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A known cut-off problem hampers the interpretation of quality of life (QOL) scores. The purpose of this study was to apply a novel approach for the EORTC QLQ-C30 instrument to identify the proportion of breast cancer (BC) patients in need of supportive care. Changes in QOL during the COVID-19 pandemic were evaluated, as well as changes over time (after treatment termination and up to 4 years later). Data were obtained from a cohort study on young adult BC patients with minor children participating in a mother–child rehab program. Cross-sectional QOL data were collected from 2015 to 2021 (baseline). Follow-up data were available for up to 4 years after diagnosis for a subgroup. The baseline cohort included 853 women (mean age 35 years). More than 50% had a need for supportive care. In the subgroup with follow-up, this proportion remained at a high level up to several years after diagnosis. During the COVID-19 pandemic, changes regarding the proportion with this need were not as high as expected—with the exception of changes on the QLQ-C30 scale ‘role functioning’ (+15%). Even several years after diagnosis, every second BC patient with minor children had a need for supportive care, which is much higher than previously found. Healthcare staff should be aware of this potential need and should address this issue.

ABEMACARE: Abemaciclib in Combination with Endocrine Therapy as First Line Therapy in Metastatic Breast Cancer Patients with Symptomatic Visceral Metastases or High Tumor Burden – A prospective Multicenter Observational Study Sophia Ramsperger, Franziska Kotzur, Lothar Müller, Stephan Seitz, Peter A. Fasching, Stefanie Jilg, Dorothea Fischer, Silvia Egert-Schwender, Victoria Kehl, Ute Reuning, Lukas Rief, Romina Rösch, Holger Bronger, Christof Winter, Marion Kiechle, Johannes Ettl Background: Combined endocrine therapy with Cyclin-dependent kinase 4 and 6 (CDK 4/6) inhibitors and aromatase inhibitor (AI) or Fulvestrant has become standard of care in first line therapy of estrogen receptor (ER) positive, HER2 negative metastatic breast cancer. Numeral trials have shown excellent results regarding disease control and survival while maintaining quality of life for patients. In the MONARCH 2 and MONARCH 3 trials, patients with liver metastases derived a particularly large benefit from the use of Abemaciclib. Nevertheless, in real world many patients with endocrine sensitive metastatic breast cancer are still being treated with chemotherapy in first line. Symptomatic visceral disease and/or high tumor burden are often seen as reasons for upfront chemotherapy even in the absence of visceral crisis. In this specific patient population Abemacare aims at determining the efficacy of Abemaciclib in combination with endocrine therapy as first line treatment. Further, the question is addressed, whether circulating tumor DNA might serve as a predictive biomarker for early tumor response. Study Design: Abemacare is a prospective multicenter noninterventional, observational study. 96 patients in 10 German cancer centers who receive first line Abemaciclib in combination with AI or Fulvestrant are planned to be enrolled. Recruitment started in December 2020. As of July 1st 2022, 51 patients have been included in six study sites. Patients with documented ER-positive, HER2-negative metastatic breast cancer and measurable visceral disease are eligible if they fulfill one of the following inclusion criteria: Presence of clinical signs or symptoms of visceral disease (e.g. pleural effusion, ascites, abdominal pain from liver or peritoneal metastases, dyspnea from pleural effusion or lymphangiosis of the lung, elevated liver enzymes or bilirubin level (> 2x ULN)) or signs of high tumor burden (e.g. LDH > 399 U/l with K+ in normal range, abnormal CEA or CA 15-3 level (> 2x ULN), radiographic signs of lymphangiosis of the lung, cytologically proven bone marrow infiltration). Patients with prior therapy with a CDK 4/6 inhibitor in any setting or first line therapy for metastatic disease are excluded from the trial. Primary endpoint is best objective response rate (ORR) defined by the proportion of patients who are evaluated using RECIST V1.1 as having partial (PR) or complete response (CR) while being on study treatment. ORR will be analyzed using the one group χ2 test at the 5% significance level. The test hypotheses are as follows: H0: ORR = 0.43, HA: ORR ≠ 0.43. In addition, ORR will be reported with a 95% CI. Several additional endpoints regarding disease control and patient reported outcomes will also be evaluated. Plasma samples for ctDNA are being collected at d1 and d15 of cycle 1 and d1 of cycle 2 and 3. Contact information: For further information please contact the leading physician Dr. Johannes Ettl via johannes.ettl@tum.de This study is supported by Eli Lilly and Company. NCT04681768 a>Disclosure(s): Johannes Ettl, n/a: Amgen, Celgene, Eisai, Myriad, Teva.: Consulting Fees (e.g., advisory boards) (Ongoing); Novartis: Consulting Fees (e.g., advisory boards) (Ongoing); Pfizer, Pierre Fabre, Lilly, Roche, AstraZeneca, Daiichi, Gilead, Seagen: Consulting Fees (e.g., advisory boards) (Ongoing) Ramsperger Sophia, n/a: No financial relationships to disclose Franziska Kotzur, n/a: No financial relationships to disclose Lothar Müller, n/a: No financial relationships to disclose Stephan Seitz, n/a: AstraZeneca: Consulting Fees (e.g., advisory boards) (Ongoing), Fees for Non-CME Services Received Directly from Commercial Interest or their Agents (e.g., speakers’ bureaus) (Ongoing); GE; Gedeon-Richter; GSK; Lilly;: Consulting Fees (e.g., advisory boards) (Ongoing) Peter A. Fasching, MD: Agendia: Consulting Fees (e.g., advisory boards) (Ongoing); AstraZeneca: Consulting Fees (e.g., advisory boards) (Ongoing); Biontech: Contracted Research (Ongoing); Cepheid: Contracted Research (Ongoing); Daiichi Sankyo: Consulting Fees (e.g., advisory boards) (Ongoing); Eisai: Consulting Fees (e.g., advisory boards) (Ongoing); Genentech: Consulting Fees (e.g., advisory boards) (Ongoing); Gilead: Consulting Fees (e.g., advisory boards) (Ongoing); Lilly: Consulting Fees (e.g., advisory boards) (Ongoing); Merck Sharp & Dohme: Consulting Fees (e.g., advisory boards) (Ongoing); Novartis: Consulting Fees (e.g., advisory boards) (Ongoing); Pfizer: Consulting Fees (e.g., advisory boards) (Ongoing); Pierre Fabre: Consulting Fees (e.g., advisory boards) (Ongoing); Roche: Consulting Fees (e.g., advisory boards) (Ongoing); Sanofi Aventis: Consulting Fees (e.g., advisory boards) (Ongoing); SeaGen: Consulting Fees (e.g., advisory boards) (Ongoing) Stefanie Jilg, n/a: No financial relationships to disclose Dorothea Fischer, n/a: No financial relationships to disclose Silvia Egert-Schwender, n/a: No financial relationships to disclose Kehl Victora, n/a: No financial relationships to disclose Ute Reuning, n/a: No financial relationships to disclose Romina Rösch, n/a: No financial relationships to disclose Lukas Rief, n/a: No financial relationships to disclose Holger Bronger, n/a: No financial relationships to disclose Christof Winter, n/a: No financial relationships to disclose Marion Kiechle, n/a: Myriad Genetics, Bavarian KVB, DKMS Life, BLAEK, TEVA, Exeltis. Equity owner: Therawis Diagnostic GmbH, AIM GmbH.: Consulting Fees (e.g., advisory boards) (Ongoing), Contracted Research (Ongoing), Fees for Non-CME Services Received Directly from Commercial Interest or their Agents (e.g., speakers’ bureaus) (Ongoing) Citation Format: Johannes Ettl, Ramsperger Sophia, Franziska Kotzur, Lothar Müller, Stephan Seitz, Peter A. Fasching, Stefanie Jilg, Dorothea Fischer, Silvia Egert-Schwender, Kehl Victora, Ute Reuning, Romina Rösch, Lukas Rief, Holger Bronger, Christof Winter, Marion Kiechle. ABEMACARE: Abemaciclib in Combination with Endocrine Therapy as First Line Therapy in Metastatic Breast Cancer Patients with Symptomatic Visceral Metastases or High Tumor Burden – A prospective multicenter observational study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT2-01-09.

