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  • 1
    ISSN: 1432-1335
    Keywords: Key words Breast cancer ; Bone marrow biopsy ; Metastases
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This study was performed to analyze the relevance of iliac crest biopsy in patients with primary breast cancer with regard to metastases of the primary tumor and osteogenic disease. We performed intraoperative bilateral biopsy of the anterior iliac crests in 1465 patients with primary breast cancer. The bone specimens were histologically evaluated with regard to quality of the biopsy, tumor involvement, and osteogenic and hematogenic disease. Accurate and clear evaluation of the iliac crest biopsies was possible in 1365 patients (93%). Osteopenia was diagnosed in 48 patients (3.5%); 24 patients (1.7%) showed histological evidence of tumor involvement of the skeletal system. All these 24 patients received systemic (adjuvant) therapy after surgery. Ten patients had micrometastases, although in 5 of them both the postoperative bone scan and X-rays showed no pathological results. In 10 women with histologically negative bone biopsies, metastases to the bone were diagnosed by bone scan and radiological methods. Random perioperative iliac bone biopsy cannot be recommended in patients with primary breast cancer. Iliac crest biopsy is relevant in certain scenarios (e.g. suspected recurrence, doubtful bone scan).
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-0843
    Keywords: Key words Breast cancer ; High-dose chemotherapy ; Peripheral blood stem cell transplantation ; Prognostic indicators ; Tumour cells
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We report on the efficacy and toxicity of a sequential high-dose therapy with peripheral blood stem cell (PBSC) support in 107 patients with high-risk stage II/III breast cancer. There were 90 patients with more than 9 tumour-positive axillary lymph nodes. An induction therapy of two cycles of ifosfamide (total dose, 7,500 mg/m2) and epirubicin (120 mg/m2) was given, and PBSC were harvested during granulocyte colony-stimulating factor (G-CSF)-supported leukocyte recovery following the second cycle. The PBSC-supported high-dose chemotherapy consisted of two cycles of ifosfamide (total dose 12,000 mg/m2), carboplatin (900 mg/m2) and epirubicin (180 mg/m2). Patients were autografted with a median number of 4.1 × 106 CD34+ cells/kg (range 1.9–26.5 × 106), resulting in haematological reconstitution within approximately 2 weeks following high-dose therapy. The toxicity was moderate in general, and there was no treatment-related toxic death. Twenty-nine patients (27.1% of all patients) relapsed between 3 and 46 months following the last cycle of high-dose therapy (median 15 months). The probability of disease-free and overall survival at 3 years was 56% and 83%, respectively. A multivariate analysis showed that patients with stage II disease had a significantly better probability of disease-free survival (71%) in comparison with patients with stage III disease (30%). The probability of disease-free survival was also significantly better for patients with oestrogen receptor-positive tumours (62%) compared with patients with receptor-negative ones (40%). In conclusion, sequential high-dose chemotherapy with PBSC support can be safely administered to patients with high-risk stage II/III breast cancer. Further intensification of the therapy including the addition of non-cross-resistant drugs or immunological approaches may be envisaged for patients with stage III disease and hormone receptor-negative tumours.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Archives of gynecology and obstetrics 256 (1995), S. S21 
    ISSN: 1432-0711
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Archives of gynecology and obstetrics 256 (1995), S. S21 
    ISSN: 1432-0711
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1432-1335
    Keywords: Key words Breast cancer ; Chemotherapy ; Transplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The purpose of this phase II study was to evaluate the therapeutic efficacy and toxicity of a tandem or triple high-dose chemotherapy (HDC) with autologous peripheral blood stem cell transplantation (PBSCT) in patients with metastatic breast cancer (MBC) as first line chemotherapy. Conventional chemotherapy consisted of two cycles of epirubicin 120 mg/m2 and ifosfamide 7500 mg/m2 in the case of tandem HDC and one cycle of paclitaxel 135 mg/m2, epirubicin 90 mg/m2 and ifosfamide 6000 mg/m2 in the case of triple HDC. Tandem HDC was composed of two cycles of epirubicin 180 mg/m2, ifosfamide 12000 mg/m2 and carboplatin 900 mg/m2. In the case of triple HDC, paclitaxel 180 mg/m2, etoposide 1500 mg/m2 and thiotepa 600 mg/m2 was added as the third cycle. Patients with tandem HDC (n = 20) were evaluable for both survival and toxicity, and patients with triple HDC (n = 21) only for toxicity because of short-term follow-up. Both tandem and triple HDC were well tolerated and could be safely administered. Non-hematological WHO grade 3 or 4 toxicities were mucositis (8), temporary renal insufficiency (1), myocardial infarction (1), and neuropathy (1). No toxic death occurred. The Kaplan-Meier estimates for 44-months without progression and the overall survival were 12% and 38% respectively. The median survival was 22 months (95% CI: 7.4–51.7 months) and the median progression-free interval 14 months (95% CI: 5.1–43.7 months). In a population with an unfavorable prognosis, tandem HDC showed similar efficacy as to that described in other phase II studies. Triple HDC seems not to improve patient outcome compared to tandem HDC, but a long-term follow up is required.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1573-7217
    Keywords: tumour cell detection ; cathepsin D ; breast cancer ; micrometastasis ; prognostic factor
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Patients with an elevated level of cathepsin D in breast cancer tissue have an adverse prognosis. This study evaluated the prognostic relevance of cathepsin D detection in disseminated tumour cells in bone marrow. Bone marrow was sampled intraoperatively from both anterior iliac crests in 290 patients with primary breast cancer. Interphase cells were enhanced and stained immunocytologically with two antibodies: BM2, which detects tumour-associated glycoprotein TAG 12, which is typically expressed by almost all breast cancer cells, and the anti-cathepsin D antibody. 67 of 149 BM2-positive women (45%) developed metastatic disease (median follow-up time: 69 months). Of these, 15 were cathepsin D-positive (22%). Patients with cathepsin D-positive cells in bone marrow (n = 26; 9%) had a significantly shorter metastasis-free interval (38 months) compared with women who were cathepsin D-negative (64.5 months). The worst prognosis was seen in patients positive for both markers (30.5 months), followed by those who were cathepsin D-negative and BM2-positive (48 months). The detection of cathepsin D on disseminated tumour cells characterises a subgroup of patients with a poorer prognosis who should undergo more aggressive adjuvant systemic therapy.
