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Neoadjuvant chemotherapy (NACT) is frequently used in patients with early breast cancer. Randomized controlled trials have demonstrated similar survival after NACT or adjuvant chemotherapy (ACT). However, certain subtypes may benefit more when NACT contains regimes leading to high rates of pathologic complete response (pCR) rates. In this study we analyzed data using the OncoBox research from 94,638 patients treated in 55 breast cancer centers to describe the current clinical practice of and outcomes after NACT under routine conditions. These data were compared to patients treated with ACT. 40% of all patients received chemotherapy. The use of NACT increased over time from 5% in 2007 up to 17.3% in 2016. The proportion of patients receiving NACT varied by subtype. It was low in patients with HR-positive/HER2-negative breast cancer (5.8%). However, 31.8% of patients with triple-negative, 31.9% with HR-negative/HER2-positive, and 26.5% with HR-positive/HER2-positive breast cancer received NACT. The rates of pCR were higher in patients with HR-positive/HER2-positive, HR-negative/HER2-positive and triple-negative tumors (36, 53 and 38%) compared to HR-positive/HER2-negative tumors (12%). PCR was achieved more often in HER2-positive and triple-negative tumors over time.This is the largest study on use and effects of NACT in German breast cancer centers. It demonstrates the increased use of NACT based on recommendations in current clinical guidelines. An improvement of pCR was shown in particular in HER2-positive and triple-negative breast cancer, which is consistent with data from randomized controlled trails.

Cavity shaving (CS) is a surgical technique used in the treatment of breast cancer (BC). It may reduce margin positivity in histologic assessment and consequently reduces re- excision rates in breast conserving surgery (BCS). The evidence for this assumption is described in the present review.A systematic review of relevant literature in English from January 1999 to April 2019 was conducted. The analysis included studies on CS and its effects on re-excision rates and margin positivity. We searched PubMed databases for relevant publications. In total, 22 studies were included in the present review.The benefit from CS on re-excision rates and histologic margin positivity was variable. Out of 22 studies, 17 reported a reduction in both re-excision rates and histologic margin positivity in margin shaved patients. Four studies could not find a significant reduction of second surgeries and residual tumor rates. One study suggested that CS after BCS was superior to single BCS only in subgroup analysis in IDC tumors.CS is a surgical technique that was shown to reduce re-excision and margin positivity rates in most of the studies. Furthermore, it can be a useful tool to assess specimen margins and detect multifocality.

In recent years, a vast quantity of clinical data has been accumulated on the pathophysiology of symptomatic vulvovaginal atrophy (VVA)/genitourinary syndrome of menopause (GSM) in peri- and postmenopausal women and on the treatment options for these conditions. Guidelines from several societies have recently been updated in favor of VVA/GSM vaginal therapy with the lowest possible doses of estrogens. The combination of a vaginal ultra-low dose of 0.03 mg of estriol (E3) and lyophilized, viable Lactobacillus acidophilus KS400 (0.03 mg-E3/L) is a unique product with a dual mechanism of action supporting not only the proliferation and maturation of the vaginal epithelium, but also restoration of the lactobacillary microflora. It has been demonstrated efficiently to establish and maintain a healthy vaginal ecosystem. Use of this combination considerably improves the clinical signs and symptoms as well as the quality of life of menopausal women suffering from vaginal atrophy. This combination therapy is well tolerated with a low overall incidence of side-effects and negligible estriol absorption. Based on recent scientific evidence and current treatment guidelines, the 0.03 mg-E3/L combination could be considered one of the options for the treatment of symptomatic vaginal atrophy in aging menopausal women.

Patientinnen mit Brustkrebs leiden haufig wahrend und nach der Therapie ihrer Erkrankung unter Symptomen, die auf niedrige Ostrogenspiegel zuruckzufuhren sind. Dies kann zur relevanten Beeintrachtigung der Lebensqualitat fuhren. Ostrogene konnen die Symptome zwar lindern, sind aber in dieser Situation grundsatzlich kontraindiziert. Die meisten therapeutischen Alternativen reichen allerdings haufig fur eine Symptomkontrolle nicht aus. In Ausnahmefallen kann bei besonders starker Beeintrachtigung der Lebensqualitat eine Therapie mit Ostrogenen erwogen werden. In dieser Ubersicht werden die moglichen Risiken und Behandlungsstrategien erlautert.