Treatment of cancer patients has become challenging when large parts of hospital services need to be shut down as a consequence of a local COVID-19 outbreak that requires rapid containment measures, in conjunction with the shifting of priorities to vital services. Reports providing conceptual frameworks and first experiences on how to maintain a clinical hematology/oncology service during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic are scarce. Here, we report our first 8 weeks of experience after implementing a procedural plan at a hematology/oncology unit with its associated cancer center at a large academic teaching hospital in Germany. By strictly separating team workflows and implementing vigorous testing for SARS-CoV-2 infections for all patients and staff members irrespective of clinical symptoms, we were successful in maintaining a comprehensive hematology/oncology service to allow for the continuation of treatment for our patients. Notably, this was achieved without introducing or further transmitting SARS-CoV-2 infections within the unit and the entire center. Although challenging, our approach appears safe and feasible and may help others to set up or optimize their procedures for cancer treatment or for other exceedingly vulnerable patient cohorts.

Background: Breast cancer in young women is associated with unfavourable tumour biology and is the main cause of death in this group. Conditional survival analysis estimates survival rates under the pre-condition of already having survived a certain time. Objectives: To describe conditional disease-free and overall survival of female breast cancer patients according to clinical subtypes and age. Methods: This study analyses information from 1,858 breast cancer patients aged between 21 and 54 years, who were taking part in a post-therapeutic rehab programme (time between diagnosis and rehab start: maximum 24, median 11 months). Mean follow-up time was 3.6 years. We describe biological, clinical and pathological features in regard to different age groups (Results: Very young and young patients differed in regard to hormone receptor negativity, tumour grade, lymphovascular invasion, and molecular subtypes. Young women bore triple-negative and HER2-like disease more frequently. Conditional 5-year overall survival did not differ substantially between women Conclusions: Conditional 5-year overall survival after non-metastatic breast cancer was as high as 95.5%, and disease-free survival was 85.2%. When controlling for time between diagnosis and rehab start, molecular subtypes influenced overall and disease-free survival prospects. When additionally controlling for clinical characteristics, this effect only remained stable for disease-free survival.

Introduction PARP (Poly ADP Ribose Polymerase) inhibitors are an effective maintenance therapy for various entities, such as BRCA (breast cancer gene) mutated or HRD (homologous recombination deficiency) positive primary platin-sensitive advanced ovarian cancer after platin induction therapy and in relapse after responding to carboplatin reinduction. Other entities are metastatic BRCA mutated pancreas, prostate and Her2-negative breast cancer. Therefore, patients with allergic reactions to PARP inhibitors should undergo a desensitization procedure to be able to receive this efficient therapy. Case report We conducted a two-day desensitization on a 45-year-s old patient with advanced ovarian cancer who displayed symptoms of an allergic reaction to Olaparib. Management and outcome Using an Olaparib tablet suspension, we orally administered increasing Olaparib doses, starting with 12.5 mg and reaching a cumulative dose of 387.5 mg on the first day and starting with 100 mg and reaching a cumulative dose of 600 mg on the second day, without concomitant antiallergic medication. Except for mild erythema on day one receding within the hour, no further allergic reactions appeared during desensitization. The patient has since received 300 mg of Olaparib twice a day without further complications or interruptions. Conclusion Desensitization in a two-day suspension protocol is a safe method that ensures effective maintenance therapy for patients with allergic reactions to PARP inhibitors.

Zusammenfassung Ziel der Studie Die Informiertheit von Krebspatienten beeinflusst verschiedene Bereiche. Ziel der Studie ist zu untersuchen, welche Informationsquellen junge Brustkrebspatientinnen mit Kindern nutzen und wie sie die Informationslage bewerten. Methodik Die Teilnehmerinnen waren Rehabilitandinnen einer Reha-Masnahme fur junge Mutter mit nicht-fernmetastasiertem Brustkrebs (Projekt „gemeinsam gesund werden“ in Gromitz). Mittels Fragebogen wurden das Informationsverhalten, die Informationslage, klinische und soziodemographische Daten erfasst. Ergebnisse Die Patientinnen (n = 827) nutzten diverse zusatzliche Informationsquellen, vorrangig das Internet (69,5%; n = 767). Die Mehrheit fuhlte sich ausreichend uber die Erkrankung informiert und fand die Informationen hierzu leicht verstandlich. Ein sozialer Gradient hinsichtlich der Mediennutzung, der Informationsbewertung und dem Einholen einer Zweitmeinung war zu beobachten. Schlussfolgerung Fur Brustkrebspatientinnen hat das Internet eine zentrale Bedeutung. Die Hinweise auf einen sozialen Gradienten betonen, dass Informationsquellen auch auf Patientinnen mit niedrigerer sozialer Lage ausgerichtet werden mussen.

On a late autumn day, Michael Zeuske and I met in his office at the University of Cologne to discuss his most recent research on the “Hidden Atlantic.” We talked about his eight years of archival w...

