TY  - THES
A1  - von Bosse, Felix
T1  - Risikofaktoren der venoarteriellen extrakorporalen Membranoxygenierung bei Post-Kardiotomie-Patienten
T1  - Risk factors of veno-arterial extracorporeal-membrane-oxygenation (va-ECMO) in post-cardiotomy patients
N2  - Die extrakorporale Membranoxygenierung ist ein seit Jahrzehnten etabliertes Verfahren, Patienten trotz kardialem und/oder pulmonalem Versagen ein zeitbegrenztes Überleben zu ermöglichen. Obgleich sich an den Grundzügen der Herangehensweise bis heute wenig verändert hat, konnte diese Hochrisikotherapie mithilfe der Entwicklung blutschonenderer Materialien und der Verwendung verbesserter Pumpen und Oxygenatoren zunehmend effizienter gestaltet werden. 
Durch eine Überlebensanalyse aller ECMO-Patienten der Datenbank der Klinik für Tho-rax-, Herz- und Thorakale Gefäßchirurgie des Universitätsklinikums Würzburg zwischen 2015 und 2018 (172 Fälle) sollten unabhängige Risikofaktoren für ein negatives Outcome der Therapie identifiziert werden. Insbesondere den Laborparametern während der ersten 72 Stunden am System galt hierbei ein besonderes Augenmerk, aber auch Vorerkrankun-gen, Komplikationen, Substitutionen während der Therapie und weitere Parameter wurden für jeden Patienten individuell ermittelt und tabellarisch festgehalten. 
Insgesamt verstarben davon 125 Patienten (72,7%), 47 Patienten (27,3%) überlebten und konnten entlassen werden. Bei 24 der 125 verstorbenen Patienten (14%) konnte zwar ein Weaning vom System erfolgreich durchgeführt werden (>24h), sie verstarben jedoch während des anschließenden stationären Aufenthaltes.
Bei den präinsertionell erhobenen Parametern waren der BMI und der Euroscore II bei verstorbenen Patienten signifikant höher, ebenso wie die Cross-Clamp-Zeit und der SO-FA-Score.
Für die Laborwerte an ECMO ergaben sich für den Serumlaktatspiegel und die Throm-bozytenanzahl der Patienten die signifikantesten Unterschiede. Auch andere Laborparame-ter erwiesen sich in beiden Gruppen als signifikant unterschiedlich: Insbesondere der Quick Wert der überlebenden Patienten war zu Beginn signifikant höher. Auch der Fibri-nogenspiegel der Gruppe der überlebenden Patienten lag ab der 12 Stunden Marke signi-fikant höher.
Verstorbene Patienten erhielten mehr Blutpräparate als Überlebende. Außerdem führte ein dialysepflichtiges Nierenversagen im Laufe der Therapie zu signifikant schlechterem Out-come.
Wider Erwarten waren während der Therapie auftretende Blutungskomplikationen nicht mit schlechterem Outcome assoziiert. Jedoch konnte bei Auftritt von Thromben im Sys-tem, die einen Austausch des Oxygenators/ECMO-Systems nötig machten, sowie Magen-Darm-Ischämien und Kompartmentsyndrom ein klarer Überlebensnachteil erfasst werden. 
Abschließend ließ sich mittels multivariater logistischer Regression zeigen, dass der SO-FA-Score, der Serumlaktatspiegel und die Thrombozytenanzahl sowie eine adjuvante I-ABP Implantation und der Bedarf einer Nierenersatztherapie den größten Einfluss auf das Überleben der Patienten hatten.
N2  - Extracorporeal Life Support is a well established therapy for high risk patients with heart and/or lung failure. Although ECMO has increased a lot in number of cases, as well as in centres worldwide within the past few years, mortality still remains high. 
The aim was to identify risk factors which led to a negative outcome on ECMO. 
This retro-perspective study includes all patients from 01.01.2015 - 31.12.2018 that received va-ECMO support after cardiac surgery at the "Heart and thoracal surgery centre" (HTC) of the University-hospital in Würzburg (UKW). Out of those 172 patients, 47 patients (27,3%) survived and 125 patients (72,7%) died during the therapy. Regarding all parameters before ECMO-Insertion, high Body-Mass-Index (BMI), long "Cross-Clamp" time of the aorta during the operation (X-Clamp), as well as high SOFA-Score and high Euroscore II, were associated with significant higher mortality. SOFA-Score, in comparison with Euroscore II, turned out to be more reliable, concerning outcome prediction.
During the first 72 hours on ECMO, non-survivors had significant higher lactate-levels and lower platelet count than survivers. 
Additional usage of intraaortic balloon pump (IABP) was associated with better survival, whereas renal failure leading to dialysis was mostly identified among non-survivors.
"Bleeding" was the most frequently occuring complication, even though it didn't have any impact on the patient's outcome. Non-survivors showed overall more clotting events, especially in the oxygentor and the extracorporeal system itself and needed significant more substitution of blood preserves than patients that survived the therapy.
KW  - ECMO
KW  - Outcome
KW  - Post-Kardiotomie-Patient
KW  - Laborparameter
KW  - survival
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-258198
ER  - 
TY  - JOUR
A1  - Merzenich, Hiltrud
A1  - Baaken, Dan
A1  - Schmidt, Marcus
A1  - Bekes, Inga
A1  - Schwentner, Lukas
A1  - Janni, Wolfgang
A1  - Woeckel, Achim
A1  - Bartkowiak, Detlef
A1  - Wiegel, Thomas
A1  - Blettner, Maria
A1  - Wollschläger, Daniel
A1  - Schmidberger, Heinz
T1  - Cardiac late effects after modern 3D-conformal radiotherapy in breast cancer patients: a retrospective cohort study in Germany (ESCaRa)
JF  - Breast Cancer Research and Treatment
N2  - Purpose
Radiotherapy (RT) was identified as a risk factor for long-term cardiac effects in breast cancer patients treated until the 1990s. However, modern techniques reduce radiation exposure of the heart, but some exposure remains unavoidable. In a retrospective cohort study, we investigated cardiac mortality and morbidity of breast cancer survivors treated with recent RT in Germany.

