TY - THES A1 - Schnaidt, Ulrike T1 - Das Plattenepithelkarzinom der Mundhöhle. Eine retrospektive Analyse der Therapieergebnisse und Überlebensraten bei neoadjuvanter Behandlung des Würzburger Patientenkollektivs aus den Jahren 1993-2007 T1 - The oropharyngeal squamous cell carcinoma. A retrospective study to evaluate the outcome and survival rates of patients after preoperative combined radiochemotherapy in Wuerzburg from 1993 to 2007 N2 - In einem Zeitraum zwischen 1993 und 2007 wurden an der Klinik für Mund-, Kiefer-, und Gesichtschirurgie der Universität Würzburg insgesamt 140 Patienten mit einem primären Plattenepithelkarzinom der Oropharynxregion in eine retrospektive Studie einbezogen. Grundvoraussetzung war, dass alle Patienten eine neoadjuvante, präoperative Radiochemotherapie mit einer Gesamtstrahlendosis von 40 Gy über 4 Wochen erhielten. Parallel zu den ersten 5 Bestrahlungstagen wurden den Patienten 60 mg/m² Körperoberfläche Carboplatin verabreicht. Ziel der Studie war, die Ergebnisse und Überlebensraten dieser multimodalen Therapie zu erforschen. Das Durchschnittsalter des Gesamtpatientengutes lag bei 55,6 Jahren, das Verhältnis zwischen Männern und Frauen betrug 4,4:1. Mit 37,9% war die häufigste Tumorlokalisation der Mundboden. In 83,3% der Fälle war das Plattenepithelkarzinom verhornend und zu 72,9% mäßig differenziert (G2). T4 Tumoren traten mit 52,1% am häufigsten auf. Klinisch wurden 62,1% pathologische Lymphknoten diagnostiziert. Nach der neoadjuvanten Radiochemotherapie wurde bei allen Patienten eine Operation durchgeführt. Pathohistologisch konnten 93,6% R0-Resektionen nachgewiesen werden. Im weiteren Krankheitsverlauf erlitten 36,4% der Patienten ein Rezidiv. Die 5-Jahresüberlebensrate der tumorassoziiert Verstorbenen betrug 64,1%. Einen signifikanten Einfluss auf das Überleben zeigten das pT-Stadium (p< 0,01), das pN-Stadium (p< 0,01), das Grading (p= 0,031), die R0-Resektion (p< 0,01) sowie das Auftreten der Rezidive (p< 0,01). Beim Überlebensvergleich mit aktuellen Studien konnte diese signifikante Prognoseverbesserung bestätigt werden. N2 - Between 1993 and 2007 a total number of 140 patients with primary oropharyngeal squamous cell carcinoma (SCC) were included in a retrospective study at the Department of Oral and Maxillofacial Surgery, University Wuerzburg. All patients underwent preoperative combined radiochemotherapy with a target volume dose of 40 Gy over a period of 4 weeks. Simultaneously Carboplatin (60 mg/m²) was given on days 1 to 5 during radiotherapy. The aim of our study was to evaluate the outcome and survival rates for this type of treatment. The mean age of our patients was 55.6 years, the ratio of male and female patients averages 4.4:1. With 37.9% the floor of the mouth was the most frequent location. 83.3% of the tumors were keratinized, while 72.9% had a G2 grading. T4 lesions occurred in 52.1% of the cases. In 62.1% there were found pathological lymph nodes after clinical diagnostics. Preoperative radiochemotherapy was followed by surgery. In 93.6% no tumor cells could be detected microscopically (R0). 36.4% of all patients suffered from recurrence of SCC. The 5 year survival rate was 64.1%. The survival was influenced significantly by pT (p< 0.01), pN (p< 0.01), grading (p= 0.031), R0 resections (p< 0.01) and recurrence of the carcinoma (p< 0.01). In accordance with comparable recent studies significant improvements in prognosis and survival of the SCC as a result of preoperative radiochemotherapy could be confirmed. KW - Plattenepithelcarcinom KW - Mundhöhle KW - Vorbestrahlung KW - Chemotherapie KW - Überleben KW - TNM-System KW - UICC KW - Residualtumor KW - Rezidiv KW - Grading KW - Neck-Dissection KW - oropharyngeal squamous cell carcinoma KW - neoadjuvant KW - UICC KW - radiochemotherapy KW - grading Y1 - 2007 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-28006 ER - TY - JOUR A1 - Diefenhardt, Markus A1 - Martin, Daniel A1 - Ludmir, Ethan B. A1 - Fleischmann, Maximilian A1 - Hofheinz, Ralf-Dieter A1 - Ghadimi, Michael A1 - Kosmala, Rebekka A1 - Polat, Bülent A1 - Friede, Tim A1 - Minsky, Bruce