This study aimed to facilitate individualized treatment strategies for intracerebral metastases from gynecological cancers by creating a specific overall survival (OS) score.Fifty-six patients irradiated for cerebral metastases from gynecological cancers were included. Eleven factors were retrospectively analyzed for OS: age, Eastern Cooperative Oncology Group (ECOG) performance score, cancer type, histology, histologic grading, initial stage, number of lesions, extracerebral metastases, time between cancer diagnosis and brain metastases treatment, recursive partitioning analysis class, and type of treatment. Independent predictors of OS were incorporated in the score (better OS, 1 point; worse OS, 0 points).On Cox proportional hazards analysis, performance score (hazards ratio, 1.98; 95% confidence interval, 1.30-3.23; P = 0.001), no extracerebral metastases (3.34; 1.46-8.96; P = 0.003), and recursive partitioning analysis class 1 (3.27; 1.97-5.65; P0.001) were significant. The following points were assigned: ECOG score 1 to 2 = 1 point, ECOG score 3 to 4 = 0 points, no extracerebral metastases = 1 point, extracerebral metastases = 0 points. Sum scores were 0 (n = 32), 1 (n = 15), or 2 points (n = 9). Six-month OS rates were 6%, 67%, and 100%, respectively (P0.001).A predictive tool including 3 groups with significantly different OS probabilities was designed for patients with cerebral metastases from gynecological cancers. This tool will aid in choosing individual treatments.

Rationale: Pathological biomechanical signaling induces vascular anomalies including cerebral cavernous malformations (CCM), which are caused by a clonal loss of CCM1/KRIT1 (Krev interaction trapped protein 1), CCM2/MGC4607, or CCM3/PDCD10. Why patients typically experience lesions only in lowly perfused venous capillaries of the cerebrovasculature is completely unknown. Objective: In contrast, animal models with a complete loss of CCM proteins lack a functional heart and blood flow and exhibit vascular anomalies within major blood vessels as well. This finding raises the possibility that hemodynamics may play a role in the context of this vascular pathology. Methods and Results: Here, we used a genetic approach to restore cardiac function and blood flow in a zebrafish model of CCM1. We find that blood flow prevents cardiovascular anomalies including a hyperplastic expansion within a large Ccm1-deficient vascular bed, the lateral dorsal aorta. Conclusions: This study identifies blood flow as an important physiological factor that is protective in the cause of this devastating vascular pathology.

TPS6102 Background: Ovarian cancer (OC) is associated with the highest mortality rates among gynecological malignancies, with most patients being diagnosed in advanced stages. The most common histological subtype is high grade serous OC, which is characterized by deficiency in homologous recombination. Debulking surgery, followed by platinum based chemotherapy and bevacizumab (bev), followed by maintenance therapy with bev, is the standard therapy for advanced BRCA wild type (BRCAwt) OC patients in Germany. BRCA mutant patients will receive maintenance with olaparib, according to SOLO1 data. The anticancer effects of PARP inhibitors (PARPi) seem to be increased by the addition of antiangiogenic drugs. Preclinical data showed increased HRD in tumors pretreated with bev, and clinical trials showed a benefit of the combination of antiangiogenic drugs and PARPi vs. PARPi alone. NOGGO Ov-42/MAMOC trial (NCT04227522) is a phase III, randomized, placebo-controlled study evaluating rucaparib maintenance following bevacizumab maintenance for the treatment of advanced primary high grade BRCAwt OC. Methods: 190 patients with histologically confirmed advanced (FIGO stage IIIA- IV of the 2014 FIGO classification) high grade serous or high grade endometrioid (based on local histopathological findings) OC, fallopian tube cancer, primary peritoneal cancer or clear cell carcinoma of the ovary will be randomized 2:1 to receive either rucaparib 600mg BID or placebo as maintenance therapy following first line chemotherapy with 6 cycles of Carboplatin/Paclitaxel and at least 12 cycles of bev, given together with chemotherapy and as maintenance. Only BRCAwt patients will be included in the trial. Randomization is stratified by surgery planned timepoint (neoadjuvant vs. adjuvant), surgical outcome (no residual tumor mass vs. residual tumor mass), response to chemotherapy followed by bev (CR/NED vs. PR/SD) and study center. Treatment will continue for 24 months or until disease progression, unacceptable toxicity, or withdrawal. Primary endpoint is PFS in BRCAwt patients per RECIST v1.1. Secondary endpoints are PFS2, quality of life (EORTC QLQ-C30/OV28, FSI, SF-12, PROC-CTCAE, every day memory questionnaire), daily activity, time to next medical intervention, time to next subsequent therapy, safety assessments and OS. Clinical trial information: NCT04227522.

The extent to which cancer patients are well-informed can have manifold effects. The aim of this study was to explore both the sources of information that young breast cancer patients with children use and how they evaluate the information obtained.Participants were recruited within a rehabilitation program for young mothers with non-metastatic breast cancer (the Groemitz project "gemeinsam gesund werden"). Data on information seeking, the level of information, socio-demographic data and clinical characteristics were collected using a questionnaire.The patients (n=827) used several additional sources of information - most frequently the internet (69.5%; n=767). The majority felt well informed about their disease and found the information provided easy to understand. A social gradient was observed in relation to media use, information evaluation and obtaining a second opinion.To young breast cancer patients, the internet is crucial for obtaining further information. The indication of a social gradient underlines the importance of addressing the information needs of patients with a lower socioeconomic status.

Background Vitamin D is known for its anticancer potential. Prostaglandin E2 (PGE2) is a proliferative and inflammation-activating agent. The production of PGE2 is dependent on the activity of cyclooxygenase-2 (COX2). A link between vitamin D and PGE2 metabolism was shown recently. Materials and methods In MDA-MB-231 and MCF-7 breast cancer cell lines, we investigated the influence of calcitriol and the COX2 inhibitor celecoxib on cell growth via the MTT test, as well as on the protein and mRNA expression of COX2 using western blot and quantitative real-time polymerase chain reaction (qRT-PCR). Results The proliferation of MCF-7 and MDA-MB-231 was inhibited by both calcitriol and the COX2 inhibitor celecoxib and even more strongly by their combination. Moreover, calcitriol inhibited COX2 protein expression in MDA-MB-231 cells, as well as COX2 mRNA expression in both cell lines. Conclusion The combination of calcitriol and celecoxib demonstrated a synergistic growth-inhibitory effect in breast cancer cell lines.