Methods
A total of 11,982 breast cancer patients treated between 1998 and 2008 were included. A mortality follow-up was conducted until 06/2018. In order to assess cardiac morbidity occurring after breast cancer treatment, a questionnaire was sent out in 2014 and 2019. The effect of breast cancer laterality on cardiac mortality and morbidity was investigated as a proxy for radiation exposure. We used Cox Proportional Hazards regression analysis, taking potential confounders into account.

Results
After a median follow-up time of 11.1 years, there was no significant association of tumor laterality with cardiac mortality in irradiated patients (hazard ratio (HR) for left-sided versus right-sided tumor 1.09; 95% confidence interval (CI) 0.85–1.41). Furthermore, tumor laterality was not identified as a significant risk factor for cardiac morbidity (HR = 1.05; 95%CI 0.88–1.25).

Conclusions
Even though RT for left-sided breast cancer on average incurs higher radiation dose to the heart than RT for right-sided tumors, we found no evidence that laterality is a strong risk factor for cardiac disease after contemporary RT. However, larger sample sizes, longer follow-up, detailed information on individual risk factors and heart dose are needed to assess clinically manifest late effects of current cancer therapy.
KW  - breast cancer
KW  - 3D-conformal radiotherapy
KW  - cardiac mortality
KW  - cardiac morbidity
KW  - cohort study
KW  - survival
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-308606
SN  - 0167-6806
SN  - 1573-7217
VL  - 191
IS  - 1
ER  - 
TY  - JOUR
A1  - Koehler, Viktoria Florentine
A1  - Adam, Pia
A1  - Fuss, Carmina Teresa
A1  - Jiang, Linmiao
A1  - Berg, Elke
A1  - Frank-Raue, Karin
A1  - Raue, Friedhelm
A1  - Hoster, Eva
A1  - Knösel, Thomas
A1  - Schildhaus, Hans-Ulrich
A1  - Negele, Thomas
A1  - Siebolts, Udo
A1  - Lorenz, Kerstin
A1  - Allelein, Stephanie
A1  - Schott, Matthias
A1  - Spitzweg, Christine
A1  - Kroiss, Matthias
T1  - Treatment of RET-positive advanced medullary thyroid cancer with multi-tyrosine kinase inhibitors — a retrospective multi-center registry analysis
JF  - Cancers
N2  - Background: RET (rearranged during transfection) variants are the most prevalent oncogenic events in medullary thyroid cancer (MTC). In advanced disease, multi-tyrosine kinase inhibitors (MKIs) cabozantinib and vandetanib are the approved standard treatment irrespective of RET status. The actual outcome of patients with RET-positive MTC treated with MKIs is ill described. Methods: We here retrospectively determined the RET oncogene variant status with a targeted DNA Custom Panel in a prospectively collected cohort of 48 patients with advanced MTC treated with vandetanib and/or cabozantinib at four German referral centers. Progression-free survival (PFS) and overall survival (OS) probabilities were estimated using the Kaplan-Meier method. Results: In total, 44/48 (92%) patients had germline or somatic RET variants. The M918T variant was found in 29/44 (66%) cases. In total, 2/32 (6%) patients with a somatic RET variant had further somatic variants, while in 1/32 (3%) patient with a germline RET variant, additional variants were found. Only 1/48 (2%) patient had a pathogenic HRAS variant, and no variants were found in 3 cases. In first-line treatment, the median OS was 53 (95% CI (95% confidence interval), 32–NR (not reached); n = 36), and the median PFS was 21 months (12–39; n = 33) in RET-positive MTC patients. In second-line treatment, the median OS was 18 (13–79; n = 22), and the median PFS was 3.5 months (2–14; n = 22) in RET-positive cases. Conclusions: RET variants were highly prevalent in patients with advanced MTC. The treatment results in RET-positive cases were similar to those reported in unselected cohorts.
KW  - medullary thyroid cancer
KW  - rearranged during transfection
KW  - variant
KW  - multi-tyrosine kinase inhibitor
KW  - survival
KW  - treatment outcome
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-281776
SN  - 2072-6694
VL  - 14
IS  - 14
ER  -