This study was a detailed microscopic analysis of the changes of vaginal microflora characteristics after application of 0.03 mg estriol-lactobacilli combination on the vaginal ecosystem in postmenopausal breast cancer (BC) survivors on aromatase inhibitors (AI) with severe atrophic vaginitis. A total of 16 BC women on AI applied daily one vaginal tablet of Gynoflor® for 28 days followed by a maintenance therapy of three tablets weekly for 8 weeks. During four follow up visits a smear from the upper lateral vaginal wall was analysed by phase contrast microscopy at 400 times magnification in order to classify the lactobacillary grades(LBG), bacterial vaginosis (BV), aerobic vaginitis (AV), vulvovaginal candidosis (VVC), proportional number of leukocytes and evidence of parabasal cells and epitheliolysis. LBG improved from 81% LBG-III at entry to 88% LBG-I&IIa after 2 weeks of initial therapy, which further improved upon follow up (p < 0.001). Whereas BV was a rare event, AV was frequent and substantially improved during treatment (p < 0.01). While at entry most patients had moderate or severe AV, after maintenance therapy no patient except one had AV. The number of leukocytes dropped dramatically from a score of 1.78 ± 0.70 to 1.06 ± 0.25 which was consistent till the end of the study (p < 0.01). Parabasal cells dropped from a score of 3.4 ± 0.64 at entry to 1.3 ± 0.60 at the final visit (p trend < 0.01). Starting from a low rate of Candida colonisation of 2/14 (14%), a sudden rise to 7/16 (44%) occurred after 2 weeks, to return back to base levels at subsequent visits. The vaginal use of ultra-low dose estriol and lactobacilli results in rapid and enduring improvement of all markers of the vaginal microflora and epithelial vaginal cell quality in women with breast cancer on AI with dyspareunia. Candida may develop soon after its use, but rapidly disappears again upon their prolonged use. Due to its excellent safety profiles and clinical efficacy we recommend this product as first choice in women on AI with severe dyspareunia. ispartof: European Journal of Clinical Microbiology & Infectious Diseases vol:34 issue:10 pages:2023-8 ispartof: location:Germany status: published

Hintergrund Das Mammakarzinom ist mit etwa 70.000 Neuerkrankungen pro Jahr die haufigste Krebserkrankung der Frau. Da nach den aktuellen Inzidenzraten des Robert Koch-Instituts etwa eine von 8 Frauen im Laufe ihres Lebens an Brustkrebs erkrankt, ist es sinnvoll, Praventionsstrategien zu entwickeln. Insbesondere betrifft dies Frauen, die Risiko- bzw. Hochrisikogruppen angehoren. Grundsatzlich werden drei Arten von Pravention unterschieden: Primar-, Sekundar- und Tertiarpravention. Der Fokus dieses Beitrags soll auf die Chemopravention zur Primarpravention des Mammakarzinoms gelegt werden.

Aufgrund der guten Prognose von Mammakarzinompatientinnen nimmt die Verbesserung bzw. Erhaltung der Lebensqualitat in der Nachsorge einen zunehmenden Stellenwert ein. Gerade der vermehrte Einsatz von Aromatasehemmern hat in den vergangenen Jahren zu einer Zunahme der vaginalen Atrophie mit Symptomen wie Scheidentrockenheit, petechialen Blutungen, Dyspareunie und rezidivierenden Zystitiden gefuhrt. Gerade diese Symptome beeinflussen in gravierender Weise die Lebensqualitat von Mammakarzinompatientinnen. Die Anwendung einer lokalen Ostrogentherapie stellt die effektivste Behandlungsform der Vaginalatrophie dar. Die Anwendung einer systemischen bzw. einer lokalen Hormontherapie bei Brustkrebspatientinnen ist jedoch kontraindiziert. Zur Beurteilung der Sicherheit einer vaginalen ET sind weitere klinische Studien erforderlich.

Even though randomized controlled clinical trials demonstrated improved survival by adjuvant trastuzumab treatment of HER2-positive breast cancer patients, data on its effect in clinical routine are scarce. This study evaluated the use and efficacy of trastuzumab in routine treatment of HER2-positive breast cancer patients. Data from the clinical cancer registry Regensburg (Germany) were analyzed. The present study investigated 6,991 female patients with primary invasive breast cancer. In premenopausal HER2-positive patients a considerable increase of trastuzumab therapy was observed from 58.1% in 2006 to 90.9% in 2011, whereas in postmenopausal patients trastuzumab was rather used on a constant rate of 49.1%. Best overall survival (OS) was found in HER2/steroid hormone receptor-positive patients receiving guideline concordant treatment with trastuzumab plus chemotherapy (CHT) plus antihormone therapy (AHT) with a 7-year OS rate of 96% compared to the non-trastuzumab group with a 7-year OS rate of 92%. In multivariable analysis, HER2-positive patients treated with CHT or AHT who did not get trastuzumab, had a worse 7-year OS (65%,P=0.006versus 79%,P=0.017) than the control groups. This population-based study demonstrated that guideline concordant use of adjuvant trastuzumab improves OS for HER2-positive breast cancer patients treated in routine clinical care.