BACKGROUND: ExteNET showed that 1 year of neratinib, an irreversible pan-HER tyrosine kinase inhibitor, significantly improves 2-year invasive disease-free survival after trastuzumab-based adjuvant therapy in women with HER2-positive breast cancer. We report updated efficacy outcomes from a protocol-defined 5-year follow-up sensitivity analysis and long-term toxicity findings. METHODS: In this ongoing randomised, double-blind, placebo-controlled, phase 3 trial, eligible women aged 18 years or older (≥20 years in Japan) with stage 1-3c (modified to stage 2-3c in February, 2010) operable breast cancer, who had completed neoadjuvant and adjuvant chemotherapy plus trastuzumab with no evidence of disease recurrence or metastatic disease at study entry. Patients who were eligible patients were randomly assigned (1:1) via permuted blocks stratified according to hormone receptor status (hormone receptor-positive vs hormone receptor-negative), nodal status (0 vs 1-3 vs or ≥4 positive nodes), and trastuzumab adjuvant regimen (given sequentially vs concurrently with chemotherapy), then implemented centrally via an interactive voice and web-response system, to receive 1 year of oral neratinib 240 mg/day or matching placebo. Treatment was given continuously for 1 year, unless disease recurrence or new breast cancer, intolerable adverse events, or consent withdrawal occurred. Patients, investigators, and trial funder were masked to treatment allocation. The predefined endpoint of the 5-year analysis was invasive disease-free survival, analysed by intention to treat. ExteNET is registered with ClinicalTrials.gov, number NCT00878709, and is closed to new participants. FINDINGS: Between July 9, 2009, and Oct 24, 2011, 2840 eligible women with early HER2-positive breast cancer were recruited from community-based and academic institutions in 40 countries and randomly assigned to receive neratinib (n=1420) or placebo (n=1420). After a median follow-up of 5·2 years (IQR 2·1-5·3), patients in the neratinib group had significantly fewer invasive disease-free survival events than those in the placebo group (116 vs 163 events; stratified hazard ratio 0·73, 95% CI 0·57-0·92, p=0·0083). The 5-year invasive disease-free survival was 90·2% (95% CI 88·3-91·8) in the neratinib group and 87·7% (85·7-89·4) in the placebo group. Without diarrhoea prophylaxis, the most common grade 3-4 adverse events in the neratinib group, compared with the placebo group, were diarrhoea (561 [40%] grade 3 and one [BACKGROUND: ExteNET showed that 1 year of neratinib, an irreversible pan-HER tyrosine kinase inhibitor, significantly improves 2-year invasive disease-free survival after trastuzumab-based adjuvant therapy in women with HER2-positive breast cancer. We report updated efficacy outcomes from a protocol-defined 5-year follow-up sensitivity analysis and long-term toxicity findings.METHODS: In this ongoing randomised, double-blind, placebo-controlled, phase 3 trial, eligible women aged 18 years or older (≥20 years in Japan) with stage 1-3c (modified to stage 2-3c in February, 2010) operable breast cancer, who had completed neoadjuvant and adjuvant chemotherapy plus trastuzumab with no evidence of disease recurrence or metastatic disease at study entry. Patients who were eligible patients were randomly assigned (1:1) via permuted blocks stratified according to hormone receptor status (hormone receptor-positive vs hormone receptor-negative), nodal status (0 vs 1-3 vs or ≥4 positive nodes), and trastuzumab adjuvant regimen (given sequentially vs concurrently with chemotherapy), then implemented centrally via an interactive voice and web-response system, to receive 1 year of oral neratinib 240 mg/day or matching placebo. Treatment was given continuously for 1 year, unless disease recurrence or new breast cancer, intolerable adverse events, or consent withdrawal occurred. Patients, investigators, and trial funder were masked to treatment allocation. The predefined endpoint of the 5-year analysis was invasive disease-free survival, analysed by intention to treat. ExteNET is registered with ClinicalTrials.gov, number NCT00878709, and is closed to new participants.FINDINGS: Between July 9, 2009, and Oct 24, 2011, 2840 eligible women with early HER2-positive breast cancer were recruited from community-based and academic institutions in 40 countries and randomly assigned to receive neratinib (n=1420) or placebo (n=1420). After a median follow-up of 5·2 years (IQR 2·1-5·3), patients in the neratinib group had significantly fewer invasive disease-free survival events than those in the placebo group (116 vs 163 events; stratified hazard ratio 0·73, 95% CI 0·57-0·92, p=0·0083). The 5-year invasive disease-free survival was 90·2% (95% CI 88·3-91·8) in the neratinib group and 87·7% (85·7-89·4) in the placebo group. Without diarrhoea prophylaxis, the most common grade 3-4 adverse events in the neratinib group, compared with the placebo group, were diarrhoea (561 [40%] grade 3 and one [INTERPRETATION: At the 5-year follow-up, 1 year of extended adjuvant therapy with neratinib, administered after chemotherapy and trastuzumab, significantly reduced the proportion of clinically relevant breast cancer relapses-ie, those that might lead to death, such as distant and locoregional relapses outside the preserved breast-without increasing the risk of long-term toxicity. An analysis of overall survival is planned after 248 events.FUNDING: Wyeth, Pfizer, and Puma Biotechnology.

To evaluate the feasibility of hypofractionation with SIB in all settings in Germany to prepare a multicenter treatment comparison.Eligible patients had histopathologically confirmed breast cancer operated by BCS. Patients received WBI 40.0 Gy in 16 fractions of 2.5 Gy. A SIB with 0.5 Gy per fraction was administered to the tumor bed, thereby giving 48.0 Gy in 16 fractions to the boost-PTV sparing heart, LAD, lung, contralateral breast. The primary study objective was feasibility, administration of specified dose in 16 fractions within 22-29 days with adherence to certain dose constraints (heart; LAD; contralateral breast); secondary endpoints were toxicity, QoL.151 patients were recruited from 7 institutions between 07/11-10/12. 10 patients met exclusion criteria prior to irradiation. All but two patients (99%) received the prescribed dose in the PTVs. Adherence to dose constraints and time limits was achieved in 89% (95% CI 82% to 93%). 11 AE were reported in 10 patients; five related to concurrent endocrine therapy. Two of the AEs were related to radiotherapy: grade 3 hot flushes in two cases. QoL remained unchanged.Hypofractionation with a SIB is feasible and was well tolerated in this study.

Eric Hayot is Distinguished Professor of Comparative Literature and Asian Studies at Penn State University, where his research focuses on transnational history of literary and cultural forms, as we...

Background: The purpose of the study was to characterize the treatment of young mothers with breast cancer in Germany and to investigate whether it followed applicable guidelines. Method: Retrospective data obtained between 2002 and 2011 for 1,053 mothers with children of < 12 years of age with adjuvantly treated loco-regional primary breast cancer were analyzed. Collected data included sociodemographic data, TNM stage, biology of tumor and therapies. Actually received therapies were compared to those suggested in guideline treatment plans. Results: The mean age of the patients was 39 years. 97% of the women with node positivity received an axillary dissection. Overall, 90% of the patients received chemotherapy with a guideline adherence range of 87-99% depending on clinical parameters. For radiation therapy, guideline adherence was high (range 82-100%). 95% of the patients with a hormone receptor-positive tumor received endocrine therapy; in 94%, tamoxifen therapy was performed in compliance with guidelines, whereas gonadotropin-releasing hormone (GnRH) agonist therapy complied with the guidelines in 52% of the cases. Conclusion: Guideline adherence in young mothers with breast cancer in Germany was high (with the exception of GnRH therapy), as comorbidity or the ambiguity of the therapeutic success does not need to be considered as much in this young, otherwise usually healthy, cohort compared to an age-heterogeneous group.