D. A1 - Rödel, Claus A1 - Fokas, Emmanouil T1 - Development and validation of a predictive model for toxicity of neoadjuvant chemoradiotherapy in rectal cancer in the CAO/ARO/AIO-04 phase III trial JF - Cancers N2 - Background: There is a lack of predictive models to identify patients at risk of high neoadjuvant chemoradiotherapy (CRT)-related acute toxicity in rectal cancer. Patient and Methods: The CAO/ARO/AIO-04 trial was divided into a development (n = 831) and a validation (n = 405) cohort. Using a best subset selection approach, predictive models for grade 3–4 acute toxicity were calculated including clinicopathologic characteristics, pretreatment blood parameters, and baseline results of quality-of-life questionnaires and evaluated using the area under the ROC curve. The final model was internally and externally validated. Results: In the development cohort, 155 patients developed grade 3–4 toxicities due to CRT. In the final evaluation, 15 parameters were included in the logistic regression models using best-subset selection. BMI, gender, and emotional functioning remained significant for predicting toxicity, with a discrimination ability adjusted for overfitting of AUC 0.687. The odds of experiencing high-grade toxicity were 3.8 times higher in the intermediate and 6.4 times higher in the high-risk group (p < 0.001). Rates of toxicity (p = 0.001) and low treatment adherence (p = 0.007) remained significantly different in the validation cohort, whereas discrimination ability was not significantly worse (DeLong test 0.09). Conclusion: We developed and validated a predictive model for toxicity using gender, BMI, and emotional functioning. Such a model could help identify patients at risk for treatment-related high-grade toxicity to assist in treatment guidance and patient participation in shared decision making. KW - rectal cancer KW - toxicity KW - neoadjuvant KW - chemoradiotherapy KW - risk score Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-288081 SN - 2072-6694 VL - 14 IS - 18 ER - TY - JOUR A1 - Lichthardt, Sven A1 - Kerscher, Alexander A1 - Dietz, Ulrich A. A1 - Jurowich, Christian A1 - Kunzmann, Volker A1 - von Rahden, Burkhard H. A. A1 - Germer, Christoph-Thomas A1 - Wiegering, Armin T1 - Original article: role of adjuvant chemotherapy in a perioperative chemotherapy regimen for gastric cancer JF - BMC Cancer N2 - Background Multimodal treatment strategies – perioperative chemotherapy (CTx) and radical surgery – are currently accepted as treatment standard for locally advanced gastric cancer. However, the role of adjuvant postoperative CTx (postCTx) in addition to neoadjuvant preoperative CTx (preCTx) in this setting remains controversial. Methods Between 4/2006 and 12/2013, 116 patients with locally advanced gastric cancer were treated with preCTx. 72 patients (62 %), in whom complete tumor resection (R0, subtotal/total gastrectomy with D2-lymphadenectomy) was achieved, were divided into two groups, one of which receiving adjuvant therapy (n = 52) and one without (n = 20). These groups were analyzed with regard to survival and exclusion criteria for adjuvant therapy. Results Postoperative complications, as well as their severity grade, did not correlate with fewer postCTx cycles administered (p = n.s.). Long-term survival was shorter in patients receiving postCTx in comparison to patients without postCTx, but did not show statistical significance. In per protocol analysis by excluding two patients with perioperative death, a shorter 3-year survival rate was observed in patients receiving postCTx compared to patients without postCTx (3-year survival: 71.2 % postCTx group vs. 90.0 % non-postCTx group; p = 0.038). Conclusion These results appear contradicting to the anticipated outcome. While speculative, they question the value of post-CTx. Prospectively randomized studies are needed to elucidate the role of postCTx. KW - gastric cancer KW - chemotherapy KW - neoadjuvant KW - multimodal KW - complication KW - adjuvant KW - risk factor KW - survival Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-147743 VL - 16 IS - 650 ER -