National Cancer Control Plans (NCCP) are necessary to improve cancer care and reduce mortality. We have reported previously on European institutional health structures and transformation of theoretical health care standards into a practical approach. For the latter consideration of the patients' perspective was considered as highly important and chosen as subject for this meeting.Several European organizations have realized deficits in this area. They promote equal and timely access to cancer care since current inequities lead to disparities in cancer survival across Europe. Patients' support working groups are focussing on employment issues, financial services, psychosocial screening and support, palliative care and rehabilitation. They also identified cancer research including patients' views as highly important. Workshops during the 3rd European Roundtable Meeting (ERTM) covered the issues transparency in patient care, implementation of new knowledge and decision making in partnership with the patient.It was concluded that patient views and perspectives have to be considered during the whole continuum of cancer care. Access to treatment, transparency and including patients into the development process are relevant aspects.

Screening programs for cervical cancer and breast cancer lead to a clear reduction of mortality. Starting in 2018 screening for cervical cancer will be structured as an organized program as already exists for breast cancer. In future screening for cervical cancer will be primarily performed by human papillomavirus (HPV) testing at intervals of 5 years while cytological examination (Pap smear) will also be available as an additional or alternative procedure. For breast cancer screening in Germany an annual clinical examination with palpation and mammography screening at 2‑year intervals is provided for women aged between 50 and 69 years. In Germany only approximately 50 % of invited women have used the opportunity to participate in screening in recent years. Weighing the benefits against the harms of cancer screening programs is always important in the process of evaluation of different strategies.

Einleitung: Parachordome stellen eine seltene Variante von Tumoren des myoepthelialen Weichgewebes dar. Sie finden sich meist bei jungeren Erwachsenen subcutan oder subfaszial im Bereich der Extremitaten. Sie sind meist langsam wachsend und benigne, ein Teil neigt allerdings zu Lokalrezidiven und zur Metastasierung. Fallbericht: Eine 60-jahrige Patientin stellte sich mit dem V.a. ein groses Mammakarzinom rechts vor. Die rechte Mamma war durch einen nicht verschieblichen, derben bis in die Axilla reichenden Tumor mit einer Ausdehnung von maximal 50 × 30 cm vergrosert. Bildgebend imponierte ein teils solider vorwiegend zystischer gut umschriebener Tumor mit Infiltration in die Thoraxwand und das lokale Weichgewebe. Der Tumor grenzte an die Linea medioaxillaris bis supraclavicular und reichte bis zum Os ileum. Histologisch ergab sich ein myoepitheliales Karzinom des Weichgewebes (Parachordom). In den Staginguntersuchungen fand sich eine solitare Lungenmetastase (2,2 × 2,5 cm). Es folgte eine neoadjuvante Chemotherapie nach dem VIP-E Schema. Bei guter Vertraglichkeit und Tumorregress wurden insgesamt 7 Zyklen bis zur Ausreizung des Toxizitatsprofils verabreicht. Letztlich zeigte sich ein lokal deutlicher Befundregress bei gleichbleibender Grose der Lungenmetastase. Bei nun moglicher Operabilitat erfolgte die Ablatio mammae rechts (R0) mit Defektdeckung durch einen DIEAP-flap. Adjuvant folgte die Radiatio der Thoraxwand und stereotaktisch gefuhrte Radiatio der Lungenmetastase. Eine radikale operative Resektion wurde von der Patientin abgelehnt. Fazit: Parachordome stellen eine seltene Tumorentiat und auserst seltene Differentialdiagnose von Mammatumoren dar. Sie konnen zu infitrativem Wachstum, Metastasierung und Rezidivierung neigen. Von daher ist eine vollstandige Exzision mit tumorfreien Resektionsrandern anzustreben.