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Objective Treatment options for patients with recurrent ovarian carcinoma are diverse, and different therapies are recommended based on platinum-free interval (PFI). Data examining the association between platinum sensitivity, treatment strategy, and outcomes are limited, particularly for partially platinum-sensitive (PPS) patients. This study characterized clinical features and outcomes in patients with recurrent ovarian carcinoma in the context of sensitivity to platinum-based therapy. Methods Anonymized case records were obtained from eligible European medical sites. Eligible patients were 18 years or older with epithelial ovarian carcinoma who had received 1 or more platinum-based therapies and had 1 or more subsequent relapses. Patient records were categorized by PFI and analyzed based on demographic and clinical data using descriptive statistics. Results There was no difference between PFI in PPS patients receiving platinum versus nonplatinum therapy (8.9 [range, 6.0–12.0] and 8.3 [range, 6.0–11.3] months, respectively). Overall survival in patients with platinum-sensitive, PPS, platinum-resistant, and platinum-refractory disease was 43.0 (95% confidence interval [95% CI], 25.1–42.3), 20.5 (95% CI, 17.7–24.8), 12.7 (95% CI, 10.4–14.2), and 9.8 (95% CI, 6.6–14.9) months, respectively. Among PPS patients, overall survival was 23.5 (95% CI, 18.4–37.3) and 18.7 (95% CI, 11.0–23.5) months for those who received platinum and nonplatinum-based therapy, respectively. No demographic or clinical characteristics were identified that indicated a difference between PPS patients who received platinum-based therapy versus those who did not. Conclusions Partially platinum-sensitive patients with recurrent ovarian carcinoma who received platinum-based therapy had improved outcomes compared with those who did not. No clear demographic criteria for choosing platinum- versus nonplatinum-based therapy for PPS patients were identified from patient records.

Purpose Observational studies suggested that luteinizing hormone–releasing hormone agonists (LHRHa) might prevent premature ovarian failure resulting from adjuvant chemotherapy in premenopausal patients. We aimed to test the efficacy of ovarian function preservation with the LHRHa goserelin in patients with breast cancer. Patients and Methods In a prospective, randomized, open-label, controlled multicenter study, 60 patients younger than age 46 years with hormone-insensitive breast cancer were allocated to receive anthracycline/cyclophosphamide (with or without taxane) –based neoadjuvant chemotherapy with or without goserelin. The first goserelin injection was administered at least 2 weeks before the first chemotherapy cycle, continuing at 3.6 mg subcutaneously every 4 weeks until the end of the last cycle. The primary objective was the reappearance of normal ovarian function, defined as two consecutive menstrual periods within 21 to 35 days at 6 months after end of chemotherapy. Results Fifty-three patients (88.3%) experienced temporary amenorrhea (93.3% with v 83.3% without goserelin). No significant difference was observed regarding the reappearance of menstruation at 6 months after chemotherapy (70.0% with v 56.7% without goserelin; difference of 13.3%; 95% CI, −10.85 to 37.45; P = .284). All but one evaluable patient reported regular menses at 2 years after chemotherapy. Time to restoration of menstruation was 6.8 months (95% CI, 5.2 to 8.4) with goserelin and 6.1 months (95% CI, 5.3 to 6.8) without goserelin (P = .304). Chemotherapy resulted in a decreased ovarian reserve measured by inhibin B and anti-Müllerian hormone during follow-up, supporting the other findings. Conclusion Premenopausal patients with breast cancer receiving goserelin simultaneously with modern neoadjuvant chemotherapy did not experience statistically significantly less amenorrhea 6 months after end of chemotherapy compared with those receiving chemotherapy alone.

For a decade, Atlantic Studies has explored the conceptual, historical, and cultural exchanges within this specific space from the early modern to the present day. The addition of the subtitle Glob...

Nipple piercing gains popularity and social acceptance within the last years, especially among young people. The medical literature reports an increase of complications in the post-piercing period. We report a case of a young woman, who presented with a light enlargment of the right breast and tenderness in the retroareolar region following nipple piercing 5 months ago. On ultrasound, a poorly marginated hypoechoic lesion was seen which was suspicious of an inflammation. After 1 week of antibiotic therapy, the mass had enlarged. As carcinoma could not be excluded, open biopsy was performed. Histology showed signs of chronic mastitis. To date, only a few reports of breast abscess after nipple piercing have been published. With the increasing prevalence of body piercing, it is important to document and report infections which may be discovered many months following piercing. Carcinoma can mimick breast abscess and should be included in the differential diagnosis.

Die primare Pravention ist fur das Mammakarzinom wie auch fur andere Tumorerkrankungen sehr schwer durchfuhrbar und von der Bevolkerung kaum akzeptiert. Daher ist die sekundare Pravention umso wichtiger. Die in der Fruherkennung verwendete bildgebende Diagnostik konnte in den letzten Jahren deutliche Fortschritte erzielen, durch die sowohl die Diagnostik als auch die Therapie verbessert wurden. So ist die digitale Mammographie heute Standard, sowohl in der kurativen wie auch der Screeningmammographie. Des Weiteren bietet sie Moglichkeiten wie die Tomosynthese und die Anwendung von CAD-Systemen. Zukunftig wird die senologische Diagnostik im Rahmen der Fruherkennung von diesen neuen Moglichkeiten beeinflusst werden. In den letzten Jahren wurde in Deutschland das flachendeckende Mammographiescreening fur Frauen zwischen 50 und 69 Jahren sowie eine intensivierte Fruherkennung fur Frauen mit familiarer Mammakarzinombelastung eingefuhrt. Ergebnisse fur das Mammographiescreening werden Ende dieses Jahres erwartet. Nach der derzeitigen Datenlage kann durch den Einsatz des Screenings die brustkrebsbedingte Mortalitat um etwa 25% gesenkt werden.

