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Aachen, Germany

Heidenreich A.,University Clinic Aachen
European Urology, Supplements | Year: 2010

Context: Guidelines for the management of prostate cancer are based on specific levels of clinical evidence. Objective: This review examines the clinical evidence for the use of androgen-deprivation therapy (ADT) in prostate cancer (PCa). This is placed in the context of individual patient management and how guidelines should be adapted to optimise individual patient care. Evidence acquisition: During the 2010 Annual Congress of the European Association of Urology (EAU) in Barcelona, Spain, a satellite symposium was held on the individualised management of patients with PCa. This paper is based on one of the presentations at the symposium. Data were retrieved from recent review articles, original articles, and abstracts on adjuvant ADT in PCa. Evidence synthesis: ADT is one of the main treatment options for locally advanced and metastatic PCa. The EAU Guidelines recommend a risk adapted approach to the use of ADT in patients with locally advanced disease and in those with prostate-specific antigen (PSA) relapse following radical prostatectomy. ADT provides specific benefits in patients with a PSA rise following radical prostatectomy, such as poorly differentiated PCa (Gleason score 8-10) and a very short PSA doubling time (<12 mo). The use of immediate versus deferred ADT in locally advanced disease remains controversial, while intermittent ADT can be considered for patients with both PSA rise following local treatment or metastatic disease. Individualised patient care management is required in the modern day use of ADT in men with PCa and a balance has to be reached between the risks and benefits so that appropriate patient populations can be targeted. Patients should be actively involved in such treatment-making decisions. Conclusions: ADT is still the standard of care for non-localised PCa, but treatment strategies should be adapted to individual patient profiles. Androgen-deprivation therapy is still the standard of care for non-localised prostate cancer, but individualised patient care management is required. A balance needs to be reached between the risks and benefits so that appropriate patient populations can be targeted. Specific benefits are noted in patients with a prostate-specific antigen (PSA) rise following radical prostatectomy, poorly differentiated prostate cancer (Gleason score 8-10) and very short PSA doubling time (<12 mo). © 2010 European Association of Urology. Source

Wierts R.,Maastricht University | de Pont C.D.J.M.,Maastricht University | Brans B.,Maastricht University | Mottaghy F.M.,Maastricht University | And 2 more authors.
Methods | Year: 2011

Advanced personalized dosimetry for molecular nuclear therapy has been shown to be feasible in clinical practice. At the same time instrumentation and dosimetric software are still evolving at a high pace. Procedures developed so far differ in approach and sophistication, and standard operating procedures necessary for accurate patient specific dosimetry do not yet exist. For this reason we restricted ourselves to reviewing the literature and highlighting relevant developments. © 2011 Elsevier Inc. Source

Fearon K.,Royal Infirmary | Strasser F.,Oncological Palliative Medicine | Anker S.D.,Applied Cachexia Research | Anker S.D.,Center for Clinical and Basic Research | And 16 more authors.
The Lancet Oncology | Year: 2011

To develop a framework for the definition and classification of cancer cachexia a panel of experts participated in a formal consensus process, including focus groups and two Delphi rounds. Cancer cachexia was defined as a multifactorial syndrome defined by an ongoing loss of skeletal muscle mass (with or without loss of fat mass) that cannot be fully reversed by conventional nutritional support and leads to progressive functional impairment. Its pathophysiology is characterised by a negative protein and energy balance driven by a variable combination of reduced food intake and abnormal metabolism. The agreed diagnostic criterion for cachexia was weight loss greater than 5%, or weight loss greater than 2% in individuals already showing depletion according to current bodyweight and height (body-mass index [BMI] <20 kg/m2) or skeletal muscle mass (sarcopenia). An agreement was made that the cachexia syndrome can develop progressively through various stages-precachexia to cachexia to refractory cachexia. Severity can be classified according to degree of depletion of energy stores and body protein (BMI) in combination with degree of ongoing weight loss. Assessment for classification and clinical management should include the following domains: anorexia or reduced food intake, catabolic drive, muscle mass and strength, functional and psychosocial impairment. Consensus exists on a framework for the definition and classification of cancer cachexia. After validation, this should aid clinical trial design, development of practice guidelines, and, eventually, routine clinical management. © 2011 Elsevier Ltd. Source

Schumann C.,University of Ulm | Hetzel M.,Red Cross | Babiak A.J.,Red Cross | Hetzel J.,University of Tubingen | And 5 more authors.
Journal of Thoracic and Cardiovascular Surgery | Year: 2010

Objective: In addition to use of a laser, argon plasma coagulation, electrocautery, or coring with a rigid bronchoscope, tumor debulking with a flexible cryoprobe is used for therapeutic bronchoscopy with an immediate effect for endobronchial pathologies. We performed this analysis to determine the usefulness, efficacy, and safety of the flexible cryorecanalization in a large population under routine conditions. Methods: We identified 225 bronchoscopic interventions that were done as cryorecanalization with a flexible cryoprobe. All patients had symptomatic airway stenosis. We determined the endoscopic success rate and safety (bleeding and perforation) of the procedure. Results: Successful cryorecanalization was achieved in 205 (91.1%) of 225 patients. The flexible cryoprobe was used with all patients, in most patients in combination with flexible bronchoscopy and only in a minority (n = 31, 13.8%) in combination with a rigid bronchoscope. Additional interventional techniques used were endobronchial stents (n = 11, 4.9%) and argon plasma coagulation (n = 37, 16.4%). Mild bleeding (if ice-cold NaCl or epinephrine solution was necessary) occurred in 9 (4.0%) patients, moderate bleeding (if argon plasma coagulation or a bronchus blocker was required) occurred in 18 (8.0%) patients, and severe bleeding (events with hemodynamic instability) never occurred. Conclusions: Cryorecanalization with the flexible cryoprobe for treatment of symptomatic endobronchial tumor stenosis is a safe technique with a high success rate and immediate treatment effect. © 2010 The American Association for Thoracic Surgery. Source

Schwantes U.,Dr. R. Pfleger GmbH | Grosse J.,University Clinic Aachen | Wiedemann A.,Witten/Herdecke University
International Urogynecology Journal and Pelvic Floor Dysfunction | Year: 2015

Introduction and hypothesis: Unsatisfactory treatment outcome sometimes is described as frequently occurring in patients treated with first-line therapy for overactive bladder (OAB). The present article reviews the different circumstances which may result in failure to respond to lifestyle interventions, behavioral therapy, and/or antimuscarinic treatment. Methods: An extensive literature search was conducted to identify relevant articles on pathophysiological, clinical, and pharmacological aspects of refractory OAB. Results: Missing definition, unrealistic individual expectation of treatment outcomes, lack of communication between physician and patient as well as pathophysiological and pharmacological processes were identified as relevant for failure to respond to first-line OAB treatment. Increase of patient’s motivation to adhere to the prescribed treatment, critical examination of the patient in regard to the initial diagnosis, and individual adjustment of antimuscarinic therapy may be appropriate tools to improve treatment outcome in OAB patients. Conclusions: Overall, the incidence of refractory OAB seems to be overestimated. There are several approaches to improve therapy results. © 2015, The Author(s). Source

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