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Der Onkologe 4 (1998), S. 914-922 
    ISSN: 1433-0415
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Ziel der operativen Therapie des Mammakarzinoms ist die sichere lokale Tumorkontrolle und die Vermeidung lokaler Rezidive. In den letzten Jahrzehnten sind radikale Operationen zugunsten brusterhaltender Verfahren zunehmend verlassen worden, sodaß gegenwärtig etwa 2/3 aller Mammakarzinome organerhaltend operiert werden können. Bei der Operation muß darauf geachtet werden, daß die Tumoren inkl. ihrer umgebenden nicht-invasiven Komponente im Gesunden entfernt werden, ggf. sind Nachresektate als Zweiteingriff erforderlich. Die Indikationen zur brusterhaltenden Operation berücksichtigen hauptsächlich die Relation zwischen Tumor- und Brustgröße und die Möglichkeiten einer postoperativen Bestrahlung. Nach Mastektomien werden immer häufiger rekonstruktive Verfahren angewandt. Brustrekonstruktionen sollten, wenn möglich, primär im Anschluß an die Mastektomie vorgenommen werden.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Der Onkologe 5 (1999), S. 403-409 
    ISSN: 1433-0415
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Das Endometriumkarzinom des Korpus uteri ist mit einem Anteil von jährlich etwa 9.600 Neuerkrankungen und einem Anteil von 5–6% an allen bösartigen Neubildungen, die z. Z. vierthäufigste Krebserkrankung der Frau. Die Inzidenz der Erkrankung steigt mit dem Alter kontinuierlich an und erreicht ihren Gipfel zwischen dem 50. und 70. Lebensjahr [1]. Die operative Therapie des Endometriumkarzinoms ist die Standardtherapie. Neben der definitiven operativen Behandlung stellt die operative Therapie gleichzeitig auch die wichtigste Voraussetzung für das Staging der Erkrankung dar [11]. Die alte Klassifikation der FIGO ordnete das Endometriumkarzinom klinisch nur hinsichtlich seiner Ausbreitung innerhalb der Organgrenzen ein. Seit 1988 liegt eine neue Stadieneinteilung vor, welche die Tumorausbreitung innerhalb des Myometriums berücksichtigt, den Zervixbefall zwischen isoliertem Drüsenbefall und Stromainvasion unterscheidet und dem Stadium III alle Fälle mit Serosabefall, positiver Peritonealzytologie und Lymphknotenmetastasierung zuordnet [6, 7, 10, 18]. Diese Klassifizierung stellt das operative Staging in den Vordergrund und be- deutet für den Großteil der Patienten bereits die definitive Behandlung der Erkrankung.
    Type of Medium: Electronic Resource
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  • 9
    Electronic Resource
    Electronic Resource
    Springer
    Reproduktionsmedizin 14 (1998), S. 27-30 
    ISSN: 1434-808X
    Keywords: Schlüsselwörter Rekonstruktive Tubenchirurgie ; Tubenkatheterisierung ; Falloposkopie
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Zusammenfassung Eine genaue Beurteilung von Art und Ausmaß pathologischer Veränderungen der Tube ist Voraussetzung für die differenzierte Indikationsstellung zu tubenrekonstruktiven Maßnahmen. Etablierte diagnostische Verfahren wie die Hysterosalpingo(sono-)graphie oder Laparoskopie mit Chromopertubation erfüllen diese Anforderung jedoch nur unzureichend. Neue Techniken, wie die der hysteroskopischen Tubenkatheterisierung, selektiven Pertubation und der Falloposkopie sollen das diagnostische Spektrum erweitern, um vor allem intraluminale Läsionen früher und differenzierter zu erkennen. Das Ziel ist dabei eine immer weniger invasive, aber präzisere Patientinnenselektion als Basis für eine (auch kosten-) effizientere Therapieplanung. Die folgende Übersicht beschreibt den aktuellen Stand der technologischen und klinischen Entwicklung dieser neuen Verfahren.
    Type of Medium: Electronic Resource
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