Aufgrund des steigenden Alters Schwangerer ist eine zunehmende Anzahl an Patientinnen mit Mammakarzinom bei gleichzeitig bestehender Schwangerschaft zu beobachten. Zielgerichtete Therapien haben auserhalb der Schwangerschaft einen groseren Stellenwert bekommen, Trastuzumab konnte fur Patientinnen mit Her2-positivem Rezeptorstatus die Prognose wesentlich verbessern. Zum Einsatz in der Schwangerschaft liegen bislang wenige Einzelberichte vor, denen zufolge ein Teil der Patientinnen einen unauffalligen Schwangerschaftsverlauf aufwies. Die am haufigsten beobachtete Nebenwirkung unter Trastuzumab war das Oligo- bzw. Anhydramnion. In einem Fallbericht mit dem Tyrosinkinasehemmer Lapatinib verlief die Schwangerschaft unkompliziert, ein gesundes Kind wurde geboren. Eine antiangiogenetische Therapie ist in der Schwangerschaft streng kontraindiziert, nicht zuletzt wurde dies durch den Einsatz von Thalidomid (ConterganTM) gelernt. Dennoch wurde bei einer Schwangeren Bevacizumab lokal am Auge eingesetzt, dabei wurden Nebenwirkungen oder Folgeschaden nicht beobachtet. Um die wenigen Daten gezielt zu bundeln und in die Beratung nachfolgender Schwangerer mit Mammakarzinom einbeziehen zu konnen, sollten alle Patientinnen mit einem Mammakarzinom in der Schwangerschaft in die Registerstudie der German Breast Group (GBG) eingebracht werden.

Die Therapie des Mammakarzinoms in der Schwangerschaft stellt eine interdisziplinare Herausforderung dar, die nahezu immer einen Konflikt zwischen der optimalen Therapie fur die Mutter auf der einen Seite, die mitunter auch die Terminierung der Schwangerschaft bedeuten kann, und dem Wohl des Kindes auf der anderen Seite bedeutet. Eine insuffiziente Therapie allerdings, die vorgibt, den Feten nicht zu schadigen, kann die Gesundheit der Mutter gefahrden und moglicherweise von einer kurativen in eine palliative Situation fuhren. Daher sollte das Therapieziel innerhalb wie auserhalb der Schwangerschaft dasselbe sein: Gewahrleistung der lokoregionaren Kontrolle und Vermeidung einer Fernmetastasierung. Eine Systemtherapie sollte nicht innerhalb des ersten Trimenons erfolgen, da die Organogenese in diesen Zeitraum fallt. Wahrend eine anthrazyklinhaltige Chemotherapie im zweiten Trimenon relativ sicher durchgefuhrt werden kann, ist eine taxanhaltige Chemotherapie, eine Tamoxifen- oder Strahlentherapie erst nach der Entbindung durchzufuhren. Im Zuge aller therapeutischen Interventionen bleibt die prinzipielle Sorge, welche Langzeitfolgen daraus fur das Neugeborene entstehen.

A report on an interdisciplinary e-course experiment on language, literature and culture in the Indian Diaspora.One of the rich potentials of the World Wide Web is to enable international and interdisciplinary projects by utilizing e-learning technologies. Further, contemporary students are used to structuring much of their public and private life and learning around the use of electronic technologies. Certainly, when learning, thinking and working are no longer solitary activities, then traditional notions of teaching must be redesigned throughout our educational institutions in order to meet the challenges of the communication age – language teaching and the humanities at our universities cannot be an. Since the classroom can transcend spatially limited locations, it can transform the ‘traditional scene of instruction […] into a joint venture involving many scholars, including our students as active researchers’.

Das metastasierte Mammakarzinom ist trotz verschiedener zur Verfugung stehender Therapieoptionen eine leider nicht zu kurierende Erkrankung. Neben antiendokrinen, chemo- wie auch strahlentherapeutischen Moglichkeiten sind in den letzten Jahren zielgerichtete Therapiekonzepte kontinuierlich in den Vordergrund geruckt. Die Behandlung in der metastasierten Situation ist individuell und unter Berucksichtigung der Lebensqualitat der Patientinnen zu entscheiden. Kombinierte Chemotherapien sind effektiv, bezuglich ihrer Toxizitat allerdings nicht zu unterschatzen. Daher sind Monotherapien die bevorzugte Therapieform. Durch den Einsatz neuer, zielgerichteter Substanzen, die in Kombination mit antiendokriner oder Chemotherapie appliziert werden konnen, lassen sich effektive Kombinationstherapien mit meist tolerablen Toxizitaten durchfuhren. Jungst publizierte Daten zeigen sogar Synergismen einiger neuer Substanzen, die Mut machen, zukunftig auch chemotherapiefreie Regime in der metastasierten Situation einzusetzen.

As the site of the first black republic and the center of the African diasporic culture of Vodoun, the island of Haiti undoubtedly plays a central role in the African American imaginary in multifaceted ways. Katherine Dunham, Zora Neale Hurston, and Maya Deren, each in turn, attempted to decipher the meaning of Vodoun and Hoodoo for the community of practitioners, for non-practitioners, as well as for themselves in the context of their lives as scholars and artists. Dunham's The Dance's of Haiti (1947) and Deren's Divine Horsemen: The Living Gods of Haiti (1953) can be counted among founding texts on the anthropology and aesthetics of Vodoun. Zora Neale Hurston's work on the anthropology of the Caribbean led her to look closer to home and to explore Vodoun in Haiti and Hoodoo in Louisiana. Her Mules and Men (1935) and Tell My Horse (1938), as well as her publications in the Journal of American Anthropology, are among the first explorations in African American diasporic culture of Hoodoo, locating...

Background Restrictive dermopathy (RD) belongs to the laminopathies and mostly shows an autosomal recessive heredity pattern. This rare genetic disorder is lethal for the newborn in the neonatal period. Clinical and pathological Wndings are distinctive and allow for a speciWc diagnosis in most cases. Furthermore, polyhydramnios, decreased foetal movement, facial dysmorphisms and arthrogryposis are characteristic of RD. Respiratory insuYciency leads to an early neonatal death. Methods We present the case of an aVected infant and a review of the previously reported cases in the literature. Results The infant showed thin, shiny skin with exfoliating desquamation, a small, round and open mouth, low-set ears, a small pinched nose, joint contractures at all four extremities and distinctive pulmonic atelectasis. It died 3 h and 20 min post-partum. Histologically, the skin showed the typical pattern of an RD with the epidermis covered by an exfoliated, hyperkeratotic horn layer, clearly hypoplastic hair follicles and a considerably reduced dermis thickness, although it had a massive subcutaneous adipose tissue. Electron microscopically, the diagnosis was conWrmed. Conclusions It is important to know about this disease and to distinguish it from others like keratinization malfunctions such as ichtyosis, congenital, developmental and akinesia disturbance, etc., to know the prognosis for the aVected newborn and to provide suYcient (genetic) counselling to the families. This disorder is caused by dominant mutations of the LMNA (primary laminopathy) or recessive mutations of the ZMPSTE24 (FACE1) (secondary laminopathy) genes.

