckenbodenzentrum DBBZ
Gynakologe | Year: 2016

In the largest epidemiological survey on urinary incontinence in women worldwide, 28,000 women were enrolled in the Norwegian EPICONT study and 25 % reported involuntary micturition. The incidence of incontinence was higher with increasing age. The age composition of our population is drastically changing. In 2005, 19 % of the population was older than 65 years and by 2020 this is expected to reach 23 %. The high prevalence of continence and pelvic floor problems in women indicates a key role and a promising potential for the subspecialty urogynecology in healthcare in the near future, similar to that of oncology. Against this background it is evidently crucial to establish the subspecialty urogynecology as the fourth pillar of gynecology in Germany as has already been established in Switzerland and at the European level by the European Board & College of Obstetrics and Gynaecology (EBCOG). © 2016 Springer-Verlag Berlin Heidelberg


Fehm T.,Universitats Frauenklinik Tubingen | Souchon R.,University Hospital of Tuebingen
Onkologe | Year: 2013

Women who present with axillary lymph node metastases and no other distant metastases and no evidence of a breast cancer primary represent a potentially curable subset of individuals with CUP. The standard approach is to perform an axillary lymph node dissection followed by adjuvant systemic treatment and radiotherapy according to published guidelines for lymph node positive primary breast cancer. Mastectomy is not mandatory. In most cases occult breast cancer is associated with good prognosis. Reported 5-year survival rates after treatment of an occult primary breast cancer with axillary metastases range from 60-90%. © 2013 Springer-Verlag Berlin Heidelberg.


Kagan K.O.,Universitats Frauenklinik Tubingen | Goelz R.,University Hospital of Tuebingen | Hamprecht K.,University Hospital of Tuebingen
Gynakologe | Year: 2016

Primary infection with cytomegalovirus (CMV) affects about 0.6 % of all pregnant women. In about 80 % of the cases, these women are asymptomatic. Depending on the gestational age, the maternal–fetal transmission rate raises from 30 to 70 %. At the same time, the rate of postnatal sequelae decreases with increasing gestational age. As a consequence, a CMV infection in the first trimester carries the highest risk for an adverse outcome. Among others, postnatal symptoms of a congenital CMV infection include microcephaly and sensorineural hearing loss and are generally associated with a long-term developmental disorder. Treatment focuses on prevention of transmission. This could be realized by detailed hygiene counseling about the common ways of infection. In case of maternal infection, hyperimmunglobulines (HIG) are often used off-label in Germany to avoid maternofetal transmission. If fetal infection is documented, treatment may also involve the application of HIG or alternatively valaciclovir. © 2016, Springer-Verlag Berlin Heidelberg.


Schaffeler N.,Medizinischen Universitatsklinik Tubingen | Enck P.,Medizinischen Universitatsklinik Tubingen | Riessen I.,Medizinischen Universitatsklinik Tubingen | Seitz D.,Medizinischen Universitatsklinik Tubingen | And 3 more authors.
Zeitschrift fur Psychosomatische Medizin und Psychotherapie | Year: 2010

Objectives: The study explores whether breast-cancer patients who request psychosocial support have higher psychological strain compared to those who do not. We also explored whether scores on HADS-D and PHQ-D identify the same patients as being stressed as well as the relationship between patient's wish for psychological support and psychological strain. Methods: 115 inpatients with breast cancer took part in the screening and were asked if they wanted psychosocial support. Results: Above-normal scores in anxiety and depression are reported by 25-29%, with 41% indicating a wish for psychosocial support. These patients showed significantly higher scores on the questionnaires. Their request for psychosocial support shows a similar sensitivity (.733) and specificity (.662) as the "Distress-Thermometer" or "PO-Bado". Discussion: The desire for psychosocial support appears to be a valuable piece of additional information for indicating psychosocial support. However, HADS-D and PHQ-D agree only in 77% of the individual patients. © 2010 Vandenhoeck & Ruprecht GmbH & Co. KG.


Neunhoeffer E.,Universitats Frauenklinik Tubingen | Lawrenz B.,Universitats Frauenklinik Tubingen
Arzneimitteltherapie | Year: 2011

If the endometriosis does not cause the typical symptoms of pain and infertility and, as in many cases, only gives rise to unspecific complaints, then the diagnosis of the disease is already made more difficult. As a causal treatment does not currently exist and the disease is chronic in most cases, treatment also proves to be difficult. The choice of treatment options, their combination and sequence - surgery, pharmacotherapy, fertility treatment and complementary therapy - are based on the symptoms and requirements of the affected patient and should be individually assessed and consistently reviewed and adapted if necessary.

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