Ovarialkarzinome exprimieren jeweils in 60 bzw. 70% der Falle Rezeptoren fur Ostrogene und GnRH, sind also einer endokrinen Therapie mit Tamoxifen, Aromataseinhibitoren (AI) und GnRH-Analoga zuganglich. Tamoxifen und AI wirken uber einen Antagonismus am tumoralen Ostrogenrezeptor bzw. Senkung der Ostrogenplasmaspiegel, GnRH-Analoga wirken sehr wahrscheinlich antiproliferativ uber eine Bindung an tumorale Rezeptoren fur GnRH. Objektive Ansprechraten im Sinne einer partiellen Remission liegen bei etwa 10% bei allen Therapieformen, bei weiteren 20% der Patientinnen kommt es zu einer Stabilisierung des Krankheitsverlaufs. Gravierende Nebenwirkungen traten bei keiner der genannten Therapien auf. Alle genannten Wirkstoffe wurden lediglich in Phase-II-Studien untersucht, es ist jedoch unwahrscheinlich, dass grose Phase-III-Studien mit den genannten Praparaten in dieser Indikation durchgefuhrt werden. Die meisten Daten liegen zur Tamoxifentherapie, die wenigsten zum Einsatz von Aromatasehemmern vor. Bei mehrfach vorbehandelten Ostrogen- bzw. GnRH-rezeptorpositiven fortgeschrittenem Ovarialkarzinom stellt die Behandlung mit Tamoxifen, Aromatasehemmern und GnRH-Analoga eine sinnvolle Option dar.

The clinical diagnosis of dry eye syndrome may not appear to be a major health problem; nonetheless it is a chronic condition which affects several million people in Germany. Typical symptoms include discomfort, dryness, foreign body sensation, photophobia and light sensitivity, and it is associated with a significant reduction in the quality of life. Physiological changes associated with aging include decreased tear volume and flow , decreased tear film stability and alterations in the composition of the meibomian lipids and are correlated with tear film dysfunction. According to more recent studies into the role of tear film dysfunction in dry eye syndrome, estrogen - which has a clear role in the treatment of various menopausal symptoms - may have an adverse effect on the ocular surface and may predispose to dry eye syndrome. Dry eye syndrome is classified into two major categories: tear deficient dry eye and evaporative dry eye, each of which requires specific treatment. Therapeutic approaches include ocular lubricants and/or viscous agents to restore or increase the lipid layer of the tear film.

Peritoneal metastases represent a therapeutic challenge in the treatment of ovarian cancer. Macroscopically complete surgical cytoreduction is decisive for the patient's prognosis. The surgical part of the treatment includes a parietal and visceral peritonectomy, often carried out as a multivisceral resection. Its combination with intraperitoneal hyperthermic chemotherapy (HIPEC) has been found to significantly improve the prognosis of selected patients with gastrointestinal malignancies and peritoneal carcinomatosis. In the last four years several reports have been published on the use of a similar treatment in women with ovarian cancer, and more than 300 patients with ovarian cancer and peritoneal carcinomatosis were treated using this multimodal combination. However, the patient collectives were rather small and inhomogeneous and not all of the patients were treated according to the same protocol. Nevertheless, the technical feasibility of this method with low mortality and acceptable morbidity rates was demonstrated for patients treated in different centers. Intraoperative HIPEC enriches the presented concept but does not replace systemic or long-term intraperitoneal chemotherapy. Prospective, randomized phase III trials need to be designed, in order to define the exact role of HIPEC for this treatment concept. A protocol, combining proposals of the German Society of Visceral Surgery/Surgical Oncology Group and the Gynecology Oncology Group, would be therefore helpful.

Durch die Einnahme von Tibolon als Hormontherapie (HT) im Klimakterium und in der Postmenopause konnen vasomotorische Symptome und urogenitale Beschwerden behandelt werden. Eine Stimulation des Endometriums durch die Tibolontherapie konnte in zahlreichen Studien nicht nachgewiesen werden. Ursachlich hierfur ist die gewebespezifische Metabolisierung, die, verglichen mit konventioneller HT, zu einer sonographisch geringeren Endometriumdicke, einem deutlich besseren Nebenwirkungsprofil hinsichtlich Blutungsstorungen und histologisch zu atrophem Endometrium fuhrt. Diese Ergebnisse konnten in der kurzlich veroffentlichten THEBES (Tibolone Histology on the Endometrium and Breast Endpoint Study) bestatigt werden. In der Million Women Study ergab sich allerdings ein erhohtes relatives Risiko fur ein Endometriumkarzinom in der Tibolongruppe. Diese Ubersichtsarbeit fasst den aktuellen Kenntnisstand zur Wirkung von Tibolon auf das Endometrium zusammen.