Die Hysterektomie ist einer der haufigsten gynakologischen Eingriffe. Die Gebarmutter kann abdominal, vaginal, laparoskopisch assistiert – per laparoskopisch assistierter vaginaler Hysterektomie (LAVH) –, suprazervikal laparoskopisch oder total laparoskopisch entfernt werden. Die am weitesten verbreitete Methode ist die abdominale Hysterektomie. Studien haben mehrfach gezeigt, dass die Patientin nach vaginalem Vorgehen am schnellsten wieder der taglichen Routine nachgehen kann. Ein Grosteil bisheriger Kontraindikationen fur ein vaginales Vorgehen wurde in aktuellen Untersuchungen widerlegt. Es konnte gezeigt werden, dass selbst sehr grose Uteri ohne erhohte Morbiditat vaginal entfernt werden konnen. Die LAVH empfiehlt sich fur Patientinnen mit Voroperationen im kleinen Becken, zusatzlichen intraabdominalen Pathologien oder geplanter Adnexektomie. Ein abdominales Vorgehen bietet normalerweise keine Vorteile und sollte, bei benignen Grunderkrankungen, nur noch wenigen Indikationen vorbehalten bleiben.

Die Hysterektomie ist einer der am haufigsten durchgefuhrten gynakologischen Eingriffe. Ist die Indikation zur Gebarmutterentfernung gestellt, so gibt es zwar verschiedene Operationstechniken, zwischen denen der Operateur entscheiden kann, jedoch zwei hauptsachliche Zugangswege – abdominal oder vaginal. Zu berucksichtigen sind dabei die Vor- und Nachteile des jeweiligen Operationsverfahrens, die Grose und Mobilitat des Uterus, vorausgegangene Operationen der Patientin, die Erfahrung des Operateurs sowie die lokalen Operationsbedingungen. Im Vergleich beider Zugangswege bietet der vaginale Zugang deutliche Vorteile gegenuber dem abdominalen Vorgehen: Verkurzung der Operationszeit und Reduktion der postoperativen Schmerzen. Daher sollte er zur primaren Hysterektomie bei benignen Erkrankungen bevorzugt werden. Bei Uterus myomatosus und dysfunktionellen uterinen Blutungen ist die vaginale Hysterektomie der abdominalen vorzuziehen. Die Integration von neuen technischen Moglichkeiten, wie den bipolaren Koagulationszangen, hat in den letzten Jahren die hamostatischen Moglichkeiten verbessert und zu einem geringeren Blutverlust und reduzierten postoperativen Wundschmerzen gefuhrt.

A hemangiopericytoma of the breast is uncommon, and a hemangiopericytoma of the breast is even rarer. Only a few cases of hemangiopericytoma of the breast have been reported in literature. Here, we report a case of a 66-year-old woman who presented with a mass in her left breast. The patient had trauma to her left breast 2 years ago with consecutive hematoma. An ultrasound-guided core biopsy indicated a malignant vascular tumor. Its morphology and immunohistochemical marker profile was characteristic for a malignant hemangiopericytoma. Thus, she underwent a mastectomy and an axilla sampling. The mammogram and the ultrasound findings of 2004 are presented in relation to those of 2006. Hemangiopericytoma of the breast is infrequent, so that the characteristics of this lesion are discussed in addition to the review of the previous literature on this unusual neoplasm.

1,25-Dihydroxyvitamin D(3) (calcitriol) is the most active natural metabolite of Vitamin D(3). It has strong antiproliferative and differentiating effects on various cell types including breast cancer cells. 25-Hydroxyvitamin D(3)-1alpha-hydroxylase (1alpha-hydroxylase, CYP27B1) is one of the key enzymes in the formation of calcitriol. It has been found in breast cancer cells suggesting an autocrine regulation of formation of calcitriol in these cells. Alternative splicing of the encoding genes for this enzyme can possibly play a role in regulating the enzyme level and can explain tissue specific variations of 1alpha-hydroxylase activity. Splice variants containing intron 1 may encode for truncated proteins with deletion of protein domains which are essential for its enzymatic activity. In order to obtain more information on the abundance of 1alpha-hydroxylase splice variants, we performed a highly specific nested touchdown PCR in MCF-7 cells. The full-length sequence of 1alpha-hydroxylase and two different splice variants of this enzyme containing intron 1 were isolated. By Western blot technique we then confirmed the protein products of the full-length enzyme and its splice variants. We hypothesize that that the expression of splice variants can lead to a quantitatively lower expression of the mRNA of the full-length enzyme. The abundance of less active 1alpha-hydroxylase protein variants can alter the local synthesis of calcitriol in the cells and may explain variations of enzymatic activity in different cells and tissues.

Vitamin D is known for its anti-cancerogenous potential. Prostaglandin E2 (PGE2) is a proliferation and inflammation activating agent. The production of PGE2 is dependent on the activity of cyclooxygenase-2 (COX-2). A link between vitamin D and PGE2 metabolism was recently shown.In MDA-MB-231 and MCF-7 breast cancer cell lines we investigated the influence of calcitriol and the COX-2 inhibitor celecoxib regarding cell growth via MTT test, as well as on the protein and mRNA expression of COX-2 using western blot and qRT-PCR.The proliferation of MCF-7 and MDA-MB-231 was inhibited by both calcitriol and the COX-2 inhibitor celecoxib and even stronger by their combination. Moreover, calcitriol inhibited the COX-2 protein expression in MDA-MB-231, as well as the COX-2 mRNA expression in both cell lines.The combination of calcitriol and celecoxib demonstrated a cooperative growth-inhibiting effect in breast cancer cell lines.

Vitamin D exhibits multiple anti-proliferative and pro-differentiating actions. Prostaglandin-(PG)E2 is a tumor-promoting tissue hormone anabolized by cyclooxygenase-2 (COX-2). Recently, a link between the PG and vitamin D metabolism was reported.The influence of calcitriol and celecoxib on the proliferation of ovarian cancer cell lines was measured and the impact of calcitriol on the protein and mRNA expression of COX-2 was quantified by western blot and qRT-PCR, respectively.After COX-2 induction with interleukin (IL)-1β, 10 μM celecoxib did not significantly inhibit the proliferation of OVCAR-3 cells, whereas calcitriol showed such an effect; however, the combination of the two substances had an additive influence. After induction by IL-1β, calcitriol inhibited the COX-2 protein, as well as its mRNA expression significantly in OVCAR-3 and SKOV-3 cells.These data suggest a correlation between PG and vitamin D metabolism in their anti-tumorigenic activity in ovarian carcinomas.

To determine the optimal dose of radiosurgery-alone for patients with 1-3 cerebral metastases from breast cancer.Patients receiving 20 Gy (n=20) were compared to those receiving 16-18.5 Gy (n=10) for local control, distant brain control and overall survival. Seven other variables were also evaluated.Radiosurgery dose achieved significance on univariate (p=0.002; log-rank and Wilcoxon test) and multivariate analysis (p=0.004) of local control. Twelve-month local control rates were 94% after 20 Gy and 48% after 16-18.5 Gy. On univariate analysis of distant brain control, radiosurgery dose was not a significant factor, with 12-month rates of 73% and 60%, respectively. Regarding overall survival, radiosurgery dose was of borderline significance (p=0.059; Wilcoxon test). Twelve-month overall survival rates were 75% and 40%, respectively. On Cox regression analysis, radiosurgery dose exhibited a trend for improving survival (p=0.10).Radiosurgery with 20 Gy resulted in significantly better local control and led to a trend towards improved overall survival compared to treatment with 16-18.5 Gy.

Das Ovarialkarzinom ist der zweithaufigste Tumor der weiblichen Geschlechtsorgane. Viele Patientinnen erleiden innerhalb von 2–3 Jahren ein Rezidiv nach ursprunglich erfolgreicher Therapie mit Operation und platinhaltiger Chemotherapie. Der Stellenwert der Rezidivchirurgie beim Ovarialkarzinom lasst sich nicht durch prospektive Studiendaten mit hohem Evidenzniveau belegen, retrospektive Daten sprechen fur den klinischen Nutzen. Dies konnte auch jungst durch eine retrospektive Datenauswertung von 267 Rezidivfallen an 25 Zentren in Deutschland belegt werden (DESKTOP-Studie). Die Studie zeigt, dass nur die makroskopische Komplettresektion mit verlangertem Uberleben assoziiert ist. Weitere unabhangige Prognosefaktoren fur das Uberleben sind geringe Aszites vor der Operation und eine Chemotherapie mit Platin nach der Rezidivoperation. Die Chance, eine komplette Tumorresektion zu erreichen, hangt insbesondere von dem Allgemeinzustand der Patientin, dem Tumorstadium und Tumorrest bei der Primaroperation sowie dem Vorliegen einer Peritonealkarzinose ab.

Die Mammasonographie ist das wichtigste bildgebende Erganzungsverfahren zur Mammographie. Insbesondere in dichtem Drusengewebe, wo die Aussagekraft der Mammographie eingeschrankt ist, hat die Sonographie eine hohe Sensitivitat. In speziellen Situationen ist der Ultraschall auch das Verfahren der ersten Wahl, z. B. bei Schwangeren oder zur Kontrolle von Zysten. Mikroverkalkungen konnen aufgrund der begrenzten Auflosung oft nicht sicher diagnostiziert werden. Die Bedeutung der Doppler-Sonographie mit oder ohne Echosignalverstarker wird derzeit in Studien untersucht, sie findet noch keinen breiten Einsatz. Der 3D-Ultraschall verbessert nach neuen Untersuchungen die Spezifitat in der Erkennung maligner Tumoren in der Hand eines erfahrenen Untersuchers. Sensitivitat und Spezifitat des Brustultraschalls sind noch starker als die Mammographie von den Fertigkeiten des Untersuchers abhangig.

As actor, producer, director and editor of her films, Maya Deren can be said to utilize autobiographical strategies. However, as a modernist, Deren would deny that her films are autobiographical in any immediate sense. However, in the context of the contemporary deconstruction of a unified subject and subjectivity, the concept of autobiography has been problematized, constructing the portrayal of the autobiographical self in relation to space and time – much like film, poetry, music and dance. Similar to autobiographical acts, filmic manipulation and distortion are always performative and in flux rather than simply a clearly defined form or genre. Filmic reality, like the self in dream reality and memory, is fleeting, only to be recaptured in its narration. Using examples from Deren's Meshes of the Afternoon (1943) and Rituals in Transfigured Time (1946), this essay argues that her film work forms and at the same time does not form an autobiographical text based on the unreliability of a unified, embodied...

Uterine sarcomas are rare, highly aggressive tumors with an unfavorable prognosis. Only limited data on treatment and outcome are available and the role of lymphadenectomy is controversial for this particular tumor type.By performing a retrospective analysis, through clinical practice, we analyzed the impact of lymphadenectomy on patient outcome.Out of 52 patients, 48 women underwent surgical treatment. Among those, lymphadenectomy was performed in 58%. 10% underwent pelvic and paraaortic lymphadenectomy and 48% underwent pelvic lymphadenectomy alone.In our cohort, surgeons tended to perform paraaortic-plus-pelvic or pelvic-alone lymphadenectomy irrespective of the presence or absence of enlarged lymph nodes. Patients who underwent lymphadenectomy showed a better survival. This observation might indicate a potential role for systematic lymphadenectomy in the surgical treatment of uterine sarcoma. We review on clinical operative decisions, critically with regard to current evidence.

Sarkome der Mamma sind extrem selten, die wesentlichen Vertreter sind das Liposarkom, Leiomyosarkom, Rhabdomyosarkom und das Hamangioperizytom. Bei einer 66-jahrigen Patientin wurde in 06/2006 ein malignes Hamangioperizytom der Brust primar diagnostiziert. Es folgte eine Ablatio mit Axilla-Sampling, eine weitere Therapie war nicht indiziert. In 02/2007 wiesen lumbale Ruckenschmerzen, Glutalgien und eine rechtsbetonte Schwache beider Beine auf eine disseminierte Knochenmetastasierung hin. Eine metastasenbedingte subkutane lumbale Blutung sowie hepatische, zerebrale, pulmonale, kutane und pleurale Metastasen wurden diagnostiziert. Eine pallliative Chemotherapie mit Doxorubicin und Trofosfamid wurde initiiert, die Patientin verstarb zwei Monate spater.

The most appropriate treatment for the individual patient with brain metastases from gynecological cancer is unclear. Most of these patients receive whole-brain radiotherapy (WBRT) alone. Prognostic factors predicting the outcomes of these patients may guide the physician to select the appropriate treatment regimen for the individual patient. The data of 42 patients with brain metastases from gynecological cancer treated with WBRT alone were retrospectively analyzed. Six potential prognostic factors were evaluated for survival and intracerebral control including WBRT regimen, age, Karnofsky performance score (KPS), primary tumor type, number of brain metastases, and extracranial metastases at the time of WBRT. On univariate analysis, improved survival was associated with KPS > or = 70 (P or = 70 (P=0.003). KPS was also significant in the multivariate analysis (P=0.007). KPS was the most important predictor for both survival and intracerebral control. For patients with a KPS or = 70, more aggressive treatment regimens including longer courses of WBRT, resection or radiosurgery should be seriously considered